High-grade mucoepidermoid carcinoma in thyroglossal cyst: Post-surgical histological surprise and dilemmas

Occurrence of malignancy in the TG cyst has been rarely reported, though rare, and papillary carcinoma predominates the common type but squamous cell carcinomas, anaplastic carcinoma, and medullary have been reported rarely. Mucoepidermoid carcinomas are most commonly seen in salivary glands, and as per the available literature, there was only two cases reported in thyroglossal cyst. We are presenting a 67-year-old lady presented with a 6×8 cm hard swelling below symphysis menti with no thyromegaly and moving on protrusion of tongue, and on MRI, it was found to be thyroglossal cyst with infiltration of strap muscles. Cytological investigation revealed it to be a TG cyst malignancy. The patient underwent total thyroidectomy and radical Sistrunk’s operation. Histopathological and immunohistochemistry revealed it to be a histological examination revealed a low-grade mucoepidermoid carcinoma consistent with origin in a thyroglossal duct remnant it invaded the hyoid bone and adjacent strap muscles. Various diagnostic and treatment dilemmas in the treatment of TG cyst malignancy are discussed with reference to mucoepidermoid carcinoma. We are reporting an usual histological surprise in a thyroglossal cyst malignancy being the only second reported case of TG cyst mucoepidermoid carcinoma this case highlights the importance of removal of thyroglossal duct cysts at an early stage and aggressive surgical approach in high-grade tumors.

A rare case of co-existing branchial cyst and thyroglossal cyst

<p class="abstract">Thyroglossal duct remnants and branchial arch anomalies are the most common congenital neck masses. These anomalies typically present in childhood or early adulthood as cysts, sinuses or cartilaginous remnants, but may rarely present in late adulthood. Although both thyroglossal duct remnants and branchial cysts may be encountered individually, these anomalies are rarely encountered together in the same individual. We report the third such case of co-existing branchial cyst and thyroglossal cyst occurring in the same individual with review of embryological development of thyroglossal duct cysts and second branchial arch anomalies.</p>

Head and neck surgery

This chapter addresses head and neck surgery. It begins with thyroglossal cyst, sinus, and fistula. A thyroglossal cyst is a fluid-filled sac resulting from incomplete closure of the thyroglossal duct. Meanwhile, a thyroglossal sinus results from persistence of the whole duct. The chapter then turns to branchial cyst, sinus, and fistula, before discussing salivary calculi, acute parotitis, and salivary gland tumours. Parotitis is inflammation of the parotid gland; most patients develop this condition as an acute episode of a chronic obstructive sialadenitis. The chapter also considers head and neck cancer, which refers to cancer of upper aerodigestive tract (UADT). In addition, it examines facial trauma and neck space infections.

Thyroglossal cyst in elderly: a rare cause of inspiratory stridor

<p class="abstract">Thyroglossal cyst is the most common congenital anterior neck swelling in childhood. Commonly present as painless swelling in the 2nd decade of life but the cases are reported in the elderly age group also. It represents the persistent epithelial tract from the foramen cecum to the thyroid gland. Clinically can be diagnosed and can be differentiated with other mid-line swelling by movement with the protusion of tongue. It is usually related to the hyoid bone and may be supra-hyoid, infra-hyoid, lower part of the midline or rarely lingual in position. Ultrasonography is the investigation of choice for this cystic condition. It is safe, economical and easily available investigation among all the radiological study. MRI is helpful to diagnose cervical extension and lingual cyst. Inspite of close relation to the laryngeal structure it rarely present as laryngeal mass and causes stridor or sleep apnea as in our case. Classic Sistrunk procedure is the treatment of choice for the condition. Endoscopic CO2 Laser is useful in situation where only intraoral cyst present without cervical extension. Marsupialization is reserved for lingual cyst especially in Neonate. We are reporting this case which was present in the elderly and reported with long standing anterior neck swelling with inspiratory stridor on lying down position.</p>

1247 Fusobacterium Necrophorum - A Rare Thyroglossal Cyst Habitat That Can Be Lethal

Thyroglossal cyst is the most frequent developmental cervical anomaly with a prevalence of 7% in the population. Infection and abscess formation are common complications. Isolation of Fusobacterium Necrophorum (F. Necrophorum) made the management of this case challenging. An 18-year-old male presented to the emergency department with a 3-day history of a neck mass, sore throat, cachexia, dysphagia and fever. Clinical examination revealed an erythematous 4 x 5 fluctuant swelling in the midline of the neck with evident lymphadenopathy on level II on the left-hand side. A CT neck that was undertaken nine months ago was suggestive of a thyroglossal cyst and the patient was placed in the waiting list for surgical excision under general anaesthesia. He reported three episodes of midline neck swelling since then. Upon admission, ultrasound guided drainage was arranged, and a pus sample obtained. The presence of F. Necrophorum was reported by microbiology with instructions of urgent admission and strict antibiotic regime. Excision of the cyst was scheduled after the completion of the antibiotic course. Fusobacterium Necrophorum is a rare microorganism with increased virulence and a significant mortality rate. It has been involved in oropharyngeal infections complicated by Lemierre’s syndrome, necrobacillosis, post anginal sepsis and septic jugular thrombophlebitis making this case of particular interest.

Concurrent Papillary Carcinoma of Thyroglossal Duct Cyst and Thyroid Isthmus, Beyond the Sistrunk Procedure

Introduction/Background: Papillary carcinoma (PC) originating from the thyroglossal cyst is a rare entity. It is even more uncommon to have concurrent thyroglossal duct cyst PC and papillary thyroid carcinomas (PTC). The surgical approach for such patients would involve a combination of a Sistrunk’s procedure and total thyroidectomy. We describe management of a patient found to have multi focal PC originating from a thyroglossal duct cyst and thyroid isthmus with extensive cervical lymph node metastasis. Clinical Case: 30-year-old male presented to PCP with palpable bilateral cervical adenopathy most prominent in the right supraclavicular region. Neck ultrasound confirmed multiple metastatic appearing nodes (largest 4cm) in the central, right and left lateral cervical compartments as well as a hypoechoic, TI-RADS category 5 right thyroid isthmus nodule. FNA of the cervical nodes confirmed metastatic PTC. Neck CT in addition to extensive cervical adenopathy revealed a 2 cm solid mass inferior to the central hyoid bone with infiltrative borders and calcifications suspicious for a primary tumor. Patient underwent total thyroidectomy with central compartment lymph node dissection, excision of thyroglossal cyst and bilateral modified radical neck dissections. Histopathology report revealed a 2.4 cm thyroglossal duct tumor and a 1.1 cm tumor in the thyroid isthmus, confirming two separate tumors both being classical variants of papillary thyroid carcinoma, with no lympho-vascular invasion and 8/53 positive lymph nodes. BRAF V600E mutation was positive. On follow up, the patient is doing well and has deferred adjuvant radioactive iodine treatment for 6 months for personal reasons. Clinical Lesson/ Conclusion: PC of the thyroglossal cyst with synchronous isthmic PTC merits total thyroidectomy and central compartment dissection in addition to the Sistrunk’s procedure, as the likelihood of local metastasis is high. Presence of BRAF V600E mutation has been identified as a predictor of more aggressive behavior in isolated PC of the thyroglossal duct cyst, suggesting a need for more than a Sistrunk’s procedure in such patients. Our patient, who presented with local lymph node metastasis supports this conclusion. Determining BRAF mutation status preoperatively may be a helpful strategy in planning the extent of surgery. Keywords Thyroglossal duct cyst, Papillary thyroid carcinoma, BRAF mutation

Infrahyoid thyroglossal cyst and Neck trauma - A diagnostic conundrum

Thyroglossal duct cysts are most commonly located inferior to the hyoid bone in close relation with the thyrohyoid membrane. Very rarely, they may occupy the posterior hyoid space, and present with dysphagia. We present the clinical, pathophysiologic features and the iintraoperative findings of thisrarely described clinical entity