A thyroglossal duct cyst is a pocket in the front part of neck that is filled with fluid. Thyroglossal duct cyst and fistula speciality medical dialogues. Fistula, abnormal duct or passageway between organs. Swelling first noticed by mother when child was 7 months old. Jul 31, 20 dermatopathology reference describes thyroglossal cyst histopathology including histologic features and provides links to additional medical references. The patients comorbidities included a previous partial glossectomy for haemangioma of the tongue, chronic obstructive pulmonary disease, congestive cardiac failure and obesity body mass index 30. Reevaluation of histopathology and methods for resection. A thyroglossal duct cyst happens when your thyroid, a large gland in your neck that produces hormones, leaves behind extra cells while its forming during your development in the womb. Jul 05, 2019 thyroglossal duct cysts often occur in children, but they may present at any age. It classically moves upwards on swallowing and on tongue protrusion.
Thyroglossal duct infections and surgical outcomes by daniel j. Patil medical college, pimpri, pune, maharashtra, india. Normally, this tract disappears between the eighth and 10 th week of gestation. The thyroglossal duct cyst may rupture spontaneously and present as a draining sinus, which has been erroneously called a thyroglossal fistula, although communication with foramen caecum is extremely rare. Tgcs arise from a persistent epithelial tract, the thyroglossal duct, formed with the descent of the thyroid from the foramen caecum to its final position in the front of the neck.
It is formed from leftover tissue from the development of the thyroid gland when an embryo was forming. Distinguishing between thyroglossal duct cysts tgdc and dermoid cysts dc sonographically can be challenging. This opening can lead to fluid accumulation and infection, which necessitate the removal of the. Pdf on jan 1, 2011, fatih bora and others published thyroglossal duct fistula with double tract find, read and cite all the research you need on researchgate. Fistulas can form between various parts of the body, including between the uterus and the peritoneal cavity metroperitoneal, or uteroperitoneal, fistula, between an artery and a vein arteriovenous fistula, between the bronchi and the pleural space of the lung bronchopleural fistula, between the intestines and the vagina enterovaginal. Thyroglossal fistula definition of thyroglossal fistula by. Age, sex, length of history, presentation, preoperative investigations, operative findings, histopathology of the lesion and length of excised hyoid bone, postoperative complications and. Thyroglossal cyst, branchial fistula thyroglossal fistula a midline fistula just above the thyroid that connects the openings in the skin to a persistent embryonic thyroglossal duct. We illustrate the three sonographic features in neck masses in children recently identified as being most suggestive of tgdc septa, irregular wall and solid elements and their corresponding histopathology. Carcinoma found in histopathology of the surgical excision specimen showed a thyroglossal duct cyst with a maximum diameter of 7. Tdcs arise from remnants of the thyroglossal duct, which connects the thyroid gland to its embryologic origination in the oropharynx 1. Sometimes a fistula develops when a thyroglossal cyst is not completely removed. A retrospective study conducted from march 2014 to january 2016 including 27 patients suffering from thyroglossal fistula having 16 patients as a primary presentation without surgical history and 11 patients of recurrent disease after sistrunk.
May be helpful to blunt probe the fistula from the anal mucosal aspect the primary opening may be challenging to find the primary opening due to chronicity and scarring. Thyroglossal fistula definition of thyroglossal fistula. Thyroglossal sinuses are usually presented as a persistent mucoid discharging opening from the midline of the neck. What is the optimal depth for coreout toward the foramen cecum in a thyroglossal duct cyst operation. Microscopically, the thyroglossal cyst may be lined by respiratory or squamous. Thyroglossal duct cyst is a congenital lesion of the neck resulting from the remnant of the thyroglossal tract. Thyroglossal cyst our experience balasubramanian thiagarajan 1 ulaganathan venkatesan 2 geetha ramamoorthy 1 1 stanley medical college 2 meenakshi medical college abstract. Soeprono teaches and practices dermatopathology at loma linda university, school of medicine, department of dermatology.
Typical course of thyroglossal duct remnants yellow line the suprahyoid ductal segment may have a branching pattern like the tips of a broom figure 2. A 4mm cystic mass noted along the anterior border of the left sternocleidomastoid muscle. If the cyst ruptures, it may form a thyroglossal duct sinus or a thyroglossal duct fistula that exits through the overlying skin. Typically there is a midline opening on the skin that discharges mucus. Thyroglossal duct cyst is a well recognized developmental abnormality. It develops at the base of the tongue, at an area called the foramen caecum, and descends in front of the pharyngeal gut along the thyroglossal tract. Ministry of health and family welfare, government of india has issued the standard treatment guidelines for thyroglossal duct cyst and fistula. The thyroid cyst usually arises within the midline this midline location being an important diagnostic characteristic, presenting as a round, smooth, nontender mass on palpation but can be painful and tender, if infected.
Thyroglossal duct cyst tgdc is the most common congenital midline neck mass in children. Sep 26, 2017 a thyroglossal duct cyst happens when your thyroid, a large gland in your neck that produces hormones, leaves behind extra cells while its forming during your development in the womb. Thyroglossal fistula article about thyroglossal fistula by. Thyroglossal cyst differential diagnosis and complications. Thyroglossal duct cyst is the most common congenital neck mass.
Thyroglossal duct cysts are the most common nonodontogenic cyst in the neck and most common pediatric cystic neck anomaly and are therefore important to recognize. Thyroglossal definition of thyroglossal by medical. On rare occasions, the duct may become trapped and incorporated into the second and third arch components of the hyoid bone. Thyroglossal duct cyst is a congenital malformation that occurs due to incomplete closure of the thyroglossal duct. Whilst thyroglossal cysts and fistulae constitute one of the commonest congenital anomalies encountered in the midline of the neck, they must be regarded as relatively infrequent occurrences, constituting about onethird of all tumors, cysts and fistulae in the neck, excluding lymph node involvements. Thyroglossal duct remnants in infants and children. When it fails to do so, thyroglossal duct epithelium will persist and may proliferate and secrete mucus to form a cystic mass. Pdf thyroglossal duct pathology and mimics researchgate. Management of thyroglossal duct cyst 668 p j m h s vol. Age, sex, length of history, presentation, preoperative investigations, operative findings, histopathology of the lesion and length of excised hyoid bone, postoperative complications and length of followup were recorded. Thyroglossal duct cyst in children what is a thyroglossal duct cyst in children. Carcinoma found in thyroglossal cyst is a fibrous cyst that forms from a persistent thyroglossal duct.
This procedure is the removal of a thyroglossal cyst and part of the hyoid bone which is above the larynx, through a cut along the upper part of the neck. A 59yearold male patient presented with a progressive cystic swelling in the neck which moved on swallowing and protrusion of tongue. Histopathology of the surgical excision specimen showed a thyroglossal duct cyst with a maximum diameter of 7. Fortunately the patient didnt develop it at least in the first 6 months post op. The duct persists as a midline structure forming an open connection between the back of the tongue and the thyroid gland. Thyroglossal cyst and sinuses clinical presentations and management of thyroglossal duct cyst and sinuses ayad ahmed shihab alazzawi, azzam m. Twentyseven children underwent surgery for thyroglossal cysts and fistulas during 19892000. Thyroid follicle cells could be seen only in 3 of the 30 operated specimen.
We report our findings in 40 patients with tdcs and document the variability of sonographic patterns. Nov 05, 2017 thyroglossal duct cyst is a rare but occasional cause of a benign midline neck mass. Despite the increasing size, it was not until march 2010 when she began to develop symptoms of dysphagia and stridor especially worse at night. Thyroglossal duct cyst in typical site the thyroid gland is the first of the bodys endocrine glands to develop, beginning in the third week of gestation, even before the nervous system has begun development. Macdonald guys hospital, london, englalm aastracr whilst thyroglossal cysts and fistulae constitute one o the commonest congenital anomalies encountered in the midline of the neck, they nmst be regarded as relatively infrequent occurrences, con stituting about. A persistent duct can lead to thyroglossal duct cyst tgdc. A persistent thyroglossal duct is a usually benign medical condition in which the thyroglossal duct, a structure usually only found during embryonic development, fails to atrophy. Thyroglossal duct pathology and mimics insights into. In our study the number of patients below the age of 10 years were 9. A rare case of a concurrent large thyroglossal duct cyst. Established principles for the management of thyroglossal duct remnants have been accepted widely since sistrunks description of the operative procedure in 1928. In our experience, however, tdcs have a variable sonographic appearance.
Apr 12, 2019 after learning the diagnosis of the tgdc by histopathology we were considering the possibility of the patient developing thyroglossal duct fistula which can occur in as high as 85% cases when sistrunks operation was not done 5, 7. The thyroglossal duct arises from foramen cecum located at the junction of anterior two thirds and posterior third of the tongue 1. Apart from being a quiescent embryological remnant, it presents itself clinically at any age and often requires surgical excision. They also may give rise to sinuses, fistulae, or cysts. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep.
Important differentiating feature of thyroglossal duct. On imaging, suprahyoid thyroglossal duct cysts are generally midline simple or complex cystic structures, while infrahyoid cysts are commonly paramedian in location. Management of thyroglossal fistula and recurrent thyroglossal. Infected thyroglossal cyst if the cyst becomes complicated the presentation may be different. Thyroglossal fistula synonyms, thyroglossal fistula antonyms. Tgdcs are caused by a persistent epithelial tract, the thyroglossal duct, during the descent of the thyroid from the foramen cecum to its final position in the anterior neck. A retrospective study conducted from march 2014 to january 2016 including 27 patients suffering from thyroglossal fistula having 16 patients as a primary presentation without surgical history and 11 patients of recurrent disease. From there it passes in front of the body of the hyoid bone, curving backwards and superiorly to reach behind the bone before once more turning inferiorly and continuing to the isthmus of the thyroid.
Thyroglossal duct cyst excision iowa head and neck protocols. After 8 years of steady growth, the previously asymptomatic mass began to cause stridor and dysphagia. An 85yearold lady presented with a large midline neck mass. Figure showing thyroglossal cyst along with middle portion of hyoid bone after removal histopathology. May 08, 2015 thyroglossal cysts tgcs represent the most common congenital anomaly of the neck. A rare case of a concurrent large thyroglossal duct cyst with.
Previous reports have suggested that thyroglossal duct cysts tdcs appear on sonograms as welldefined cystic masses with thin walls and posterior enhancement. Diagnostic pitfalls and a study of 14 cases shirish s chandanwale, archana c buch, kaur r chawla, pratik u mittal department of pathology, padm. Thyroglossal duct fistula managed successfully using single incision. The infant is eating well, thriving, and otherwise healthy 3. It may follow a surgical procedure with improper healing, or it may be caused by injury, abscess, or infection with penetration deep enough to reach another organ or the skin. Characteristics of thyroglossal duct cyst confirmed by histopathology n 102. During development, the thyroglossal duct wraps inferiorly around the hyoid bone. A clinicopathologic series of 685 thyroglossal duct remnant cysts. Synonyms for thyroglossal fistula in free thesaurus. Fnac of 14 patients of tdc diagnosed clinically and by ultrasound examination of neck was studied. Unusual association of diseasessymptoms a rare case of a. The dissected specimen was sent for histopathological exami.
Clinical presentations and management of thyroglossal duct. Critical anatomic landmarks of thyroglossal duct anomalies and ectopic thyroid. This study shares our experiences in managing patients with thyroglossal cysts. Intrathyroid thyroglos sal duct cyst in an adult is a. Soepronos textbook is available on and includes detailed information on over 600 entities and includes four dvd diskettes with highresolution images that provide a virtual dermatopathology reference and guide. These findings were in agreement with various studies in the literature1,3. Thyroglossal fistula synonyms, thyroglossal fistula. Investigations were inconclusive and thyroid profile was normal. Rarely, the thyroid, or a portion of it, remains at the foramen cecum and is called lingual thyroid. Stephen goldstone fistula surgery using hyfrecator conmed surgical technique duration. They represent remnants from the embryological migration of thyroid tissue from foramen caecum to the thyroid fossa. While a fistula to the skin is common, persistence of the tract to the foramen cecum is not. Radiologic findings in persistent thyroglossal tract fistulas.
Waldhausen, md department of surgery, childrens hospital and regional medical center, university of washington school of medicine, g0035, 4800 sand point way, ne, seattle, wa 98105, usa congenital cervical cysts, sinuses, and. Huge thyroglossal duct cyst at the suprasternal notch. Dec 14, 2010 thyroglossal duct cyst is a congenital malformation that occurs due to incomplete closure of the thyroglossal duct. The most common developmental anomaly of thyroid gland, and the most common congenital neck mass. It usually becomes symptomatic following a respiratory tract infection and is usually diagnosed at 5.
1071 202 808 415 1567 364 130 428 1107 1227 660 342 1424 743 344 676 1441 1086 1394 1211 1360 1118 1399 316 1015 603 649 939 1441 1274 942 979 178 1175 488 1085 316 972 1379 1064 738 1286 492 867 790