Thyroglossal duct cyst masquerading as a haematoma

Thyroglossal duct cysts most frequently present in childhood as painless midline swellings around the level of the hyoid. Classically the cyst moves upwards on protruding the tongue. Here we report a novel case of a thyroglossal cyst in an adult in whom the history, examination and fine needle aspiration cytology were typical of a traumatic haematoma. This case is also unique because the thyroglossal duct cyst extended beyond the thyroid gland to the suprasternal notch and actually required two parallel transverse cervical incisions for its complete en bloc removal.     

Thyroglossal duct cyst: an unusual presentation

Most thyroglossal duct cysts are located at or very close to the midline. They generally manifest as painless neck swellings, and they move on protrusion of the tongue and during deglutition. We describe a case of thyroglossal duct cyst that was unusual in that the cyst was located far from the midline, it did not move on protrusion of the tongue, and it was associated with symptoms of dysphagia and extensive neck swelling that mimicked a colloid goiter     

30例小儿甲状舌管囊肿术后不置引流管的临床分析

摘要：目的探讨小儿甲状舌管囊肿术后不置引流管的可行性。方法通过回顾性分析昆明市儿童医院2016年1月~2017年1月30例初发甲状舌管囊肿而术后未置引流管的患儿，在年龄、性别及手术方式有可比性的前提下，通过疼痛评分量表的观察并记录术后1、2、3、4、48 h的疼痛情况，同时观察并记录术后血肿、皮下积气、切口感染、咽瘘、声音嘶哑、舌肌运动困难、吞咽困难、呼吸困难及发声困难等并发症的发生率以及随访半年的复发情况来判断术后未置引流管的影响。结果患儿在年龄、性别、手术方式等方面有可比性的情况下，初发甲状舌管囊肿而术后未放置引流管的30例患儿均未发现血肿、皮下积气等上述并发症，随访半年均未见复发。结论小儿甲状舌管囊肿术后不置引流并不增加术后并发症发生率及复发率，并且不置引流可以增加患儿舒适度，减轻术后疼痛，减少患儿自主拔出引流管的可能性以及降低术后护理难度。因此，甲状舌管囊肿术后可不常规放置引流管。     

Squamous cell carcinoma arising in a thyroglossal duct cyst.

Carcinoma arising in a thyroglossal duct cyst is a rare event, occurring in less than 1% of abnormalities of the thyroglossal duct. To date, there have been approximately 100 cases reported, with papillary carcinoma accounting for the vast majority. Squamous cell carcinoma, on the other hand, is an even rarer event. Its clinical course in the elderly, consisting of recurrent drainage and suppuration, may distinguish it from other neoplastic conditions of thyroglossal duct cyst. We present a 65-year-old man with squamous cell carcinoma in a recurrently discharging thyroglossal duct cyst to illustrate important distinguishing clinical features of this condition.     

Presentations of thyroglossal duct cysts in adults

The thyroglossal duct cyst is the most common congenital neck mass, resulting from persistence and dilatation of remnants of an epithelial tract formed during migration of the thyroid during embryogenesis. Approximately 7% of the population has thyroglossal duct remnants. Although thyroglossal duct cysts generally present clinically in children, it is important to understand that the lesion can present in adults as well, sometimes much later in life. Incidental carcinoma of the thyroglossal duct cyst is rare, but is more likely to occur in adults than children. Between 1991 and 1998, 11 cases of thyroglossal duct cysts were seen in adult patients at Georgetown University Medical Center, including 2 cases containing papillary carcinoma. This report discusses their clinical presentations and management. Received: 11 September 1998 / Accepted: 23 October 1998     

Management of incidental thyroglossal duct cysts during laryngotracheal reconstruction

Thyroglossal duct cysts originate from trapped elements of the thyroglossal duct tract during embryological descent of the thyroid gland. The incidental finding of a thyroglossal duct cyst during cervical surgery has not been described previously. We present four cases of small asymptomatic thyroglossal duct cysts discovered as an incidental finding during laryngotracheal reconstruction. In each case, the cyst was removed using a Sistrunk procedure. In all four cases the patient was successfully decannulated, and there were no cases of cyst recurrence. We also consider the implications that these four cases may have on the perceived incidence of the thyroglossal duct cysts and their management.     

舌根部甲状舌管囊肿的诊断与治疗

目的 探讨发生于舌根部的非典型甲状舌管囊肿的临床表现、诊断和治疗方法.方法 回顾分析4例发生于舌根部的甲状舌管囊肿患者的临床资料,手术采用支撑喉镜下激光切除术和颈外径路Sistrunk术.结果 咽部异物感、咽部阻塞感是发生于舌根的甲状舌管囊肿的主要临床表现;颈部超声和CT检查是明确诊断的主要检查方法.支撑喉镜下激光手术无一例外均导致囊肿复发,3例复发1次,1例复发3次,颈外径路Sistrunk术将囊肿完整切除.结论 发生于舌根的甲状舌管囊肿应常规行颈部超声和CT检查,以明确诊断;治疗首选颈外径路Sistrunk术式.     

Subglottic thyroglossal duct cyst: a rare intralaryngeal presentation

Thyroglossal duct cysts are common midline neck swellings that can present at any site along their migratory pathway. They are frequently situated just below the hyoid bone. Extension to the subglottic area is very rare; such an unusual presentation can complicate the diagnosis of a thyroglossal duct cyst. We report the case of a 30-year-old man who presented with a subglottic thyroglossal duct cyst and associated laryngeal symptoms. To the best of our knowledge, only 2 similar cases have been previously reported in the literature, both of which occurred in 2-year-old boys. We believe, therefore, that ours is the first reported case of a subglottic thyroglossal duct cyst in an adult. We discuss the clinical presentation, diagnosis, and treatment of our patient, and we summarize the literature on intralaryngeal thyroglossal duct cysts.     

Papillary carcinoma in a supra hyoid thyroglossal duct cyst — an unusual presentation

Carcinomatous transformation of ectopic thyroid elements within the thyroglossal tract is a rare entity. We report a case of primary papillary carcinoma of thyroid presenting within the thyroglossal duct cyst in a 23 year old gentleman. The patient presented to us, as a case of suprahyoid thyroglossal cyst with sub-lingual involvement and he underwent surgical excision of the entire thyroglossal tract by Sistrunk’s approach. The post-operative histopathological diagnosis was of a papillary carcinoma within the thyroglossal duct cyst. Hence, the patient was evaluated for a malignant focus in the thyroid which proved negative. He was counseled regarding the possibility of developing Carcinoma in the thyroid gland and offered two options of further management viz., total thyroidectomy followed by life long thyroid suppression or watchful observation and follow up. As the patient belonged to the low risk group, he opted for the second option. He is presently kept under meticulous follow up and remains asymptomatic till date. We present the pre- and post-operative imaging, intra-operative findings, histo-pathological features and review the present world literature on this rare entity.     

Imaging case study of the month. Thyroglossal duct cyst with intralaryngeal extension

OBJECTIVES: Thyroglossal duct cysts with intralaryngeal extension are rare. We present only the 10th reported case in the literature. METHODS: The clinical presentation, diagnosis, and treatment of the patient are reviewed and summarized. The uniqueness of the case, as well as the diagnostic and treatment pitfalls of this subgroup of patients, is presented. RESULTS: Our patient, at 76 years of age, is the only woman and the oldest person reported to have had a thyroglossal duct cyst with intralaryngeal extension. CONCLUSIONS: Intralaryngeal extension should be considered when there is hoarseness, dysphagia, or dyspnea associated with a thyroglossal duct cyst. Office laryngoscopy and computed tomography make the diagnosis. Care must be taken with airway management and intraoperative dissection for good outcomes.     

Endolaryngeal extension of thyroglossal duct cyst

Thyroglossal duct cysts are the most common congenital neck masses that develop during childhood, The masses develop from remnants of thyroglossal ducts, and typically appear as midline neck masses. Endolaryngeal extension of thyroglossal duct cysts has been reported mostly as midline neck swelling. We observed a case of extension of the thyroglossal duct cyst to the supraglottic area without neck swelling. A 50-year-old man presented with a 1-month history of foreign-body sensation in the throat. Fiberscopic and radiologic findings were similar to those associated with a saccular cyst, but its proximity to the hyoid bone raised the possibility of thyroglossal duct cyst. Operation was performed via an external incision to completely remove the cyst. Postoperative fiberscopy revealed that the aryepiglottic fold swelling had disappeared. Diagnosis of thyroglossal duct cyst was confirmed on the basis of pathological findings. In cases in which it is difficult to remove the cyst from the hyoid membrane, the hyoid bone midline portion should be dissected. Thyroglossal duct cysts should be considered in cases with a submucosal tumor in the supraglottic region, and radiological examinations should be performed.     

True thyroglossal fistula

Thyroglossal duct anomalies are the most common malformations in the neck and constitute 70% of all the congenital cervical masses. They are more common in the pediatric population under 5 years of age, and 60% of lesions are diagnosed before the age of 20. They represent remnants from the embryological migration of thyroid tissue from foramen caecum to the thyroid fossa. The thyroglossal duct cyst may rupture spontaneously and present as a draining sinus, which has been erroneously called a thyroglossal fistula, although communication with foramen caecum is extremely rare. We hereby present a case of true thyroglossal fistula in a 21‐year‐old male with a fistulous communication between the neck skin and foramen caecum. Laryngoscope, 2009     

Papillary carcinoma of the thyroglossal duct cyst in childhood

Thyroglossal duct carcinoma is a rare malignancy that is usually diagnosed postoperatively. Approximately 150 cases have been reported in the literature. Eighty-five percent of these were papillary carcinomas. Controversies exist concerning its nature and treatment. In this report, we present an 11-year-old boy with an anterior cervical cystic mass originating in the thyroglossal duct. After a primary Sistrunk procedure, the cyst and tract extending to the foramen caecum at the base of the tongue in continuity with the midportion of the hyoid bone were resected. Histopathologic study demonstrated a papillary carcinoma. After 4 months of follow-up, the patient is asymptomatic without any evidence of recurrence. The clinical and histopathological features and therapeutic options are discussed.     

Thyroglossal duct carcinoma: A rational approach to management

Objective: To discuss the authors' experience with thyroglossal duct carcinoma and present a rational approach to the management of this entity. Study Design and Methods: A retrospective review of the cytopathology and pathology records of all patients with the diagnosis of a thyroglossal duct remnant from 1965 to 1997 was performed. Results: Three cases of papillary thyroglossal duct carcinoma were identified, with one suspected squamous cell carcinoma by needle aspiration. The papillary carcinomas are discussed in detail to illustrate the difficulty encountered in managing the thyroid gland in the setting of a thyroglossal duct carcinoma. Fine-needle aspiration proved effective in making the diagnosis preoperatively. Conclusions: The authors recommend that a thyroglossal duct cyst with a microscopic focus of papillary carcinoma, without cyst wall invasion, be managed with a Sistrunk procedure. Treatment of all other thyroglossal duct papillary carcinomas should include removal of all thyroid tissue followed by radioactive iodine treatment.     

Anterior lingual thyroglossal cyst: antenatal diagnosis,management, and long-term outcome

OBJECTIVE: To describe the long-term outcome of a large anterior lingual thyroglossal duct cyst, diagnosed antenatally by ultrasound that completely obstructed the oral cavity and had almost completely replaced the anterior two-thirds lingual musculature. METHODS: Longitudinal observation. RESULTS: Anticipated airway obstruction at birth did not occur. Complete cyst removal occurred at day 2 of life with a rim of lingual muscle observed present only on the left side. Complete and safe oral feeding was achieved by day 11 of life. Progressive muscle mass development and function with mild asymmetry was observed during sequential assessments. Vigorous speech therapy was started at age 7 months achieved 80-100% intelligible speech with minimal misarticulations at age 33 months. CONCLUSION: This case demonstrates the remarkable compensatory ability of the tongue to achieve almost normal function with minimal anterior musculature that is critical to deglutition and articulation. Early speech therapy appears key to improving functional outcomes of speech. A strong central nervous system basis for suckle development is suggested by the rapid development of a safe and effective suckle and swallow soon after cyst resection and in spite of in utero tongue fixation.     

Intralaryngeal thyroglossal duct cyst: implications for the migratory pathway of the thyroglossal duct

An atypically located thyroglossal duct cyst in a 42-year-old man is described. A purely intralaryngeal thyroglossal duct cyst is extremely rare and can mimic other laryngeal lesions. This case demonstrates that thyroglossal duct cyst is a possible cause of intralaryngeal swellings and would have significant implications for the manner in which they are managed.     

内镜下低温等离子治疗舌甲状舌管囊肿

目的：探讨内镜下低温等离子治疗舌甲状舌管囊肿的手术方法、疗效和适应证。方法：对11例舌甲状舌管囊肿患者行内镜下低温等离子舌甲状舌管囊肿切除术,观察疗效及并发症情况。结果：1l例患者术后症状改善,无严重并发症发生,随访1-3年,无复发。结论：内镜下低温等离子治疗舌甲状舌管囊肿手术时间短,术中出血少,术后反应轻、恢复快,疗效满意。     

A Thyroglossal Duct Cyst Causing Obstructive Sleep Apnea in Adult

Obstructive sleep apnea (OSA) is a common disorder. It usually results from the structural compromise of the upper airway. In patients with OSA, the obstruction predominantly occurs along the pharyngeal airway, and also a variety of tumors have been reported to cause such a condition. We present here the case of a thyroglossal duct cyst causing OSA in adult. This case demonstrates that thyroglossal duct cyst or some kind of mass lesions in the airway lesions should be considered in the differential diagnosis of OSA patients.     

甲状舌管残留临床分析

目的　探讨甲状舌管囊肿及瘘的复发因素及治疗情况。方法　回顾性分析我科2010年1月～2013年3月收治的114例甲状舌管囊肿及瘘患者的临床资料。结果　所有病例均经手术治疗,其中113例行Sistrunk术式切除,1例单纯囊肿切除,术后均一期愈合,随访6～46个月,3例复发,其中2例成人再次行Sistrunk扩大根治术,术后未再复发。结论　误诊、非典型的甲状舌管残留、急性感染时行手术、病变组织切除不完全、手术年龄过小和术中囊肿破裂是导致术后复发的重要因素,术前抗感染及术中对舌骨及残端的处理是治疗与防止复发的关键。     

Atypical thyroglossal duct cyst

Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.