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>

Thyroglossal Duct Cyst Carcinoma in a Young Female: Case Report and Review of Literature

Thyroglossal duct remnants form during embryologic development and can develop into a thyroglossal duct cyst (TGDC). In rare cases, carcinoma is present within these cysts, most commonly papillary thyroid carcinoma. Diagnosis is difficult, but imaging and fine-needle aspiration (FNA) biopsies can help with the diagnosis. Given the rarity of TGDC carcinoma, treatment is not well agreed upon and can include the Sistrunk procedure, thyroidectomy, nodal dissection, and postoperative radioactive iodine treatment. Here, we describe the presentation, workup, and treatment of a 20-year-old female with papillary thyroid carcinoma present within both a thyroglossal duct cyst and the thyroid gland.

Why Central Neck Dissection Works (and Fails) for Recurrent Thyroglossal Duct Remnants

Objective: To review the patient characteristics and outcomes for children and undergoing central neck dissection for control of recurrent thyroglossal duct cysts and fistula following prior Sistrunk procedures and children requiring surgery for refractory infection. Methods: We performed a computerized review of all children who were evaluated for thyroglossal duct cysts during the years 1999-2018 by a single surgeon operating at an urban children’s hospital and an outpatient surgical center. Those requiring a central neck dissection for control of recurrent disease or intractable infection were identified. Age at time of surgery, sex, surgical procedure, and postoperative complications were recorded. These data were combined with similar data from a published report by the same surgeon in the years 1990-1998 to complete a 28-year review. Results: 18 central neck dissections were performed including 13 for recurrent thyroglossal duct remnants after Sistrunk procedures and 5 primary surgeries for intractable infection. Ages ranged from 3 to 19 years (median = 10 years) and 13 of 18 were girls (72%). Four children had their first Sistrunk surgery performed by the senior author. Three children operated elsewhere had intact hyoid bones at the time of revision surgery, suggesting less-than-Sistrunk primary surgeries. Central neck dissection controlled disease in the lower neck in all cases. One child re-fistulized at the level of the hyoid. Conclusions: Central neck dissection in combination with a Sistrunk-type dissection of the tongue base is effective in the control of recurrent infection following unsuccessful Sistrunk surgery and aids in dissection for children with intractable infection. Although this technique reliably controls infrahyoid disease and improves access to the hyoid and posterior hyoid space, it does nothing to address the difficulties of following the thyroglossal tract into the tongue base.

A Rare Case of 18F-FDG Uptake in an Ectopic Thyroid Carcinoma of the Anterior Middle Neck Lacking Thyroglossal Duct Remnants

An 80-year old female presented with a well-defined tumor of the anterior middle neck, and a diagnosis of thyroglossal duct cyst was made. When the tumor size increased, malignancy was suspected. Ultrasonography revealed a smooth, heterogeneously hypoechoic area at her anterior neck. Contrast-enhanced computed tomography showed a well-defined contrast-enhanced tumor inferior to the hyoid bone. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) showed a fluorine-18 fluorodeoxyglucose-avid tumor with a maximum standardized uptake value of 12.8. Surgical tumor resection was performed, and the histopathological finding was ectopic papillary carcinoma lacking thyroglossal duct remnants, which is very rare. To our knowledge, few cases of ectopic thyroid carcinoma with 18F-FDG PET/CT findings have been reported. Ectopic thyroid carcinoma lacking thyroglossal duct remnants should be considered a differential diagnosis in cases of 18F-FDG uptake in an anterior middle neck tumor.

Papillary thyroid carcinoma of thyroglossal duct cyst; a case report and review of the literature

Thyroglossal duct remnants are the most common midline neck swellings, but malignancy arising in them is a rare finding. Among the carcinomas arising in the thyroglossal duct cyst, papillary thyroid carcinoma is the commonest. Most of the cases of papillary thyroid carcinoma of thyroglossal duct cyst are asymptomatic and clinically diagnosed as thyroglossal duct cyst. It may remain undetected on fine needle aspiration cytology and ultrasonography; therefore diagnosis is established only after pathologic evaluation of biopsy. Hence careful histopathological examination of the excised specimen with high level of suspicion is mandatory in these cases. We are report a case of papillary thyroid carcinoma of thyroglossal duct cyst in a 30-year-old female.Journal of Pathology of Nepal (2012) Vol. 2, 328-330DOI: http://dx.doi.org/10.3126/jpn.v2i4.6889