Thyroglossal Cyst Research Articles

Clinical Characteristics and Prognosis of Infants and Children

Thyroglossal duct cysts (TGDCs) are congenital and developmental abnormalities in infants and young children. This retrospective case series study examined the characteristics of 7 patients <3 years (mean age, 1.9 years) with TGDC complicated with a parapharyngeal mass treated at one hospital between January 2019 and 2022. Four patients had a painless mass around the neck, 2 had a painless mass associated with snoring, and 1 presented repeated swelling and pain. B-ultrasound suggested 6 cases of TGDC and 1 possible lymphangioma. All patients were treated with Sistrunk surgery to remove the TGDC. Six patients had no cyst recurrence during follow-up (6 months to 2 years). In conclusion, TGDC complicated with a parapharyngeal mass has complex and variable clinical manifestations. Completely removing the cyst while sparing thyroid cartilage and surrounding vascular and neuroanatomical structures is important to avoid complications. The patients are likely to be free from recurrence after surgery.

Male with Graves Disease and Primary Thyroid Cancer in the Thyroglossal Cyst

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Benign and Malignant Thyroglossal Duct Cyst Remnants: Systematic Review and Case Series of 1842 Surgical Cases

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

AB175. SOH23ABS_026. An unusual case of thyroglossal duct cyst carcinoma presenting in the sublingual space, and its multidisciplinary management

Background: Thyroglossal duct cysts (TGDCs) are the most common congenital anomaly of thyroid gland development, with a <1% risk of malignancy occurring within them. It's rare for a TGDC to be located in floor of the mouth region or the sublingual space since both these areas are not part of the typical embryological migration route of the thyroid gland.

Histopathologic profile of cutaneous cystic lesions in teaching hospital, Nnewi, South-east, Nigeria

Background A cyst is an enclosed space or abnormal sac within a tissue, usually containing fluid or semisolid matter and lined by epithelium. Aims and objectives To study all the cutaneous cystic lesions with respect to age, sex, anatomic site, and histologic types in a population of Nnewi, South-East Nigerian. It also aimed at highlighting the importance of histology in evaluating and preventing misdiagnoses encountered in cutaneous cystic lesions. Patients and methods A retrospective review was performed on the histopathology register on all histologically diagnosed cutaneous cysts at the Histopathology Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria from 2011 to 2019. Results A total of 94 cutaneous cystic lesions, accounting for 1.3% (94/7204) of all surgical biopsy specimens, were included in this study. An overall clinicopathological correlation showed 26.6% (25/94) accuracy, but 73.4% were incorrectly diagnosed, with 7.4% (5/69) of cases misdiagnosed clinically as malignant lesions and one case of malignant cystic lesion diagnosed clinically as benign cyst. There were 49 males and 45 females, giving a slight male predominance, with male to female ratio of 1.1 : 1. The age ranged from 6 weeks to 79 years, with a mean±SD age of 26.5±21.1 years, and a peak age group of 0–10 years, representing 29.8% (28/94). Benign cutaneous cystic lesions were far commoner than malignant ones and included majorly epidermal inclusion cyst [37.2% (35/94)], pilar cyst [17.0% (16/94)], thyroglossal cyst [12.8% (12/94)], and dermoid cyst [8.5% (8/94)]. The only malignant cutaneous cyst was immature cystic teratoma [1.06% (1/94)]. The anatomic site most frequently affected was the head and neck [63.8% (60/94)]. Conclusion Histopathologic evaluation is still the gold standard in eliminating misdiagnosis of these lesions. Epidermal inclusion cysts followed by pilar cysts were commonest cutaneous cystic lesions in our environment and occur more at the third decade and above, whereas cystic hygroma, dermoid cysts, and brachial cyst were predominant at the first decade of life.

Avascular midline oropharyngeal anatomy allows for expanded indications for transoral robotic surgery in pediatric patients.

Transoral robotic surgery (TORS) in children is in its infancy, and indications have been primarily limited to lingual tonsillar hypertrophy and superficial mucosal lesions. However, the relatively avascular channel of the midline posterior tongue, vallecula, and posterior hyoid space provides a safe plane of dissection for deep lesions of the tongue and access to structures in the anterior neck. As robotic surgeons gain experience, application of this technology will continue to grow. The method is retrospective case series. We present seven patients who had either a primary (n = 3) or recurrent (n = 4) lingual thyroglossal duct cyst (TGDC) and underwent TORS excision. Four of the seven patients also underwent transoral resection of the central portion of the hyoid bone, while three had central hyoid resection during prior surgery. Two minor complications occurred with no evidence of lesion recurrence after mean follow-up of 19.7 mo. The midline avascular channel of the tongue allows for relatively bloodless surgical access to pathologies of the midline base of tongue and anterior neck. Lingual thyroglossal duct cysts can safely be removed via aTORS approach with evidence of limited recurrence. Robotic technology can provide safe and effective surgical alternatives for children with a variety of pathologies, and we aim to promote the widespread adoption of TORS in pediatric head and neck surgery by sharing our knowledge and clinical experience. Further study and publication are needed to establish safety and efficacy.

Transoral Robotic Excision of Paediatric Lingual Thyroglossal Duct Cyst.

Lingual thyroglossal duct cyst (TGDC) is a rare variant of TGDC that emerges within the tongue base. It presents a unique surgical challenge. There are different approaches to managing this condition. Transoral robotic surgery (TORS) has been successfully used for lesions of the tongue base in adults. This report presents a 7year old boy with a cystic lesion in the base of tongue, which was diagnosed to be a lingual TGDC. The cyst was excised transorally using Da Vinci Robotic system. The surgery was performed in a short operating time with no complications or recurrence on follow up. TORS is an effective and reliable method of excision of lingual TGDC in the paediatric population. Lingual TGDC can be managed by simple excision of the cyst without excision of hyoid bone. Further studies are needed to confirm the safety and recurrence rates of this technique in paediatric population.

Bronchogenic cyst: a diagnostic challenge as cervical swelling

Introduction: Bronchogenic cyst is a developmental anomaly of primitive foregut, usually diagnosed at birth or soon after. Commonly seen as intrapulmonary and mediastinal pathology, it is also reported at other sites, including neck, as a subcutaneous swelling. It seldom produces symptom unless it keeps growing due to persistent secretion and produces compressive symptoms. Abscess formation, discharging sinus or malignant transformation may occur rarely. Case report: A 26 years old male presented with a midline suprasternal swelling. Clinical examination revealed a 6x4cm size soft, mobile, nontender, cystic swelling which did not move upward on deglutition or on protrusion of tongue. Radiological evaluation of neck confirmed a cystic lesion in subcutaneous plane. Differential diagnosis of Thyroglossal cyst, dermoid cyst, branchial cyst, bronchogenic cyst, and Trichilemmal cyst were considered. Histological examination following excision confirmed the diagnosis of Bronchogenic cyst. Discussion: Surgery is the treatment of choice in cases of cervical cystic swellings which merit a wide range of differential diagnosis. Diagnosis of Bronchogenic cyst is confirmed by typical respiratory epithelial lining with interspersed goblet cells and smooth muscle fibres in the cyst lining.

Diagnostic accuracy of ultrasonography to distinguish thyroglossal duct cysts from dermoid cysts in children with a midline neck swelling

IntroductionMidline neck swellings are very common in children and mostly caused by thyroglossal duct cysts (TGDCs) or dermoid cysts (DCs). Since DCs can undergo simple excision, whilst TGDCs demand more thorough resection via Sistrunk procedure, it is important to differentiate between both pre-operatively. Previous studies have suggested an ultrasound-score (SIST) based on presence of septae, wall irregularity and solid components could do so. This study aims to evaluate the diagnostic accuracy of this score. MethodsAll patients (≤18 years) undergoing surgery between 2006 and 2018 for a midline neck mass at our tertiary centre with a histopathological diagnosis of TGDC or DC were retrospectively included. The pre-operative ultrasound was evaluated by an experienced radiologist and the SIST as well as location, tract, echogenicity, margin and multilocularity were scored. ResultsWe included 97 children, of whom 67 (69 %) with TGDCs. The SIST showed a sensitivity of 37 %, specificity of 97 %, a positive predictive value of 96 % and a negative predictive value of 35 % for the SIST-score in detecting TGDCs, which resulted in an AUC of 0.67. In addition, internal echogenicity (P < 0.01) and margin definition (P < 0.01) were significantly associated to TGDC diagnosis whilst location and multilocularity were deemed insignificant following Bonferroni correction. ConclusionWe conclude that the SIST-score seems very capable to rule in TGDC. However, the SIST-score is far from making a clear distinction between DC and TGDCs preoperatively. The addition of other ultrasound variables, such as margin definition and echogenicity, might increase the diagnostic accuracy and demands further research.

THYROGLOSSAL DUCT CYSTS SURGERY OUTCOMES

Objective Thyroglossal duct cysts are the most common congenital neck mass in the midline of the neck. Cystic formations develop due to the partial or complete lack of obliteration of the thyroglossal duct. It may lead to transformation to malignancy, although rarely. Our study aims to discuss the outcomes, examination findings, clinical features, and treatment methods of 51 patients operated on for thyroglossal duct cysts to contribute to the literature. Methods The 51 cases that underwent surgery (Sistrunk, Cystectomy, Thyroidectomy) with a preliminary diagnosis of thyroglossal duct cyst in ENT and HNS clinics were evaluated retrospectively. The patient's sociodemographic data, main complaints, examination findings, diagnostic methods, surgical techniques, recurrence and complication rates after treatment, and pathology results were analyzed in this study. Results Of the 51 patients, 35 (69%) were adults, and 16 (31%) were children. The most common reason 40 (78%) for admission was swelling in the midline of the neck, less commonly 8 (16%) swelling under the chin, 4 (8%) of patients with an average follow-up of 28 months (max 32; min 8; SD 3 months) were performed revision operations. Surgical treatment has consisted of the Sistrunk procedure (n = 47; 92%), cystectomy (n = 4; 8%), or thyroidectomy (n = 1; 2%). Papillary thyroid carcinoma was diagnosed in 2 (4%) patients, and medullary thyroid carcinoma was in 1 (2%) in our cases. They were no significant differences in gender and age, sociodemographics data. Conclusion Thyroglossal duct cysts should be considered in the differential diagnosis of patients presenting with swelling in the midline of the neck. Sistrunk operation, a safe surgical procedure with the least recurrence rate and a low risk of complications, is recommended as surgical treatment. Keywords: Thyroglossal duct cyst, Midline neck mass, Sistrunk operation

Primary thyroglossal duct cyst surgery: A UK tertiary referral paediatric centre experience.

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Papillary carcinoma affecting a lateral thyroglossal cyst duct and thyroid: a case report

Thyroglossal duct cyst is the most common congenital benign cervical lesion in the population; the presence of thyroglossal duct cyst carcinoma is very rare; added to this, its association with papillary thyroid carcinoma is even more rare. Treatment is usually surgical and associated with a partial or total thyroidectomy according to each case.

Predictors of residual disease following pediatric thyroglossal duct cyst excision

ObjectivesResidual thyroglossal duct cyst (TGDC) following surgical excision is not uncommon. This study aimed to search for risk factors for residual disease that either required revision surgery or were resolved with only conservative treatment and follow up. MethodsA retrospective study of consecutive children who underwent surgical excision for thyroglossal duct cysts between 2008 and 2021 at Schneider Children's Medical Center of Israel, a tertiary referral center in Israel. ResultsOut of 102 children, 54 (53 %) had an uneventful recovery, 32 (31 %) had post-operative complications which were managed without revision surgery, and 16 (16 %) underwent revision surgery. A comparison of the three groups showed that children who had early post-operative complications (up to one month) were more likely to respond to conservative treatment (57 %). In contrast children with late complications had a higher probability (59 %) of undergoing revision surgery. The presence of a pre-operative cutaneous fistula was significantly associated with revision surgery (p = 0.012). In addition, children with no prior history of neck infection were more likely to have an uneventful recovery (p = 0.005). ConclusionsTGDC disease has a wide range of clinical presentations both before and after surgery. A significant percentage of children with persistent post-operative symptoms may resolve without revision surgery. The presence of a pre-operative cutaneous fistula and late post-operative complications are the main risk factors for revision surgery.

Thyroglossal Duct Cyst Carcinoma: Lessons from a 20-Case Series.

Thyroglossal duct cyst (TDC) is a common congenital cyst with an incidence of about 7%. Thyroglossal duct cyst carcinoma (TDCC) is a rare sequel which arises from TDC and has an incidence of about 1%. As these are rare, they do not have well-defined management guidelines. The aim of this study was to analyse the clinical profile and pathological characteristics of patients with thyroglossal duct cyst carcinoma and to propose a protocol for their treatment and follow-up. A retrospective study was done from January 2000 to December 2019. All the clinical details, imaging characteristics, treatment and histopathology were analysed. The mean age group in our study was 37.9years with a female preponderance. The clinical features like rapid increase in size, fixity of the lump and lymph node metastasis were not very common. Seventy-five percent of our patients who underwent imaging had suspicious characteristics. Fifty-six percent of our patients had FNAC suggestive of TDCC. Fifty percent of our patients had concomitant thyroid carcinoma. None of our patients had distant metastasis at follow-up. TDCC is rare and a disease of young adulthood and usually has good prognosis. It may be a clinical surprise or a small lesion which can be detected with ultrasound and targeted FNAC. There is high rate of concomitant thyroid carcinoma and hence needs careful assessment. Sistrunk's procedure with total thyroidectomy either staged or simultaneously has good outcome and permits adjuvant treatment.

Diagnosing Midline Neck Masses: Comparing Clinical Exam, the SIST Score, and the 4S Algorithm.

To validate and compare novel ultrasound scoring systems for dermoid cysts and thyroglossal duct cysts among pediatric patients. Retrospective study. Tertiary care children's hospital. An electronic medical record query of patients younger than 18 years old who underwent primary excision of a neck mass between January 2005 and February 2022, who underwent preoperative ultrasound, and had final histopathologic diagnosis of either thyroglossal duct cysts or dermoid cysts. This generated 260 results, of which 134 patients met the inclusion criteria. Charts were reviewed for demographic data, clinical impressions, and radiographic studies. Radiologists blindly reviewed ultrasound for SIST score (septae + irregular walls + solid components = thyroglossal), and 4S algorithm (Septations, depth relative to Strap muscles, Shape, Solid parts). Statistical analyses were performed to determine the accuracy of each diagnostic modality. Of 134 patients, 90 (67%) had a final histopathologic diagnosis of thyroglossal duct cysts, and 44 (33%) were dermoid cysts. The accuracy of clinical diagnosis was 52%, and preoperative ultrasound report accuracy was 31%. The 4S and SIST accuracies were each 84%. Both the 4S algorithm and SIST score provide increased accuracy of diagnosis relative to standard preoperative ultrasound assessment. Neither scoring modality was determined to be superior. Further research is warranted in improving the accuracy of preoperative assessments for pediatric congenital neck masses.

Two-centre experience in the treatment of thyroglossal duct remnants using the modified muscle-sparing Sistrunk technique

The Sistrunk procedure has long been the method of choice for treating patients with thyroglossal duct remnants (TDRs). However, the extent of the surgical resection in the suprahyoid segment of the TDR remains controversial, as this anatomical site is the origin of both disease recurrence and surgical morbidity. The aim of this two-centre retrospective cohort study was to investigate the outcomes of a modified muscle-sparing Sistrunk procedure in primary TDRs. The primary predictor was the surgical approach, and the outcome variable was the recurrence rate. A total of 110 consecutive patients (62 (56.4%) male, 48 (43.6%) female) who underwent a modified muscle-sparing Sistrunk procedure were included in the study. Their mean age at presentation was 26.9 ± 18.9 years. A modified muscle-sparing Sistrunk procedure using cold instruments, electrocautery, and a harmonic scalpel was performed in all patients. Recurrence was recorded in six (5.5%) patients. The median hospital stay was 2 days (range 1–7 days), and the median follow-up duration was 7 years (range 2–13 years). There was no significant difference in recurrence rate between the conventional and modified muscle-sparing Sistrunk procedure in primary TDRs. The study findings showed that the modified muscle-sparing Sistrunk procedure had low recurrence and complication rates in the context of primary TDR.

Gasless submental approach endoscopic removal of thyroglossal cyst

Objective: To explore the safety and feasibility of gasless submental approach endoscopic removal of thyroglossal cyst. Methods: This work prospectively included the clinical data of 13 patients who underwent the gasless submental approach endoscopic removal of thyroglossal cyst at the Department of Otolaryngology, the First Affiliated Hospital of Chongqing Medical University from August 2021 to February 2022. The operative time, bleeding volumes, postoperative complications, subjective pain levels, satisfaction with incisional scars, neck and facial deformities, and recurrences were prospectively evaluated by visual analogue scale(VAS) score. Results: All of 13 patients were successfully treated using this new technique. The patients had a median age of 38 years, ranging from 24 to 59 years, comprising of 3 males and 10 females. The length of the submental incision was about 3 cm and the median of operation time was 135 minutes. Postoperative complications were minimal. The median volume of blood loss was 10 ml. Surgical site swelling existed in 1 case and dysphagia for more than 1 week occurred in 2 cases. Patients were discharged from the hospital with a median of 3 days after surgery. On a VAS of 0-10 scores, the pain had a median of 2 on the first day after surgery, and the satisfaction with incision scars and neck and facial deformities showed a median of 8 at 6 months after surgery. There were no recurrences during the follow-up period of 9-15 months. Conclusion: Gasless submental approach endoscopic removal of thyroglossal cyst may be a reliable new surgical method that is safe and has cosmetic advantages.

Common Pediatric Otolaryngology Procedures: Ergonomic Considerations.

Background Otolaryngologists in high-volume children's hospitals developed their operating room workflow practices based on the factors of safety, efficiency, and surgeon preference. Recent data show important benefits and potential reduced risks of proper ergonomic positioning for surgeons to prevent injury. These data suggest that the current operating room workflow practices, in addition to prior training, should be monitored and hopefully improved for surgeons' health. Surprisingly, recent studies have suggested the benefits of standing versus sitting on cognitive function. Objective This study reports the workflow norms for seven operating procedures in pediatric otolaryngology. We seek to identify 1) surgeon preferences, 2) when practices become norms, and 3) whether procedure positions are associated with surgeon discomfort or injury. Methods The Otolaryngology Section of the American Academy of Pediatrics was queried employing a 23-question survey. We included demographic information, reasons for preferences, and surgeon-reported pain. We focused on three workflow issues: 1) length of procedures, 2) site selection (operating room bed vs. transport stretcher), and 3) position of the surgeon (sitting vs. standing). Results Sixty-nine American Academy of Pediatrics members completed the survey. The length of the procedure had minimal effect, with 90% sitting for short procedures such as bilateral myringotomy with tubes, myringoplasty, tonsillectomy, and adenoidectomy. All sit for direct laryngoscopy and bronchoscopy. Most stand for the removal of nasal foreign bodies, drainage of neck abscess procedures, and thyroglossal duct cyst excision. Residency training (75%) and personal comfort (81%) were the more frequently cited reasons for preference. Fewer than one in five (16%) reported preexisting neck or back pain, but this doubled (35%) throughouttheir otolaryngology practice. Conditional distributions of pain showed reports of pain were greater for individuals in practice for over 20 years. Conclusions Pediatric otolaryngologists develop their operating room preferences early during residency training. High rates of neck and back pain (35%) may develop during a surgeon's career. We suggest improved understanding of ergonomics in concert with operating room workflow should be considered during otolaryngology residency training since recent data suggest potential benefits of standing on cognitive function.

Thyroglossal duct diseases: presentation and outcomes

The incidence of thyroglossal duct diseases in the general population is about 7%. We aimed to demonstrate the clinical presentations and management of thyroglossal duct diseases. We conducted a retrospective review of all patients who underwent surgery for histopathologically confirmed thyroglossal duct cyst, sinus, or fistula at a single center. A total of 151 cases were included in this study. There were more female patients (87, 58%) than male patients (64, 42%). The patients' ages ranged from 1 to 63 years old. The most prevalent complaint was painless upper midline neck swelling (93.3%). Most cases were diagnosed as thyroglossal duct cysts (137, 90.7%). Six cases (4%) were associated with carcinoma. All the cases were managed using the modified Sistrunk procedure. There were no procedure-related complications, and five cases of recurrence. Although thyroglossal duct cyst is the most common neck anomaly in children, it may also present with various characteristics later in life. This condition can be managed successfully without complications and with a low recurrence rate.

Papillary Thyroid Carcinoma Arising in Thyroglossal Duct Cyst and Locally Infiltrated to Hyoid Bone: Issue of Individualized Management

Thyroglossal duct cyst (TGDC) is the most common developmental anomaly of the thyroid gland, while TGDC carcinoma with local infiltration to the hyoid bone is extremely rare. The reported case of papillary thyroid carcinoma (PTC) was diagnosed in TGDC along with local infiltration to the hyoid bone and needed individualized management. A 70-year-old male patient presented with a history of PTC arising in TGDC and locally infiltrated to the hyoid bone followed by total thyroidectomy and radical sistrunk operations and was referred to National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for radioactive iodine therapy (RAIT). His post-operative ultrasound of the neck revealed an irregular shaped, fungating, grossly non-homogenous mixed echogenic mass lesion invading the hyoid bone, measuring about 25 X 28 mm. Radioactive iodine(131I) of 150 mCi was administered because the residual hyoid bone mass was inoperable and he was on thyroxine suppression therapy. The post-therapy 131I scan (RxWBS) showed two intense foci of radiotracer concentration (RTC) in the upper area (above the thyroid bed) and an intense focal RTC in the fundal region of the stomach. The activity in the stomach region was evaluated by ultrasound imaging, which revealed a soft tissue mass or thickening of the mid-region of the posterior wall of the stomach (3.3 cm X 1.6 cm). A CT scan of the chest was also performed to rule out metastasis, and it revealed multiple nodular lesions in both lung fields (most likely secondary) as well as tiny subcentric lymphnodes in the lower pre- and right paratracheal regions after nearly one month of RAIT when the patient was stable for examination. EBRT is still under consideration as adjuvant therapy. Tyrosine kinase inhibitors (TKI) may be considered in cases of refractoriness to radioiodine and disease progression. Bangladesh J. Nuclear Med. 26(1): 67-70, 2023