Congenital Masses Research Articles

Endoscopy-Assisted Thyroglossal Duct Cyst Resection: A Scoping Review.

Thyroglossal duct cysts (TGDCs) are a common congenital mass in the cervical region. As the traditional surgical approach for TGDC removal, the Sistrunk procedure, often leaves a visible neck scar, the demand for improved cosmetic outcomes has increased. Emerging endoscopy-assisted approaches offer promise for addressing cosmetic concerns. We conducted a scoping review to evaluate the feasibility and safety of endoscopy-assisted TGDC surgery. PubMed, Embase, and Cochrane databases. Electronic databases were searched from their respective inception dates to January 2023. Data on surgical approach, patient demographics, surgical procedure, and postoperative outcomes were extracted and analyzed. The quality of the studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. The literature search yielded nine articles published between 2011 and 2022. Overall, 85 patients in these studies successfully underwent endoscopy-assisted TGDC surgery using various approaches, including areolar, axillo-breast, transoral-vestibular, and transoral-sublingual. The operative time varied across the studies, ranging from 50 to 480 min. TGDC sizes ranged from 1 to 3 cm in diameter. Complications, including infection, skin bruising, and dysarthria, were reported in seven patients (8%). No cases of conversion to open surgery or postoperative recurrences were reported. Endoscopy-assisted surgery is a potential alternative for patients seeking TGDC resection with satisfactory aesthetic results while ensuring safety. However, existing evidence is insufficient to support the superior effectiveness of endoscopy-assisted TGDC surgery over the traditional Sistrunk procedure. Laryngoscope, 134:3038-3043, 2024.

The laparoscopic surgery results of isolated enteric duplication in the transverse mesocolon: A case report

Enteric duplication cysts found throughout the alimentary tract are rare congenital mass lesions, which usually share a common wall with the gastrointestinal tract. However, many cases of isolated enteric duplication (IED) cysts, reported in the literature, are without any attachment to the gastrointestinal tract. We report a case of an IED cyst located in the transverse mesocolon, which was successful treatment with laparoscopy, in Children’s Hospital #1, Ho Chi Minh City, Vietnam. A girl turned 3 years old presented with dull abdominal pain and vomiting. Abdominopelvic computed tomography revealed a lesion located around duodenojejunal flexure with a thick wall. Laparoscopy detected a mobile cystic mass found on the mesentery of the transverse colon, which was not connection or attachment to any part of the adjacent intestine. Histopathology of the cyst wall was compatible with an EDC. The IED cyst is an unusual phenomenon that confuse with other diagnosis in clinical. The definitive diagnosis of IED is based on histopathology. Laparoscopic resection of the cyst is the preferred treatment.

Chiari Malformation (CM) type III surgical management in infant: a case report

Background: Chiari Malformations (CM) is a collection of hindbrain abnormalities ranging from simple to complete agenesis of the cerebellum. Type III CM (CM III) is the rarest CM, with herniation of the cerebellum and brainstem into a posterior encephalocele and other intracranial anomalies. Reduction of the viable herniated brain, along with providing intracranial space and inadequate closure, often presents as the main problem. This case study aims to evaluate the Chiari malformation type III surgical management in infants. Case Presentation: A 16-day-old male infant with an intact congenital mass in the occipital, with no neurological deficit. Radiological examination shows a defect in the occipital skull consisting of cystic non-contrast enhancing lesion and parenchymal tissue herniated through the defect. The cele excision and defect closure were performed, and viable neural tissue was found inside the sac. Blossom flower-like trim expanded the fossa posterior space and put the viable neural tissue inside the intracranial room. The defect was then closed with a dura, periosteal patch, and tension-free two-layered scalp closure. Post-operative follow-up presented a good outcome, and 1-year follow-up showed good recovery, with developmental delay, following developmental rehabilitation. Conclusion: CM III is rare and has poor outcomes because neurological deficits and respiratory problems usually follow it. Operative management patient with CM III was presented with occipital encephalocele with no post-operative complication. Occipital bone reconstruction using a blossomed-flower-like technique could be considered to create adequate room for viable neural tissue.

Surgical approach to evaluate neck mass in children concerning management protocols

Background: Neck masses in children are not common presentations in Head-neck specialized practice but when present they createpotential diagnostic dilemmas for consulting surgeon. These children may present as havingapparently simple harmless mass in the neckbut there are several alarming diagnostic possibilities. Attending surgeons should concern about the wide range ofdifferential diagnoses. Objective: Differential diagnosis and management of Neck masses in children differ from those in adults. A systematic approach to diseases and judicious investigation protocol is crucial to ensure appropriate assessment and management. This prospective study was undertaken to assessmanagementprotocol for the evaluation process of neck mass in case of children. Methods:This is a prospective study of 6 yearsin the tertiary hospital based in Dhaka between 2016 and 2022. 385 (131, girls, 254 boys) patients aged between 2 years to 14 years were reviewed. The history, physical examination findings, imaging reports (USG, color Doppler, CT, and MRI)FNAC, and the histopathology report are taken into consideration as managementprotocol for the evaluation process. Results: In this studyauthors observed congenital masses were most commonly found in this age group, followed by Infectious and neoplastic masses, at a rate of 57.40%, 27.53%, and 15.06% respectively. Thyroglossal Cyst constituted 33.48% of congenital masses. Non-Hodgkin lymphoma was the most frequent type of malignancy (50%). The lateral neck was the most affected site (47.01%). Conclusion: The diagnosis can be reached with a brief history and prompt physical examination. Ultrasound and Color duplex study should be the first choice for evaluation. Fine needle aspiration cytology followed by excisional biopsyfind out the tissue of origin. FNAC can guide the surgeon initially to reach the disease and give the clue for the next steps on evaluation. CT SCAN & MRI should be avoided if not clearly indicated as both need sedation in case of children and CT emits radiation effect.

Management of Pediatric Persistent Asymptomatic Cervical Lymphadenopathy.

Persistent asymptomatic cervical lymphadenopathy (PACL) is a common outpatient referral diagnosis for pediatric otolaryngologists. Historically, excisional biopsy under general anesthesia has been the gold standard for diagnosis but is associated with some risks. Current literature provides little guidance on less invasive monitoring. Our hypothesis is that the majority of children who present with PACL can be safely monitored with ultrasound and avoid the risks of excisional biopsy. A retrospective review was performed of patients <18 years of age, referred to a tertiary care children's hospital for PACL who also underwent at least 1 neck ultrasound from 2007 to 2021. Patients with acute neck infections, congenital masses, or known rheumatologic, immunologic, or malignant conditions were excluded. A multivariate logistic regression model was used to determine patient and nodal factors associated with the decision for operative management. University of California, San Francisco Pediatric Otolaryngology Department. Among the 197 patients meeting inclusion criteria, 30 (15.2%) underwent surgical biopsy. Overall, 26% underwent repeat ultrasound with a mean interval of 6.6 months, and a mean decrease in nodal size of 0.34 cm. Of the 30 surgical cases, 27 (90%) patients had benign pathology. Multivariate regression analysis revealed pain (p = .04), firmness (p < .001), and lack of a normal fatty hilum on ultrasound (p = .04) as statistically significantly correlated with decisions for surgical management. The majority of pediatric PACLis benign and does not require an excisional biopsy to rule out lymphoma. Serial clinical follow-up with neck ultrasound can be used to safely monitor patients.

Fibromatosis colli: a rare case report

Fibromatosis colli, a rare benign congenital mass of the sternocleidomastoid muscle, is mainly found in the neonatal age group, often at the age of 2 to 4 weeks of life. Also known as a pseudo tumour, its aetiology is still unknown and may occur due to injury of the sternocleidomastoid muscle in the last trimester of intrauterine life or during delivery. Frequently manifests as restriction of neck movement and enlarging neck mass at around 14-28 days after birth. Ultrasonography (USG) neck is the preferred diagnostic modality. Treatment is mainly conservative consisting of observation and stretching exercises. Surgical intervention is required in &lt;10% of cases and consists of a tenotomy of the sternocleidomastoid muscle. We present a case report of fibromatosis colli in a 15-day-old female neonate with a history of birth trauma presented with a right neck mass and torticollis, diagnosed using high-frequency ultrasound. This condition regressed in the next few months while the patient was instituted only conservative treatment. Thus, signifying the importance of clinical diagnosis and differentiation from other causes of neck masses to prevent unnecessary investigation and overtreatment.

Nasal glial heterotopia in a 5-month-old girl – a case report

Nasal glial heterotopia is a rare congenital mass that is more commonly noted in infants. We report a case of nasal glial heterotopia in a 5-month-old girl initially presenting with unilateral nasal obstruction. Diagnostic imaging showed a tissue mass in the nasal cavity. The mass was resected via endoscopic surgery. We present the approach to radiological examination and clinical course of the case. In cases of infant nasal glial heterotopia recurrence of the mass is possible if it is not completely excised, so it is essential to be careful during the procedure and perform routine follow-ups. Differential diagnosis includes mainly meningocele and encephalocele, polyps and nasal dermoid cyst. Although nasal glial heterotopia is a rare condition, it should be taken into consideration in diagnosis of infants with nasal obstruction.

The laparoscopic surgery results of isolated enteric duplication in the transverse mesocolon: A case report

Introduction: Enteric duplication cysts found throughout the alimentary tract are rare congenital mass lesions, which usually share a common wall with the gastrointestinal tract. However, many cases of isolated enteric duplication (IED) cysts, reported in the literature, are without any attachment to the gastrointestinal tract. We report a case of an IED cyst located in the transverse mesocolon, which was successful treatment with laparoscopy, in Children’s Hospital #1, Ho Chi Minh City, Vietnam. Case presentation: A girl turned 3 years old presented with dull abdominal pain and vomiting. Abdominopelvic computed tomography revealed a lesion located around duodenojejunal flexure with a thick wall. Laparoscopy detected a mobile cystic mass found on the mesentery of the transverse colon, which was not connection or attachment to any part of the adjacent intestine. Histopathology of the cyst wall was compatible with an EDC. Conclusion: The IED cyst is an unusual phenomenon that confuse with other diagnosis in clinical. The definitive diagnosis of IED is based on histopathology. Laparoscopic resection of the cyst is the preferred treatment.

Retrospective Analysis of Neck Masses Diagnosed by Histopathology from Chattogram General Hospital

Background: Neck masses are found in all age groups from many causes, ranging from congenital to acquired pathology. There is a wide variation in the presentation of neck masses concerning its site of origin, clinical presentation, and the nature of the progression of the disease. This study was performed to have an idea about the prevalence of various neck masses according to age and sex so that it would help us in diagnosing the neck masses. Materials and methods: This retrospective study was performed in the Department of Otolaryngology and Head Neck Surgery, Chattogram General Hospital, Chattogram from July 2018 and June 2019, over 97 patients presented with neck mass. Results: Of 97 cases 69.1% were female and range from 7-77 years. The maximum case holding age group was 21- 30 years (26.8%). The histopathological diagnosis of the neck masses was inflammatory in 68 (70.1%), congenital in 5 (5.2%) and neoplastic in 24 (24.7%) cases. Chronic granulomatous lymphadenitis was the most common inflammatory lesion (50.5%) and a branchial cyst was the most common congenital mass (2.2%). Neoplastic masses were malignant in 10 (10.3%) and benign in 14 (14.4%) cases. The most common malignant neoplastic mass was a follicular carcinoma (6.2%), and the most common benign neoplastic mass was goitre (12.4%). Conclusions: Cervical lymphadenopathy was the most commonly encountered neck mass. Most of the neck masses are benign. Out of these cervical lymph nodes, tubercular lymphadenopathy was most common. JCMCTA 2022 ; 33 (1) : 21-24

Prevelence of dermoid cyst in congenital midline craniofacial masses in paediatric population"A case series study in tertiary care hospital.

Background: Dermoid cyst is one of the congenital craniofacial masses, most commonly occurring in pediatric population. This study will help us to know the magnitude of dermoid cysts in midline craniofacial masses in children.Objective: To determine the prevalence of dermoid cysts in midline craniofacial masses in pediatric population in tertiary care hospital. Material and Methods: This case series study was conducted at Department of Neurosurgery, Lady Reading Hospital(MTI) Peshawar, Pakistan from March 2016 to February 2019. A total of 52 patients with midline craniofacial masses were studied. After obtaining permission from hospital ethical committee and taking consent from patients included in the study, dermoid cysts in midline craniofacial masses was diagnosed on the basis of histopathology report done in our hospital laboratory. Results: The mean and standard deviation of age was 4.15±3.84years in patients with midline congenital craniofacial masses. Out of 52 patients with midline congenital craniofacial masses, 33(63.5%) patients were from the age group 1-5 years. Out of 52 patients having midline congenital craniofacial masses, 23(44.2%) were females and 29(55.8%) were males. 33 (63.5%) out of 52 patients with midline congenital craniofacial masses resided in urban areas. Out of 52 midline congenital craniofacial masses, 16 (30.8%) were dermoid cysts on histopathological report. Conclusion: Dermoid cyst is a common congenital midline craniofacial mass and is more common in males and urban population. Key words: Midline craniofacial masses, dermoid cyst.

When is pre-operative imaging required for craniofacial dermoid cysts/sinuses? A review

ObjectivesDermoid cysts/sinuses (DCS) are congenital masses occurring along lines of embryonic fusion. Midline DCS carry a risk of intracranial extension. Pre-operative computed tomography (CT) or magnetic resonance imaging (MRI) are the primary imaging modalities used and based on the results, the need to involve a neurosurgical team in the resection is determined. Although less so, non-midline locations are also at risk for intracranial communication. This study aims to quantify our institutional experience with both midline and lateral DCS for intracranial extension and discuss potential need for preoperative imaging in all DCS cases. MethodsInstitutional Review Board approval was obtained. Pediatric patients ages 0–18 years with DCS presenting to the pediatric otolaryngology, plastic surgery, and neurosurgery clinics from 2005 to 2020 were retrospectively reviewed. Data collected included patient demographics, imaging modality, location, size, complications, and presence/absence of intracranial extension. DCS location included nasoethmoidal (NE), periorbital, frontotemporal (FT), and scalp. Lesions were further classified as midline and non-midline. Results205 patients with surgically removed DCS were included for analysis. Mean age at surgery was 3 years. MRI was the most common imaging modality used (60.5%), followed by US (18%), CT (18%) and plain films (1%). Locations were: NE (69, 34%), periorbital (67, 33%), FT (28, 14%), and scalp (41, 20%). 105 DCS were midline: NE (69), periorbital (7), and scalp (29). Of these, 29 (28%) had intracranial extension: NE (8), scalp (21). 100 DCS were non-midline: periorbital (60), FT (28) and scalp (12). Of these, 7 (7%) had intracranial extension: periorbital (3), FT (3) and scalp (1). ConclusionThe risk of intracranial extension of midline craniofacial DCS is well established. We have shown that there is a percentage of lateral DCS which carry a risk for intracranial extension, and for which the involvement of a neurosurgical team may be required. Given the potential benefit, pre-operative imaging of all lateral head and neck DCS may be prudent to screen for intracranial extension.

An Approach to Nasopharyngeal Mass in Newborns: Case Series and Systematic Literature Review.

ObjectiveCongenital nasopharyngeal masses (CNMs) are rare. Presenting symptoms vary, and the differential diagnoses cover a wide spectrum of possibilities. As it is uncommon, most examples discussed in literature are described as case reports or series. Guidelines on CNM patient management do not exist. In this study, we present two (2) cases of neonates with CNMs that were encountered at our tertiary center. Additionally, to best elaborate a comprehensive, case-based approach to CNM management, we offer an up-to-date, diagnosis-to-treatment review of current literature.MethodsCase series and systematic literature review.ResultsTwenty-eight (28) studies are included since January 2000 to October 2021, with a total of 41 cases. Most common diagnosis was teratoma (78%). Female-to-male ratio was 2.5:1. Twenty percent of cases presented prenatally with polyhydramnios or elevated alpha-fetoprotein. Postnatally, the presenting symptoms most frequently encountered were respiratory distress (78%), oral mass (52%), and feeding difficulties (29%). Seventy-five percent of affected newborns showed symptoms within the first 24 hours of life. Forty percent of cases had comorbidities, especially in the head and neck region.ConclusionsCongenital nasopharyngeal masses can be detected antenatally, or symptomatically immediately after birth. Airway protection is a cornerstone in the management. Selecting the right imaging modality and convening a multidisciplinary team meeting are important toward the planning of next steps/therapeutic approach. Typically, a transnasal or transoral surgical approach will be deemed sufficient to address the problem, with a good overall prognosis.

Rare case of lingual thyroglossal cyst presenting in infant with respiratory distress

Thyroglossal duct cyst (TDC) is the most common congenital anomaly of the neck. The thyroglossal duct is an embryological structure which connects the base of the tongue to the thyroid gland, which when fails to obliterate results in this anomaly. The incidence of this anomaly is approximately 7%, representing about 75% of the congenital masses of the neck. This cystic lesion is usually mobile and nontender in nature and usually presents with respiratory distress in infants. A lingual TDC is the rarest form of a TDC, and differs from a classical thyroglossal cyst totally in presentation and management. We present here a rare case of 2-month infant presenting with respiratory distress due to lingual TDC extending up to the suprathyroid region.

Radiologic Diagnosis of Nasal Gliomas with an Illustrative Case Report.

Nasal gliomas are congenital masses of dysplastic neuroglial and fibrovascular tissue. However, other congenital nasal masses, including encephaloceles, hemangiomas, and dermoid cysts make clinical diagnosis difficult. Radiological examination is imperative to accurate diagnosis of nasal gliomas. We hereby present the diagnostic imaging features of these lesions, which necessitate inclusion into the differential diagnosis of a congenital nasal mass.

Congenital Solitary Left Atrial Mass

Rhabdomyoma in the absence of tuberous sclerosis presenting as a large solitary atrial mass is an atypical finding. We hereby present images from an infant with a fetally diagnosed large left atrial mass with no evidence of mitral valve dysfunction who subsequently developed persistent arrhythmias requiring surgical resection of the mass in the neonatal period.

CT of pelviabdominal masses in pediatrics: Diagnostic algorithm

Abstract Background Pelviabdominal masses are common in children. It can be a leadig cause of considerable morbidity and mortality. Objective To review the different pelviabdominal masses and their diagnostic criteria using the multidetector CT scans in order to build an approach for diagnosis. Methods A retrospective study, conducted at Ain Shams University hospitals on children complaining of pelviabdominal masses, the patients were investigated using CT scans in the period between June 2018 till end of May 2019. Results pelviabdominal CT scan of 70 patients were reviewed. Their age ranged from 7 days to 18 years old, the mean was 8 years of age (SD ± 5.5). 31 male : 39 female. Abdominal masses of pediatrics were congenital ( 9 case), neoplastic ( 20 cases), inflammatory ( 23 casaes) and post traumatic in origin (3 cases). The most common congenital masses were PUJO, neoplastic were neuroblastomas, inflammatory were abscess. Diagnostic approach should start with determination of the organ of origin followed by determination of its morphology and pattern of contrast enhancement. The kidney was found to be the most common organ of origin in 25.7% of cases followed by the adenxa. Conclusion the organ of origin and morphology of the lesion are key imaging features that will help the radiologist reach a definitive diagnosis or deliver a possible differential diagnosis.

Cranium Bifidum and Meningocele in the Caudal Aspect of a Lamb Head

Meningocele is a congenital defect defined as a herniation of dura through the defect of cranial bone (cranium bifidum) with an accumulation of CSF in it. This anomaly has been described in calf, lamb, foal, piglet, dog, and cat. The etiology of meningocele is unknown but genetic and environmental factors may cause meningocele in lambs. A seven-day-old female Kurdish lamb with a congenital mass (8 cm in diameter) in the caudal part of its head was referred to the Veterinary Teaching Hospital of Urmia University. The lamb was lateral recumbent and the vital signs were in the normal range. Symptoms of pain and paddling were revealed while manipulating the mass. The fluid obtained from the mass was examined under a microscope and showed no signs of bacteria or inflammatory cells. Total serum protein was 8.9 g/dL and mean platelet volume (MPV) was 2.5 fl and other blood parameters were normal. In radiography, there was a bone defect in the skull and congenital cranium bifidum and meningocele were confirmed. The meningocele mass was removed with surgery and the skin was stitched. The clinical condition of the lamb did not improve after surgery. The lamb had died 5 days after surgery. This report presents the clinical findings and radiographs of cranium bifidum in a Kurdish lamb. The prognosis for surgical treatment is poor in cases where the animal has not been able to stand and suckle since birth.

Nasal overshoot: Probably a new entity

Background: Congenital masses of the nasal tip are extremely rare. Differential diagnoses include nasal-tip teratoma, nasal chondromesenchymal hamartoma (NCMH), and heterotopic nasal glioma. Herein, the case of a newborn is reported that does not match with any of these differential diagnoses. Case presentation: A newborn male presented with a congenital pedunculated mass arising from the nasal columella. The mass was symmetrically bilobed which is very unusual for any hamartomatous or neoplastic lesions. Histologically, it was composed of cartilage and ciliated epithelium. Conclusion: Based on the uniqueness of the case it is hypothesized that the lesion could be an embryological error of frontonasal process overshoot defying, hitherto unknown, controlling mechanism. More research is needed to know how the morphometric proportion of the human body is determined by Nature.

Vallecula-cyste: een zeldzame oorzaak van progressief toenemende inspiratoire stridor bij een neonaat

Vallecular cyst: a rare cause of progressive inspiratory stridor in a neonate The medical history of an infant with progressive inspiratory stridor caused by a vallecular cyst is presented. The cyst was diagnosed via a laryngoscopy and treated by means of an excision. The postoperative course was complicated by severe stridor induced by post-intubation edema. This report elaborates on the clinical presentation and work-up. The differential diagnosis of neonatal stridor is exhaustive. A congenital vallecular mass rarely causes it. These masses can manifest in various ways. Symptoms usually develop during the first week(s) of life. Key symptoms are upper airway obstruction and feeding difficulties. Life threatening situations are also possible. Given that the exact etiology of vallecular cysts remains unclear, different hypotheses were proposed. The differential diagnosis should include a dermoid cyst, a thyroglossal duct cyst, a teratoma, an hemangioma or lingual thyroid. The diagnosis usually requires a flexible and/or direct laryngoscopy. Radiographic imaging may also contribute to the work-up, adding information about the anatomical dimensions (for example with regard to the surrounding structures), the exact location, the magnitude, the content, etc. The definitive diagnosis is made through pathological evaluation. Different treatment options are proposed, preferably endoscopic excision or marsupialization.

Congenital Lobular Capillary Hemangioma in a 48 hours old neonate: a case report and a literature review

Abstract Objectives To report an unusual presentation of a Lobular Capillary Hemangioma in a 48 h old neonate to inform practitioners on the importance of proper identification of the lesion, differential diagnosis and management. Case presentation We report the case of a newborn female presenting with a pedunculated mass on the right hand, port-wine colored that quickly turned dark purple indicating thrombosis. The mass was surgically excised without complications and histopathology analysis reported a LCH. An abdominal and renal ultrasound was requested to rule out any underlying abnormalities. At follow-up, two months later, there is adequate healing and no related complications. Conclusions Lobular Capillary Hemangioma is a rare vascular malformation that occurs at an early age in the head and neck in most cases. We report an unusual case of a newborn female patient with a pedunculated lobular hemangioma on the right hand. Surgical treatment was performed with good cosmetic results. Our case is relevant as it raises awareness of the different diagnoses a congenital mass can be and that we, as physicians, should take into consideration when making a diagnosis and treatment.