Ultrasound-guided percutaneous ethanol injection therapy of neck cysts as an alternative to surgery

Summary Introduction: Some extrathyroidal cervical cystic lesions can be treated in selected situations by minimally invasive, low-risk method – ultrasound--guided percutaneous ethanol injection therapy (US-PEIT). Here we present 6 cases of neck cysts of various origins – ranula, thyroglossal duct cyst, branchial cleft cyst, midline neck cyst of the pyramidal lobe and dermoid cyst. Method and material: The cohort consisted of 6 patients (mean age 58 ± 13.3 years), who were followed for recurrent cervical cysts located outside the thyroid gland. The cysts were visible, palpable, aesthetically unpleasant and also mechanically compressing the surrounding tissue. After repeated evacuations, they filled in again. The patients repeatedly refused the recommended surgery and demanded an alternative solution. US-PEIT of thyroid cysts is used worldwide as a full-fledged alternative to surgical treatment. We used the same procedure for the treatment of presented neck cysts. Results: The initial volume of cysts was 2–35 mL (mean 17.7 mL); the patients underwent 1–6 sclerotization sessions (mean 3.6). The patients were followed for 12 months; the final volume of solid residue was 0.1–2 mL (mean 1 mL) representing volume reduction by 80–99% (mean 92%). Therapeutic success (volume reduction > 50%) was achieved in all patients. Conclusion: US-PEIT of cervical cysts as an alternative to surgery can be used especially in elderly patients with increased surgical risk or in patients refusing surgery. In middle-aged and older adults, the possibility of a necrotic metastatic lymph node should always be considered. Therefore, a benign cytological examination and an unsuspecting ultrasonographic and CT finding are the basic conditions before performing the ethanol ablation. Key words neck cysts – ultrasound-guided percutaneous ethanol injection therapy

The importance of correct radiological diagnosis in (adenoma malignum): a case report

ABSTRACT Minimal deviation adenocarcinoma (MDA) of the cervix otherwise known as adenoma malignum is a rare variation of cervical adenocarcinoma. Radiological evaluation plays a great role to ensure an early diagnosis. Here, we report a 48-year-old woman who was presented with a mucoid vaginal discharge 10 years after a supracervical hysterectomy. Despite normal biopsy and cytology, magnetic resonance imaging showed a large cervix and multiple cervical cysts that considered adenoma malignum as a differential diagnosis. She underwent surgery and the pathology confirmed the adenoma malignum. In conclusion, radiologists, as well as gynecologists, and also pathologists may consider MDA among the differential diagnosis in patients with a vaginal discharge and multicysts in the cervix even after hysterectomy despite normal cytology and biopsy.

Thyroglossal Cyst: A Case and a Description of the Early Documentation in the Medical Literature.

Background: Thyroglossal cyst is a birth defect resulting from persistence of the thyroglossal duct. The aim of this paper is to present a case of pediatric thyroglossal cyst and to briefly describe the early documentation of the condition in the medical literature. Patients and methods: A case of childhood thyroglossal cyst is presented and a deep review of the literature is made with the aim of describing the early documentation of the condition in the medical literature Results: The occurrence of median cervical cysts was reported during the 1800s. However, Strübing (1892) was most probably the first to suggest that most of these reported cases had cysts of thyroglossal origin and not of branchial origin. In 1894, Herbert E Durham supported the suggestion of Strübing and described three cases of thyroglossal cyst. Walter Ellis Sistrunk developed the improved surgical method for the treatment of thyroglossal cyst during the 1920s that is still practiced until now. Conclusion: Herbert E Durham and Walter Ellis Sistrunk are the pioneers who are accredited for most of our current understanding of the clinical therapeutic aspects of thyroglossal cyst.

Incidence and clinical predictors of cystic squamous cell carcinoma metastases in lateral cervical cysts

ObjectiveThis study aimed to determine the incidence of metastatic squamous cell carcinoma in patients with an isolated cervical cystic mass, and to describe the clinical features that might predict the origin of cystic tumours.MethodAdult patients with isolated lateral cervical cystic masses who were scheduled for surgery from 1st January 2010 to 31st August 2016 in two tertiary care referral centres in Slovakia were analysed retrospectively.ResultsThe incidence of cystic metastases in the whole cohort and in patients aged over 40 years were 9.9 per cent and 18.5 per cent, respectively. The incidence in patients aged over 40 years (18.5 per cent) was statistically significant (p = 0.003).ConclusionThe incidence of cystic squamous cell carcinoma metastases in lateral cervical cysts in patients aged over 40 years is high enough to call for excisional biopsy with frozen section, panendoscopy with direct biopsies, tonsillectomy and even neck dissection in cases of histologically confirmed carcinoma.

The diagnosis of a cervical tumefaction in children

Neck pathology in children involves many diseases with similar clinical expression. Different disorders in paediatric practice may be clinically manifested by a cervical tumefaction. The cervical tumefaction can be represented by adenopathies or tumors. Cervical adenopathies may be unilateral or bilateral; the cause of their occurrence may be infectious, inflammatory, tumoral or may be associated with rare diseases. Tumoral cervical tumefactions can be represented by: congenital cervical cysts and fistulae, cystic lymphangiomas, thyroid swellings, malformations and cervical tumors detected antenatally. A correct diagnosis is established after a complete clinical and paraclinical assessment. In this article the authors make a review of the types of cervical tumefactions in children, emphasising the diagnostic protocol.

Cervical Thymic Cyst Mimicking Laryngocele

Cervical thymic cysts are nearly 0.3% of all congenital cervical cysts. Thymic cysts are asymptomatic, but they rarely complain of dysphagia or tracheal obstruction symptoms. A soft, mobile, and painless mass increasing with valsalva maneuver directs the diagnosis of laryngocele. There has not been any study in the literature in which thymic cyst presenting like laryngocele. We hereby present a case of thymic cyst mimicking laryngocele that has not been reported so far.