Midline Neck Research Articles

Management of pediatric thyroglossal duct cyst: A case report

Introduction: Thyroglossal duct cysts are common congenital neck anomalies in children, diagnosed through clinical assessment and ultrasound, and treated with the Sistrunk procedure to prevent complications like infection and malignancy. Case Description: We present a case of a 4-year-old male patient with a progressively enlarging neck mass for three months. The mass was asymptomatic, did not cause any eating difficulties, and moved upwards during swallowing and tongue protrusion. Upon physical examination, a soft, mobile, cystic mass approximately 3 cm in diameter was identified beneath the hyoid bone. Supporting examinations, including ultrasound and fine-needle aspiration cytology, led to the diagnosis of a thyroglossal duct cyst. The patient underwent a successful Sistrunk procedure, which involved the excision of the cyst along with a portion of the hyoid bone. Postoperative management included administration of intravenous antibiotics and paracetamol, culminating in a full recovery without any signs of infection. The patient exhibited complete wound healing within two weeks. There was no evidence of cyst recurrence during a follow-up examination six months later. Conclusion: Despite being common, thyroglossal duct cysts require thorough evaluation to avoid misdiagnosis, and are typically identified by a slowly growing midline neck mass that moves with swallowing and tongue protrusion, often near the hyoid bone.

Papillary carcinoma arising from de novo ectopic thyroid tissue within thyroglossal duct cyst: A rare case report

The most common congenital anomaly of thyroglossal duct is a thyroglossal duct cyst, but carcinoma arising from a thyroglossal duct cyst is a rare phenomenon. Carcinomas involving thyroglossal duct cysts are mostly papillary carcinomas. Definitive diagnosis of carcinomas involving thyroglossal duct cysts is done through surgical excision and subsequent histopathological examination. Most carcinomas arise de novo from ectopic thyroid tissue within thyroglossal duct cysts, but the direct spread of papillary carcinomas arising from the thyroid gland can also present themselves as carcinomas involving thyroglossal duct cysts in a minority of patients. Clinical presentation in most of the patients with carcinoma of thyroglossal duct cyst is quite similar to that of the patients with histopathologically diagnosed thyroglossal duct cyst, i.e., a painless anterior midline neck swelling with cosmetic concern and no other significant symptom(s). Careful clinical examination, imaging techniques, fine needle aspiration cytology, etc., can be helpful in indicating the presence of carcinoma preoperatively. Management of patients with thyroglossal duct cyst carcinoma involves only the Sistrunk procedure in the majority of cases. However, in a minority of patients, management by Sis trunk procedure with additional total thyroidectomy (with or without dissection of lymph nodes of the neck) and adjuvant chemo and radio-ablation therapies are needed. Here, we report a case of a 17-year-old female with papillary carcinoma involving thyroglossal duct cyst who presented with a submental swelling and was eventually managed by Sis trunk procedure, total thyroidectomy, and adjuvant therapies for optical cure. Decisions for the management of her cancer were taken through multidisciplinary interactions at tumor board meetings and by judging her surgical and therapeutic needs based on her clinical, radiological, and pathological findings.

8141 A Rare Case of Follicular Adenoma with Osseous Metaplasia and Mature Bone Formation- Is Surveillance Important?

Abstract Disclosure: K. Madani: None. Y. Al-Khazraji: None. D.H. Sacoto: None. G.K. Rai: None. R. Belokovskaya: None. A.A. Franco-Akel, MD: None. Osseous metaplasia and mature bone formation (MBF) are common in malignant thyroid and parathyroid tumors. It is very unusual to have MBF in a benign tumor-like follicular adenoma, as in the case we describe. We found only twelve such cases reported in the literature, and none addressed the cancer risk or need for surveillance for the development of potential malignancy. Thus, further studies are required to investigate the need for surveillance in patients not undergoing excision and in those with remnant thyroid tissue post-removal of the adenoma for recurrence. A 43-year-old female with history of hyperlipidemia and hypothyroidism had an incidental finding of midline neck mass during the evaluation of a left upper extremity lipoma. Ultrasound of the neck showed two nodules in the Left (L) thyroid lobe: a complex nodule measured 2.2 x 1.2 x 2.1 cm and a calcified nodule measuring 1.5 x 0.8 x 0.6 cm. MRI of the neck revealed a 1.9 cm heterogeneously enhancing nodule in the mid to lower pole of the L thyroid lobe. The patient had symptoms suggestive of compression, such as dysphagia, odynophagia, and hoarseness; thus, left hemothyroidectomy was performed. Tissue biopsy was notable for follicular adenoma with osseous metaplasia and mature bone formation. The patient remained clinically and biochemically euthyroid, with only mildly elevated thyrotropin level, and treatment with levothyroxine 25 mcg once daily was initiated. On post-surgical follow-up, there was a lack of data to support close monitoring modality and strategy for the remnant thyroid lobe and neck nodal compartments. We concluded with the patient to follow up in a clinical visit for a physical exam of the neck and to obtain a follow-up sonogram at an interval of six months, in addition to monitoring TSH levels to guide hypothyroidism therapy. Osseous metaplasia has not been established as a premalignant condition, but in certain tissues like the esophagus, metaplasia is a risk factor for malignant conversion, for instance, in Barrett’s esophagus leading to esophageal adenocarcinoma. Moreover, MBF in thyroid tissue has been attributed to the activity of basic fibroblast growth factor (bFGF) and bone morphogenetic protein-2 (BMP-2), which are linked with mitogenesis and tumorigenesis. Thus, the question arises if post-excision surveillance is required in patients with a history of osseous metaplasia in remnant thyroid tissue post-lobectomy or partial thyroidectomy. At this point, more epidemiological data on similar cases may help us understand the true risk of this clinical scenario, in order to develop a reasonable approach for surveillance. Presentation: 6/3/2024

7355 A Case of High-Risk Thyroid Tumor Markers Found in Subcutaneous Thyroid Implants in a Patient with Benign Thyroid Pathology

Abstract Disclosure: J. Fedorko: None. S. Fatima: None. A.P. Amblee: None. C.A. Poku: None. Background: While fine needle aspiration (FNA) remains the primary diagnostic tool for thyroid malignancies, the utilization of molecular markers has become increasingly common in the workup of thyroid nodules. They play a useful role in distinguishing between malignant and benign pathology when cytology is indeterminate and in formulating treatment plans. The vast majority of research for these genetic markers is conducted in cases with thyroid malignancy. However, there have been numerous cases where these genetic markers were identified in benign thyroid tissue. Case: A 73-year-old male with left hemithyroidectomy (benign left nodule) presented 6 years later with new superficial neck nodules along the midline, left thyroid bed and R thyroid lobe. FNA of the right thyroid nodule was benign. Three months later the patient underwent an excision of the midline neck nodules which revealed thyroid tissue arranged in nests of fibrotic tissue without definite features of papillary thyroid carcinoma. Molecular analysis (Thyroseq) was positive for HRAS, E1F1AX and TERT mutations thus metastatic follicular carcinoma was suspected. The patient underwent complete thyroidectomy. Pathology revealed normal thyroid tissue and a diagnosis of thyroid neck implants was made. Given the benign pathology, the plan was for close follow-up with neck imaging every 6 months. Discussion: Thyroid tissue implants can rarely be caused by previous surgical interventions, especially partial thyroidectomy. There is literature documenting similar clinical cases in which subcutaneous thyroid implants are found in patients after undergoing total or subtotal thyroidectomy. In one case series, there were cases in which thyroid implants were discovered 26 years post-surgery, with most of the cases reporting benign pathology. Given our patient’s presentation and clinical history, the possibility remains that his subcutaneous tissue findings were caused by his prior partial thyroidectomy. A recent article reviewed 60 publications and >8000 patients for the prevalence of high-risk tumor markers (RAS mutation, RET/PTC, and PAX8/PPAR-gamma chromosomal rearrangements) in benign thyroid tissue. They concluded that prevalence findings were highly variable, warning providers to exercise caution when using these genetic markers to guide diagnosis and treatment decisions. Conclusion: While certain high-risk genetic tumor markers are increasingly used to help identify thyroid malignancies, it is important to keep in mind that these genetic markers are not exclusively found in cancerous tissue, and should not be used as the sole diagnostic tool for diagnosis and treatment. While it is imperative that metastatic disease is ruled out, it is essential to consider other pathologies when evaluating recurrent thyroid and neck masses in patients with a history of benign thyroid lesions. Presentation: 6/3/2024

7817 A Rare Case of Intrathyroidal Thyroglossal Duct Cyst Presenting as a Rapidly Expanding Left Thyroid Goiter

Abstract Disclosure: C.M. Godar: None. A.J. Spiro: None. K.F. Brown: None. M.K. Shakir: None. T.D. Hoang: None. Introduction: Thyroglossal duct cysts are the most common congenital cyst in the head and neck, found during childhood as a midline neck mass. We present a rare case of a large intrathyroidal thyroglossal duct cyst with left lateral extension in an adult patient. Case Report: A 50-year-old man with family history of familial adenomatous polyposis presented for thyroid nodule evaluation. Thyroid ultrasound for screening of thyroid cancer showed a 4.8 x 4.5 x 2.5cm mixed cystic/solid hyperechoic thyroid nodule with smooth margins in the left lower thyroid lobe. He reported no compressive symptoms. FNA with standard 27G needle was insufficient for evaluation with Bethesda I result. Attempted syringe aspiration did not produce cystic fluid for analysis. The patient returned to clinic 8 weeks later due to visible enlargement of his anterior neck and new neck pressure with swallowing. Physical exam was significant for a new, firm palpable mass over the left thyroid isthmus. Bedside ultrasound noted expansion of the previously visualized mass now extending into the thyroid isthmus. FNA was reattempted with a 25G needle, and cytologic material was again inadequate. He elected to undergo left hemithyroidectomy. Histologic sections demonstrated a 3.4cm simple squamous, non-keratinizing cyst lining overlying a thickened fibrotic wall with mixed acute and chronic inflammation surrounded by benign thyroid tissue, consistent with an intrathyroidal thyroglossal duct cyst. Discussion: The thyroglossal duct derives from epithelial tissue during embryogenesis and atrophies during weeks 8-10 of gestation. A persistent duct may lead to cyst formation in the presence of remnant epithelial tissue secretions and local neck inflammation. A thyroglossal duct cyst is usually located midline in the anterior neck. This stands in comparison to a branchial cleft cyst, which arises due to failure of atrophy of the second branchial groove during embryogenesis and forms a cyst that is usually located in the upper lateral neck compartment. Other common neck masses include lipomas, dermoid cysts, or ectopic thyroid tissue. This case highlights the rarity of intrathyroidal thyroglossal duct cyst in an adult patient and the importance of definitive diagnosis and appropriate management. Presentation: 6/2/2024

The sensitivity and specificity of fine needle aspiration cytology in detecting thyroid malignancy according to Bethesda system at a teaching hospital in Saudi Arabia

ABSTRACT Background: The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) aims to standardize the terminology and morphologic criteria associated with thyroid fine-needle aspiration cytology (FNAC) results while also providing corresponding risk assessments for malignancy. contributing to more consistent and standardized reporting of thyroid nodules and aiding clinicians in making informed decisions. Since then, it has been undergoing revisions and updates to further improve its utility and accuracy. Materials and Methods: This is a retrospective study conducted at a tertiary care center. All patients with a history of thyroid gland swelling who had previously undergone FNA were included. The procedure included cytopathologists performing FNAC for all cases of midline neck swelling. Demographic and histopathology data were correlated with the cytological diagnosis. Results: We included 288 cases. Of those, 234 (81.3%) were female and 54 (18.8%) were male. The presentation age range was 18–91 years. The most reported category was benign, which constituted 30.9% of the cases followed by malignancy (27.1%). As for thyroid lesions, papillary carcinoma was the most prevalent (43.6%). The correlation on cyto-histopathology was presented in every diagnostic category, showing high heterogeneity in diagnostic specificity and sensitivity. The overall diagnostic specificity and sensitivity were 56.05% (95% confidence interval [CI]: 47.92–63.95%) and 80.92% (95% CI: 73.13–87.25%), respectively. Positive and negative predictive values were 60.57% and 77.88%, respectively. Conclusion: Our data suggests that the TBSRTC system promotes similar sensitivity and specificity to those reported elsewhere. It standardizes reporting and improves communication between cytopathologists and clinicians.

Angiomyomatous hamartoma: Unusual presentation of a rare entity

Angiomyomatous hamartoma (AMH) is a rare benign vascular growth primarily affecting inguinal and femoral lymph nodes (LNs). Here, we present a unique case of AMH manifesting as a submental neck mass, a location seldom reported in literature. A 20-year-old male presented with a palpable midline neck mass adjacent to the hyoid bone. Ultrasonography suggested a partially cystic lesion, prompting consideration of thyroglossal duct cyst or necrotic lymph node. Fine-needle aspiration (FNA) hinted at a benign cystic lesion, potentially a thyroglossal duct cyst. Surgical excision via the Sistrunk approach revealed no cyst but characteristic features of AMH upon histopathological examination. This case underscores the importance of considering AMH in the differential diagnosis of subcutaneous nodules in unusual locations and highlights the role of surgical excision for both diagnosis and treatment. Our findings expand the understanding of AMH's clinical presentation and emphasize the necessity of a comprehensive differential diagnosis approach for nodal lesions.

PECARN prediction rule for cervical spine imaging of children presenting to the emergency department with blunt trauma: a multicentre prospective observational study.

Cervical spine injuries in children are uncommon but potentially devastating; however, indiscriminate neck imaging after trauma unnecessarily exposes children to ionising radiation. The aim of this study was to derive and validate a paediatric clinical prediction rule that can be incorporated into an algorithm to guide radiographic screening for cervical spine injury among children in the emergency department. In this prospective observational cohort study, we screened children aged 0-17 years presenting with known or suspected blunt trauma at 18 specialised children's emergency departments in hospitals in the USA affiliated with the Pediatric Emergency Care Applied Research Network (PECARN). Injured children were eligible for enrolment into derivation or validation cohorts by fulfilling one of the following criteria: transported from the scene of injury to the emergency department by emergency medical services; evaluated by a trauma team; and undergone neck imaging for concern for cervical spine injury either at or before arriving at the PECARN-affiliated emergency department. Children presenting with solely penetrating trauma were excluded. Before viewing an enrolled child's neck imaging results, the attending emergency department clinician completed a clinical examination and prospectively documented cervical spine injury risk factors in an electronic questionnaire. Cervical spine injuries were determined by imaging reports and telephone follow-up with guardians within 21-28 days of the emergency room encounter, and cervical spine injury was confirmed by a paediatric neurosurgeon. Factors associated with a high risk of cervical spine injury (>10%) were identified by bivariable Poisson regression with robust error estimates, and factors associated with non-negligible risk were identified by classification and regression tree (CART) analysis. Variables were combined in the cervical spine injury prediction rule. The primary outcome of interest was cervical spine injury within 28 days of initial trauma warranting inpatient observation or surgical intervention. Rule performance measures were calculated for both derivation and validation cohorts. A clinical care algorithm for determining which risk factors warrant radiographic screening for cervical spine injury after blunt trauma was applied to the study population to estimate the potential effect on reducing CT and x-ray use in the paediatric emergency department. This study is registered with ClinicalTrials.gov, NCT05049330. Nine emergency departments participated in the derivation cohort, and nine participated in the validation cohort. In total, 22 430 children presenting with known or suspected blunt trauma were enrolled (11 857 children in the derivation cohort; 10 573 in the validation cohort). 433 (1·9%) of the total population had confirmed cervical spine injuries. The following factors were associated with a high risk of cervical spine injury: altered mental status (Glasgow Coma Scale [GCS] score of 3-8 or unresponsive on the Alert, Verbal, Pain, Unresponsive scale [AVPU] of consciousness); abnormal airway, breathing, or circulation findings; and focal neurological deficits including paresthesia, numbness, or weakness. Of 928 in the derivation cohort presenting with at least one of these risk factors, 118 (12·7%) had cervical spine injury (risk ratio 8·9 [95% CI 7·1-11·2]). The following factors were associated with non-negligible risk of cervical spine injury by CART analysis: neck pain; altered mental status (GCS score of 9-14; verbal or pain on the AVPU; or other signs of altered mental status); substantial head injury; substantial torso injury; and midline neck tenderness. The high-risk and CART-derived factors combined and applied to the validation cohort performed with 94·3% (95% CI 90·7-97·9) sensitivity, 60·4% (59·4-61·3) specificity, and 99·9% (99·8-100·0) negative predictive value. Had the algorithm been applied to all participants to guide the use of imaging, we estimated the number of children having CT might have decreased from 3856 (17·2%) to 1549 (6·9%) of 22 430 children without increasing the number of children getting plain x-rays. Incorporated into a clinical algorithm, the cervical spine injury prediction rule showed strong potential for aiding clinicians in determining which children arriving in the emergency department after blunt trauma should undergo radiographic neck imaging for potential cervical spine injury. Implementation of the clinical algorithm could decrease use of unnecessary radiographic testing in the emergency department and eliminate high-risk radiation exposure. Future work should validate the prediction rule and care algorithm in more general settings such as community emergency departments. The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Health Resources and Services Administration of the US Department of Health and Human Services in the Maternal and Child Health Bureau under the Emergency Medical Services for Children programme.

Surgical management of a midline submental neck mass in Zimbabwe: A case report

Introduction: Differential diagnoses of a pediatric neck mass are extensive, ranging across benign, malignant, congenital and infectious causes. Limited access to imaging in low-resource settings increases the complexity of narrowing this list to appropriately diagnose and treat neck masses. This occasionally allows neck masses to grow unchecked, increasing the morbidity of their presence and eventual excision. The goal of this report is to describe nuances in the diagnosis and treatment of pediatric neck masses in resource-limited settings through a case report of a neck mass in a pediatric patient.Patient presentation: A 10-year-old girl in Harare, Zimbabwe, presented for surgical management of a midline neck mass that appeared 4 years prior to presentation for definitive treatment. A myriad of barriers delayed her care, allowing the mass to grow into her floor of mouth, displacing her tongue and leading to speech and feeding difficulties.Management and outcome: At presentation to the tertiary care facility, she received a pre-operative ultrasound showing a well-circumscribed, echogenic mass. Her neck mass was surgically excised through a transoral approach. Permanent pathology was consistent with a dermoid cyst.Conclusion: At 1-month postoperative follow-up, the patient had experienced no complications and had a complete resolution of her functional symptoms and appearance.Contribution: We present a case that can illuminate the utility of ultrasound in the diagnosis of pediatric neck masses. Additionally, we facilitate an important discussion on transoral versus transcervical approach for midline neck masses with the decision hinging on size, location, surgeon preference and comfort and consideration of cosmesis.

Exploring cytologic features and potential diagnostic challenges of metastatic NUT carcinoma to the parotid gland: A case report and a comprehensive literature review.

NUT carcinoma (NC) is a highly aggressive, poorly differentiated carcinoma that harbors a t(15:19) translocation, leading to the fusion of the NUTM1 gene. While the upper aerodigestive tract along the midline (head, neck, thorax, and mediastinum) is commonly reported as the primary site of NC, subsequent cases have emerged in diverse locations. Achieving a definitive diagnosis based solely on morphology is challenging; however, it can be achieved using immunohistochemistry (IHC) specific to the NUT antibody or by demonstrating the characteristic BRD4::NUTM1 fusion. Accurate and timely diagnosis can potentially inform patient management and guide treatment. While histologic documentation of NC is commonly found, there is a limited description of its cytologic features. A 39-year-old male with a history of sinonasal squamous cell carcinoma (SCC) presented with a right parotid mass aspirated via fine needle aspiration cytology (FNA). Histologic examination of the previous sinonasal pathology reviewed at our institution revealed sheets of primitive-appearing, monotonous, undifferentiated cells with distinct, prominent nucleoli. Additionally, there were foci of abrupt keratinization, accompanied by a notable neutrophilic infiltrate. The initial diagnosis of SCC was reclassified to NC and confirmed through NUT IHC and molecular testing. Although the parotid FNA initially suggested the possibility of a variety of small round blue cell tumors, it exhibited morphological similarities to the sinonasal tumor, leading to the diagnosis of metastatic NC. Cytomorphologic features of NC are limited and can overlap with various small round blue cell tumors. Correct classification is especially pivotal in the era of targeted therapy, considering the ongoing development and evaluation of BET inhibitors targeting BRD4.

Rhabdomyomatous Mesenchymal Hamartoma: Report of 4 Cases With Histochemical and Immunohistochemical Findings and Emphasis on Potential Pitfalls.

Rhabdomyomatous mesenchymal hamartoma (RMH) typically presents as a congenital midline head and neck cutaneous polyp in infants. Perianal and mucocutaneous lesions have been reported, and recently, acquired adult-onset variants have been proposed. This makes the true prevalence, etiopathogenesis, and clinicopathologic distribution and classification of RMHs in children compared with those in adults uncertain. We performed a retrospective review to highlight the salient histopathologic, histochemical, and immunohistochemical features in RMHs and to emphasize their specific clinicopathologic criteria to avoid diagnostic pitfalls. We found 4 (0.3%) infants [2 female infants and 2 male infants, average age: 4 months] with mental, nasal, lingual, and perianal midline RMHs (average size: 1.0 cm) of 1303 patients with cutaneous polypoid lesions. Three were isolated, and 1 was associated with Goldenhar syndrome. The cutaneous polyps demonstrated intermixed skeletal muscle, adipose, and fibrocollagenous core stroma that extended into the dermis and around the dermal appendages. The lingual lesion demonstrated skeletal muscle and fibrocollagenous stroma with prominent nerve bundles and little adipose tissue. All showed interstitial loose mesenchyme. Masson trichome demarcated the triphasic stromal components. Alcian blue demonstrated the loose myxoid mesenchyme. Elastic van Gieson did not show elastic fibers. Desmin demonstrated the skeletal muscle bundles, S100 highlighted the adipose tissue lobules and the nerve bundles, and CD34 displayed the mesenchymal stroma. Ki67 showed a low proliferation index in the loose mesenchyme. Smooth muscle actin did not reveal smooth muscle bundles, but with CD31, they highlighted the thick blood vessels. CD117 revealed prominent mast cells. From our retrospective review series, 4 cases that originally diagnosed as RMHs were excluded. Likewise, we found some examples of the reported cases in the English literature that might have been mistaken for RMHs. This is because they did not fulfill the diagnostic clinicopathologic criteria. RMH constitutes a rare entity with specific clinicopathologic features. Most lesions are isolated. Some are associated with congenital anomalies and syndromes. Strict clinicopathologic diagnostic criteria should be applied to avoid mislabeling look-alike lesions for RMHs.

Incidental finding of thyroglossal duct cyst in a neonate during endotracheal intubation: a case report

BackgroundThyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient.Case presentationa 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk’s procedure to avoid future complications and anesthesia.Conclusionseven if TDC is a common lesion of pediatric patients, anecdotical neonatal cases were described in the literature, all of them symptomatic. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk’s procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.

Diagnostic Dilemma of Midline Neck Swelling in an Elderly Patient – Case Report

Diagnostic Dilemma of Midline Neck Swelling in an Elderly Patient – Case Report

An Unexpected Midline Neck Swelling in a Young Female.

An Unexpected Midline Neck Swelling in a Young Female.

Rare Cause of a Midline Neck Swelling—Congenital Thyroid Teratoma in a 14-month-old Boy: A Case Report and Review of Literature

Rare Cause of a Midline Neck Swelling—Congenital Thyroid Teratoma in a 14-month-old Boy: A Case Report and Review of Literature

The Outcome of Surgical Removal of Thyroglossal Cyst in Children; Experience of a Decade

Objective: To present postoperative outcome of surgical removal of thyroglossal cyst (TC) in children; single surgeon’s experience of a decade. Methodology: This is a retrospective study of 10 children admitted at Northern Area Armed Forces Hospital, Hafer Al Batin, Saudi Arabia, with the diagnosis of TC between period of June 2011 to October 2021. All the patients were managed by single surgeon by surgical removal with an average follow up of 5 years. There were six males and six females. The diagnosis was confirmed on clinical examination and supported by ultrasound evaluation of upper neck midline swelling. Surgical excision was done by Sistrunk procedure under general anesthesia. The outcome of surgical treatment of thyroglossal cyst is evaluated post operatively during an average regular follow up of 5 years. Results: All the 10 children were operated by Sistrunk procedure during the period from June 2011 to October 2021 who were admitted with diagnosis of thyroglossal cyst. There were no associated anomalies. All the patients had excellent cosmetic outcome without any problem of wound infection. There is no recurrence of thyroglossal cyst in this series. Conclusion: Sistrunk surgical procedure to treat thyroglossal cyst in children is safe, effective and feasible with good cosmetic results. It avoids recurrence of thyroglossal cyst and morbidity. We recommend Sistrunk operation as gold standard to treat children with TC.

Papillary carcinoma arising in a throglosal cyst with no associated thyroid lesion: An unusual case

ABSTRACT Introduction: Thyroglossal cyst is the most common development anomaly of thyroid gland as well as it represents the most common congenital neck mass. Thyroglossal duct associated malignancy is very rare, and majority is papillary carcinoma. Case: A 21-year-old female presented with a painless midline neck swelling. There are no complaints of difficulty in swallowing, breathing, or voice changes. Ultrasonography revealed a multiloculated cystic lesion in midline neck region. The patient underwent Sistrunk procedure. Histopathology revealed foci of papillary carcinoma in association with thyroglossal duct cyst. Discussion: Thyroglossal duct cyst remains the most common anomaly of thyroid development. It is also the most common congenital neck swelling. The malignancy associated with thyroglossal duct cyst is very rare. Suspicion of malignancy may arise when the cyst appears irregular, hard, and fixed. Conclusion: In our case, the presence of papillary structures in thyroglossal duct support the diagnosis of papillary carcinoma arising from thyroglossal duct rather than a secondary tumor or metastasis from other organs such as thyroid gland. A diagnosis of papillary carcinoma in a thyroglossal duct cyst requires comprehensive surgical management and vigilant follow-up.

Thyroglossal cyst – A retrospective analysis in a tertiary care center

Background: Thyroglossal duct cyst (TGDC), one of the most common congenital neck lesions, is due to the persistence and dilatation of remnants of an epithelial tract, formed during migration of the thyroid in embryogenesis. Aims and Objectives: The objective was to study the location of TGDC in different age and sex groups and variations in presentation. Materials and Methods: A retrospective study was carried out in the Department of ENT at Assam Medical College and Hospital, Dibrugarh from July 2018 to June 2023. The diagnosis was made on the basis of fine-needle aspiration cytology and ultrasonography. Results: A total of 25 cases were analyzed. Majority of them belonged to the age group of 11–20 years. Male: female ratio was 2:3. Nearly 100% of cases had a chief complaint of midline neck swelling that moves with protrusion of the tongue. Most common site of occurrence is the infrahyoid region. Nearly 80% of cases underwent Sistrunk operation. Conclusion: Thyroglossal cyst with its varied presentation is notorious for recurrence. Proper evaluation and excision are the keys toward successful outcomes.

A Case of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma Mimicking Hashimoto’s Thyroiditis

Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma (DSV-PTC) is a rare and aggressive subtype of Papillary Thyroid Carcinoma (PTC) The prognosis of this variant is as good as classic PTC, but close follow-up is necessary because of frequent tumour recurrence. The authors report a case of a 30-year-old female who presented with a 6-month history of gradually progressive midline neck swelling. Antithyroid antibodies were elevated, and radiology was suggestive of a colloid goitre. Total thyroidectomy was done along with anterior compartment lymph node removal for confirmation. Interestingly, histopathology showed a picture reminiscent of Hashimoto’s Thyroiditis (HT), but the lymph node showed tumour metastasis. Thereafter, additional sections were taken to establish the diagnosis of DSV-PTC in the thyroid. The present case highlights the importance of extensive sampling in histopathology for a suspected case of malignancy, as it can be misdiagnosed as a benign aetiology.

What is the annual risk of infection in congenital midline neck cysts in children? Thyroglossal duct cysts versus dermoid cysts

IntroductionMidline neck lumps in children are mostly found to be thyroglossal duct cysts or dermoid cysts. Thyroglossal duct cysts often have an associated sinus tract which may connect all the way to the foramen caecum on the tongue, while dermoids have no such connection. This study aims to estimate the annual infection risk for midline neck cysts based on our patient series, and to see if this differs between thyroglossal duct cysts and dermoid cysts. MethodsAll children seen at the Royal Hospital for Children, Glasgow who underwent surgical excision of a midline neck cyst between 1st January 2017 and 31st December 2021 were identified. In those whose cyst had been infected prior to surgical excision, the age at which the first episode of infection occurred was recorded and used to calculate a survival curve. ResultsWe identified 53 children (29 male, 24 female) aged 1–16 years (median 4) at the time of surgical excision. There were 26 thyroglossal and 24 dermoid cysts, plus 2 with indeterminate histology and 1 lymph node. Of the 24 dermoids, 4 suffered infection prior to surgery (17%), and 2 of these recurred after surgery (8%). Of the 26 thyroglossal cysts, 16 suffered infection prior to surgery (62%) and 5 of these recurred (19%). 78% of thyroglossal and dermoid cysts had at least 1 episode of infection by age 10 years. DiscussionIn a child with a congenital midline neck cyst that has never been infected, deferring surgery for a year comes with a 7.8% risk that the cyst will get infected.