甲状舌管囊肿术后复发的多因素分析及手术处理

目的：探讨甲状舌瞥囊肿术后复发的原因及再次手术的效果。方法：运用统计学软件，采用单因素和logisitic模型分析，分析了12例甲状舌管囊肿术后复发的原因。结果：误诊、感染和不当的手术方法是复发的主要原因，12例复发病人再次手术后，疗效满意。结论：正确的术前诊断，术前抗感染治疗及正确的手术方法可避免术后复发，再次手术是治疗甲状舌管囊肿复发病例的理想方法。     

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.     

Papillary carcinoma of thyroglossal cyst

Malignancy of thyroglossal cyst is a rare entity. Medical literature has reported only a very few cases till date. Histopathologically papillary carcinoma of thyroglossal cyst is the most common variety encountered in clinical practice. Surgical excision by Sistrunk operation is the standard treatment of choice followed by subtotal or total thyroidectomy whenever indicated. We report here two cases of thyroglossal cyst carcinomas and their respective management.     

Thyroglossal Duct Cyst,Variation in Presentation,Our Experience

Thyroglossal duct cysts are most common midline congenital swelling in head and neck region. It results from incomplete involution of thyroglossal duct. They present as midline painless swelling in neck. We have studied variation in their presentation. The retrospective study carried out in department of ENT in Gandhi Medical College Bhopal from Jan 2009 to Sept 2013. Objective of this study is, to study incidence of Thyroglossal Duct Cyst in different age and sex group and variation in presentation. Clinical records, medical records and histopathological records were studied. 10 patients diagnosed as Thyroglossal Duct Cyst included in study. 10 patients were found to be diagnosed as Thyroglossal Duct Cyst. Out of 10 pt. 6 were pediatric patients and 4 were adults. 8 patients presented with cyst while 2 presented with fistula. Out of 10 patients 3 presented with suprahyoid, 2 at the level of hyoid and 5 had infrahyoid presentation. 7 patients undergone sistrunk operation procedure while 3 undergone simple excision. Out of 3 patients who undergone simple excision 1 patient develop recurrence. Thyroglossal Duct Cyst are one of the most common asymptomatic midline neck swelling and should be differentiated with other swellings with proper investigations.     

Intrathyroid thyroglossal duct cyst simulating a thyroid nodule

A case of intrathyroid thyroglossal duct cyst is reported. A 50-year-old woman presented with a right lateral neck mass that was clinically indistinguishable from a thyroid nodule. Ultrasound-guided fine-needle aspiration biopsy (US-FNAB) revealed normal-looking squamous cells. Right thyroid lobectomy was performed and microscopic examination revealed a cyst lined by squamous epithelium that was consistent with a thyroglossal duct cyst. The lesion was completely surrounded by normal thyroid tissue. Our experience suggests that intrathyroid thyroglossal duct cyst should be remembered in the differential diagnosis of a thyroid nodule. Detection of benign squamous cells by US-FNAB may be useful for ruling out the possibility of a cystic thyroid tumor.     

Simultaneous complete branchial and thyroglossal fistula — a rare presentation

The anomalies of branchial cleft and thyroglossal tract accounts for the majority of fistulas in head neck region. A simultaneous presentation of both type of fistula in a same patient is very rare with no such cases reported in Indian literature till date. Here we present a case of simultaneous complete branchial and thyroglossal fistula in a 13-year-old girl with radiologically demonstrable internal opening on fistulogram managed surgically.     

Management of well-differentiated thyroid carcinoma presenting within a thyroglossal duct cyst

BACKGROUND AND OBJECTIVE: Well-differentiated thyroid carcinoma (WDTC) is diagnosed in approximately 1.5% of thyroglossal duct cysts (TGDC). No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioactive iodine therapy. The current review was undertaken in an attempt to clarify these issues. METHODS: Demographic, clinical, tumor, treatment, pathology, and outcome data on 57 eligible patients reported in recent literature were pooled together with 5 patients treated at our institution for this analysis. RESULTS: A Sistrunk operation was performed for resection of the thyroglossal duct cyst in the majority (90%) of patients. Histologic examination of the tumor in the cyst revealed that papillary carcinoma was the most frequent (92%) histologic type. A total thyroidectomy was performed consequent to the diagnosis of thyroglossal duct cyst carcinoma in approximately half of the 62 patients. A malignant tumor was reported in 27% of the thyroidectomy specimens. Postoperative radioactive iodine therapy was administered in 16 (26%) patients. With a median follow-up of 71 months (range 1-456 months), the 5- and 10-year Kaplan-Meier overall survival was 100 and 95.6%, respectively. There were no disease-related deaths reported in any of the patients. Univariate analysis revealed that the only significant predictor of overall survival was the extent of primary surgery for the thyroglossal cyst. The addition of total thyroidectomy to Sistrunk operation did not have a significant impact on outcome (P = 0.1). Patients treated with postoperative radioactive iodine (RAI) fared significantly worse than those that did not need RAI, which may be explained by the fact that this modality would generally be used in patients with higher risk tumors. CONCLUSIONS: The Sistrunk operation is adequate for most patients with incidentally diagnosed TGDC carcinoma in the presence of a clinically and radiologically normal thyroid gland. Results of adequate excision using the Sistrunk operation are excellent and the concept of risk-groups should be used to identify patients, who would benefit from more aggressive treatment.     

Papillary thyroid carcinoma identified after Sistrunk procedure: report of two cases and review of the literature

Thyroglossal duct cysts represent the most common congenital cervical malformations. Carcinomas arising in the thyroglossal duct cysts are rare neoplasms characterized by a relatively non aggressive behavior with rare lymph node spread. Approximately 1% of thyroglossal cysts contain a carcinoma. The most frequent histological type is papillary carcinoma, accounting for about 80% of cases. Currently, most authors agree about their primary origin ex novo from ectopic thyroid tissue in the cyst. In most cases the diagnosis of thyroglossal duct carcinoma (TDC) is not made until histopathological examination has been performed on a resected cyst without any suspected clinical sign of malignancy. The definition of the correct surgical treatment for these carcinomas is still controversial; most authors maintain that resection of a TDC with the Sistrunk procedure can be considered oncologically adequate when dealing with a differentiated carcinoma without extracapsular invasion and/or lymph node metastases and with a normal thyroid. We present two cases of papillary thyroid carcinoma identified after resection of a thyroglossal cyst according to the Sistrunk procedure and managed with different surgical approaches according to the different sites of the tumors. In addition, we discuss appropriate therapeutic strategies in light of the most recent data in the literature.     

Thyroglossal duct cyst papillary carcinoma

Thyroglossal duct cysts are usually located in the midline of the neck. The coexistence of carcinomas in thyroglossal duct cysts is extremely rare, with most being papillary carcinomas. Usually, the diagnosis is only made postoperatively after excision of the cyst. Although the Sistrunk procedure is often regarded as adequate, controversies exist concerning the need for thyroidectomy depending on histopathological findings. We report the case of a 31-year-old man diagnosed with papillary carcinoma within a thyroglossal duct cyst, who underwent total thyroidectomy as has been recommended for differentiated papillary cancer.     

Papillary carcinoma in a thyroglossal cyst: report of a case and review of literature

A 29-years old male presenting with a midline neck swelling four centimetres in diameter of one years duration was diagnosed to have a thyroglossal cyst. He underwent a Sistrunk’s operation. Histological examination of the specimen revealed a papillary thyroid carcinoma limited to the cyst wall. The thyroid scan was normal indicating no further need for surgery. The patient has been on suppressive therapy with thyroxin for one year and is currently disease-free. A review of literature is also presented.     

Primary papillary carcinoma in a thyroglossal duct cyst

A rare case of primary thyroid papillary carcinoma arising in a thyroglossal duct cyst occuring in a 46 year old man is reported. The diagnosis was not suspected preoperatively. On gross examination of the excised specimen the presence of a papillary tumour in the cystic mass suggested the diagnosis which was proved histopathologically. The thyroid gland was normal on physical examination and scintigram thus ruling out the possibility of metastasis from a primary tumour in the thyroid gland.     

甲状舌管乳头状癌诊断及治疗

目的：探讨甲状舌管乳头状癌病例的诊断治疗方法。方法：2例患者术前接受常规体检、B超、细针穿刺检查，手术均包括颈前肿块及舌骨中部的切除(Sistrunk operation)，一侧甲状腺肿块切除或腺叶切除。一例患者由于发现明显右颈肿大淋巴结，故同时实施了功能性颈清扫术。术后标本行常规病理检查。结果：2例患者标本符合甲状舌管乳头状癌诊断，并正在密切随访中。结论：甲状舌管癌为罕见病种，已有公认的诊断标准，Sistrunk手术仍为一种适当的外科治疗方法。     

Small ureterocele‐like Gartner’s duct cyst associated with ipsilateral renal aplasia: A case report

Gartner’s duct cyst associated with ipsilateral renal aplasia is a rare anomaly and fewer than 40 cases have been reported in the literature. A case of Gartner’s duct cyst presenting like an ureterocele on sonography, intravenous pyelography and CT are described.     

A Decade of Experience of Management of Thyroglossal Duct Cyst in a Tertiary Care Hospital: Differentiation Between Children and Adults

Variations in thyroglossal duct cysts (TGDCs) between children and adult are mentioned very little in literature. The lesion mostly found in children but adult population also possesses this anomaly. The aim of this study was to determine the differences in clinical presentations and surgical outcomes of TGDC between children and adults. A retrospective chart review of all patients with TGDCs managed in our hospital from July 2004 to June 2014. All records were reviewed for age, sex, location of cyst in neck and with relation to hyoid bone, size, postoperative complication and recurrence rates. Differences between children and adults were assessed. A total of 39 patients (21 children and 18 adults) were treated for TGDC. Of the pediatric group, 71.4% were male and 28.5% were female, whereas 72.2% of the adults were male and 27.7% were female. Adults were more likely to develop other complaints like neck pain, dysphagia and dyspnea. Position was almost similar in both age groups with midline and infrahyoid location while laterality was seen in adult only. Size of Cyst was found to be larger in adults. The recurrence and post operative complication rates between children and adults were not significantly different. TGDC has male predominance. Clinical presentations were almost similar in both age groups. Although lateral deviation, increase size of cyst and recurrences were seen in adults only, Sistrunk procedure is recommended as a safe and standard surgical treatment in both age groups.     

Head and neck masses in children: A clinicopathological study

Fifty children with head and neck masses were evaluated clinically and pathologically. Inflammatory swellings constituted the majority (54%). Congenital - developmental malformations were the next common lesions (30%) and neoplastic masses constituted the rest (16%). Tuberculous lymphadenitis was found to be the single most common etiology (28%). Among congenital-developmental malformations, cystic hygroma was the most frequent lesion. The incidence of branchial cleft abnormalities was found to be low and no thyroglossal duct cyst was observed in this series. Among the neoplastic masses malignant lesions were more common than benign tumours and lymphoma was the most common head and neck malignancy observed.     

Papillary carcinoma in thyroglossal duct remnants: presentation of four cases and decision procedure for prophylactic thyroid gland dissection

Papillary carcinoma in thyroglossal duct remnants is a rare and usually unexpected finding. It is controversial whether or not prophylactic thyroid gland dissection is necessary in such circumstances. We present our experience of four cases. Based on this, a consideration of published risk factors, and evaluation of the likelihood of a primary versus metastatic origin of the malignancy, we present a therapeutic decision procedure. When the thyroid is normal, the patient presents low-risk factors for thyroid cancer, and there is evidence that the malignancy is primary, removal of all thyroglossal duct remnants by the Sistrunk procedure is sufficient.     

Nasopalatine Duct Cyst: Report of a Case with Review of Literature

The nasopalatine duct cyst is the most common non-odontogenic developmental cysts. Nasopalatine duct cyst also termed as incisive canal cyst, arises from embryologic remnants of nasopalatine duct. Most of these cysts develop in the midline of anterior maxilla near the incisive foramen. This article reports a case and review of literature with respect to epidemiology, etiology, clinical presentation, radiographic and pathological findings, treatment and recurrence rates.     

Thyroid disease in northern Italian children born around the time of the Chernobyl nuclear accident.

BACKGROUND: The Chernobyl nuclear accident of 1986 caused a dramatic increase in the incidence of thyroid cancers in exposed children in Belarus. Airborne radioactivity from the reactor spread over northern Italy, where rainout gave rise to low levels of radioactivity at ground level. PATIENTS AND METHODS: As the latency between exposure to ionising radiation and development of thyroid cancer is thought to be about 10 years, in 1996/1997 all children born in 1985 and 1986 and attending school in an area of Milan, Italy were examined for thyroid nodules. A total of 3949 children were examined by two physicians blinded to the examination and diagnosis of the other. The children were to be reassessed in 2001/2002. RESULTS: In total, 1% had palpable nodules. The nodule diagnoses were: Hurtle cell adenoma (one), thyroglossal duct cyst (one), thyroid cyst (four) and thyroiditis (four). The prevalence of thyroid disease in the cohort was indistinguishable from that of populations not exposed to radioactive pollution. Only 10 children re-presented for examination 5 years later; all were negative. The direct costs of the study were estimated at 21,200 Euros. CONCLUSION: The high cost of the study in relation to reassuring lack of increase in thyroid nodule prevalence suggests that further studies are not justified.     

Collision tumor of the kidney composed of clear cell carcinoma and collecting duct carcinoma：report of a case with unusual morphology and clinical follow-up

We report the case of a 67-year-old female who presented with a large renal mass. Gross examination of the nephrectomy specimen demonstrated a 6-cm renal mass that invaded into the renal sinus and perinephric fat. Histologic examination revealed two distinct tumor types. The first type was a conventional （clear cell） renal cell carcinoma that was of low nuclear grade and comprised the minority of the overall tumor. The second type was a high-grade collecting duct carcinoma with glandular/tubular differentiation and composed the majority of the tumor. Immunohistochemical studies demonstrated distinctive patterns of the two tumor types, thus confirming two distinct lineages. Five months postoperatively, the patient developed metastasis to the lungs and right hilar lymph node region. A fine needle aspiration of a lung nodule demonstrated a metastatic, poorly differentiated carcinoma, similar to the collecting duct carcinoma component in the kidney. Collision tumors of the kidney are rare with fewer than 10 cases reported in the literature. Our report further expands the spectrum of this rare phenomenon.     

婴儿鼻软骨间叶性错构瘤临床病理观察

婴儿鼻软骨间叶性错构瘤(nasal chondromesenchymal hamartoma,NCMH)1例报告及相关文献复习.新生儿表现呼吸不畅,CT扫描发现左鼻腔鼻窦囊性肿块,肿块在内镜手术切除后1年复发.病理学显示梭形间质细胞黏液背景中透明软骨岛、动脉瘤样骨囊肿区及透明变性的胶原纤维小梁.NCMH是一种罕见的破坏性的良性病变,类似恶性肿瘤.完整切除肿瘤是预防复发的关键.