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Thyroglossal Cyst

Cysts Thyroglossal

Thyroglossal cyst is a fluid-filled swelling in the midline of the neck usually found at the level of the hyoid bone or inferior to it. It represents the remnant of the thyroglossal duct which develops during embryogenesis in the fetal foramen cecum (tongue base) and then migrates to its final destination in the middle to lower anterior cervical region. The duct is normally obliterated in the first trimester while a persistence of the duct is associated with the formation of the cyst.


Presentation

Thyroglossal cyst (TGC) is a fluid-filled remnant of the thyroglossal duct which runs from the foramen cecum at the fetal base of the tongue to the lower anterior cervical region [1] [2] [3]. TGC develops due to the anomalous formation and migration of the thyroid gland during embryogenesis. TGC is the commonest midline cervical mass found in clinical practice [4]. It is usually located at the level of the hyoid bone or inferior to it near the thyrohyoid membrane but can also be found in the lingual or submental region [5] [6].

TGC can present as an asymptomatic mass in children, frequently around the age of 6 years. Approximately 7% of TGCs have been reported to occur in adults and the most common presentation in adults is an underlying infection of the cyst [4] [7]. Clinical features of TGC include a midline cervical mass which moves with swallowing or protrusion of the tongue, sometimes accompanied by symptoms of a sore throat, odynophagia, dysphagia, and hoarseness. Sudden enlargement of the cyst, especially if it is located in the lingual or submental region can lead to airway obstruction. Occasionally TGC may present as an infected cyst or as a malignancy within the cyst [8] [9] [10]. Cases of papillary thyroid carcinoma, as well as, squamous carcinoma have been reported in older adults [11] [12] [13].

Thyroid Nodule
  • The ultrasound scan is very useful for evaluating thyroid nodules and to look for features that may indicate that the thyroid nodule is suspicious for cancer. It is also useful for looking for any enlarged lymph nodes in the neck.[singhealth.com.sg]
  • Solitary thyroid nodules affect 1–2% of children, but the risk of malignancy is greater in children than in adults, especially for cysts larger than 1 cm.[analesdepediatria.org]
  • At first evaluation in our clinic, a neck ultrasound confirmed the presence of an 11 mm thyroid nodule and additionally identified a 12 mm TGDC remnant.[hormones.gr]
  • Differential Diagnosis Dermoid cyst Lymph node Cystic hygroma Branchial cyst Lipoma Laryngocele Thyroid nodule Treatment Infected cyst treated with antibiotic to cover oropharyngeal flora (aerobes and anaerobes) and warm compresses.[pedclerk.bsd.uchicago.edu]
  • nodules, lymphatic malformations, hemangioma, midline lymphadenopathy, and salivary gland tumors.[consultant360.com]
Goiter
  • The patient had a 10-year history of multinodular goiter, which had recently been complicated by hyperthyroidism.[hormones.gr]
  • Differential diagnosis are ectopic thyroid, enlarged lymph nodes, dermoid cysts and goiter.[en.wikipedia.org]
  • 2016 2017 2018 2019 Billable/Specific Code Applicable To Congenital parenchymatous goiter (nontoxic) Congenital goiter (nontoxic) NOS Type 1 Excludes transitory congenital goiter with normal function ( P72.0 ) E03.0 ) congenital hypothyroidism ( ICD-[icd10data.com]
  • […] malformation of posterior pituitary Congenital malposition of the thyroid gland Congenital malposition of thymus Ectopic pituitary tissue Ectopic thymic tissue Ectopic thyroid tissue Female Kallman's syndrome General loss of peroxisomal function Lingual goiter[icd9data.com]
  • Other diagnoses include: Lymph nodes Goiter Dermoid cyst Lipomas Branchial cleft cyst Enlarged lymph node Ectopic thyroid anomalies which are odontogenic in origin.[lecturio.com]
Soft Tissue Swelling
  • Soft tissue swelling occurs, along with airway obstruction and trouble swallowing, due to the rapid enlargement of the cyst.With infections, there can be rare cases where an expression of fluid is projected into the pharynx causing other problems within[en.wikipedia.org]
Dyspepsia
  • There may be difficulty breathing, dysphagia (difficulty swallowing), or dyspepsia (discomfort in the upper abdomen), especially if the cyst becomes large.[en.wikipedia.org]
Submental Mass
  • The patient's chief complaint was a submental mass. The mass was 6 x 4 cm, elastic, soft, and smooth-surfaced. CT examination showed high-density areas in part of the interior of the mass.[ncbi.nlm.nih.gov]
Submental Mass
  • The patient's chief complaint was a submental mass. The mass was 6 x 4 cm, elastic, soft, and smooth-surfaced. CT examination showed high-density areas in part of the interior of the mass.[ncbi.nlm.nih.gov]
Neck Mass
  • Cervical bronchogenic cyst is a rare congenital malformation that usually appears as a painless neck mass.[ncbi.nlm.nih.gov]
  • Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages.Thyroglossal cysts are the most common cause of midline neck masses[en.wikipedia.org]
  • Symptoms Thyroglossal duct cysts most often present with a palpable (able to be felt) asymptomatic midline neck mass at or below the level of the hyoid bone. The neck mass moves with swallowing.[healthcentral.com]
Neck Swelling
  • A benign thyroglossal cyst is a common clinical condition and is second only to a cervical lymph node as the most common cause of a solitary neck swelling.[ncbi.nlm.nih.gov]
  • Associations: Ectopic thyroid (40%) Differential diagnoses: The differentials for Thyroglossal cyst includes other causes of midline neck swelling.[epomedicine.com]
  • Lumps within the thyroid gland They present as neck swellings and include thyroid cysts, adenomas and malignancy, all of which commonly present as a single thyroid nodule.[lecturio.com]
  • Case 3 The third case is a case of 85-year-old woman who presented with an anterior neck swelling for the past 10 years and difficulty in breathing for the past 1 month which was gradually worsening.[saudisurgj.org]
  • Keywords: Cystic neck swelling, Sistrunk′s operation, thyroglossal duct cyst How to cite this article: Ramalingam W, Chugh R. Thyroglossal duct cyst: Unusual presentation in an adult.[laryngologyandvoice.org]

Workup

TGCs are diagnosed clinically but radiological testing is required to confirm the diagnosis and to detect the presence of the thyroid gland in children. Physical examination finding of a midline cervical mass which moves with swallowing or protrusion of the tongue is the classical presentation of TGC.

A majority of clinicians prefer ultrasound for initial diagnosis, especially in children, as it is non-invasive, easily available, is not associated with exposure to radiation, and does not require sedation. Ultrasound reveals fluctuant, cystic mass which occasionally spread cervical strap muscles. The fluid within the cyst appears anechoic although in some cases the fluid may contain debris. The walls of the cyst are thin and avascular. Rarely, in a presence of an infection, there may be evidence of inflammatory changes.

Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to delineate the extent of the mass and its anatomic relationship to neighboring structures [10] [14] [15] [16]. CT findings include a well circumscribed cystic lesion with rim enhancement [17]. The cysts have a thin wall and appear smooth, well defined, homogeneously attenuated, and located usually within 2 cm of the midline. There may be displacement of the sternocleidomastoid either posteriorly or posterolaterally and in certain cases, TGCs may be embedded in the infrahyoid (strap) muscles. CT scan is preferred in adults as TGCs are rare in adults and therefore have a broader differential diagnosis and also because the incidence of malignancies associated with TGCs in adults is higher which CT scans are able to detect better than the ultrasound.

MRI is preferred when TGCs are located near the base of the tongue. TGC features on MRI are a low, variable T1 signal in uncomplicated cysts and a high signal if there is previous hemorrhage or infection [18]. T2 image shows a high signal.

Treatment

  • Before initiating treatment, primary papillary carcinoma of the thyroid gland must be excluded. The treatment options range from simple excision to a Sistrunk operation with concurrent cervical lymph node dissection.[ncbi.nlm.nih.gov]
  • Treatment Options Definitive treatment is surgery to completely excise the lesion. If the cyst is infected, it should be treated with antibiotics to cover typical head and neck flora prior to surgical treatment.[dermatologyadvisor.com]

Prognosis

  • Prognosis is good as metastasis is uncommon. Sistrunk procedure is adequate if histology does not reveal extracystic extension.[ncbi.nlm.nih.gov]
  • Prognosis Recurrence occurs in approximately 3-5% of the cases and is increased by incomplete excision and a history of recurrent infections. Differential diagnosis cervical branchial cysts See also thyroglossal tract[humpath.com]
  • Histopathological type of tumour like squamous cell or anasplastic will give poorer prognosis. Those who had initial Sistrunk procedure have better prognosis than simple cystectomy [ 13 ].[omicsonline.org]
  • […] high signal (most common 6 ) due to previous hemorrhage or infection high protein (probably due to previous complication) T2: typically high signal T1 C (Gd) no enhancement in uncomplicated cysts thin peripheral enhancement may be seen Treatment and prognosis[radiopaedia.org]

Etiology

  • The literature is reviewed regarding the embryology, epidemiology, etiology, symptomatology, radiology, histology, and treatment of this cyst and its malignant counterpart.[ncbi.nlm.nih.gov]
  • Etiology The etiology of TDC is remnant tissue from the tract formed during the normal migration of thyroid tissue from the base of the tongue to the lower neck.[dermatologyadvisor.com]
  • Most common congenital anomaly of the neck 2-4% of all neck masses Over half present in the first decade of life but may also be seen in adults Pyramidal lobe of the thyroid is the most common remnant of the thyroglossal tract (50% of population) Etiology[learningradiology.com]
  • Etiology of Thyroglossal Cysts The development of the thyroid gland begins at the 4th week of gestation from the floor of the pharynx (the formation of the future tongue) at the site of foramen cecum.[lecturio.com]

Epidemiology

  • The literature is reviewed regarding the embryology, epidemiology, etiology, symptomatology, radiology, histology, and treatment of this cyst and its malignant counterpart.[ncbi.nlm.nih.gov]
  • […] thyroglossal cyst cyst of the thyroglossal tract Tuesday 9 March 2004 Cyst of the thyreoglossal tract; thyroglossal tract cyst, thyreoglossal cyst Digital case (Digital slides) HPC:374 : Cyst of the thyroglossal tract HPC:417 : Cyst of the thyroglossal tract Epidemiology[humpath.com]
  • Epidemiology: 90% of the cases present before 10 years of age or may remain asymptomatic until infected (can present at any age) Most common congenital neck swelling 2nd most common benign neck mass after lymphadenopathy Most common anomalies of thyroid[epomedicine.com]
  • Epidemiology: TGDC slightly more common in females. It most commonly presents in the first decade of life, usually between years two and five. It may present with redness, and drainage if it is infected.[eapsa.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The pathophysiology of TDC is the failure of cells of the thyroglossal tract to involute.[dermatologyadvisor.com]
  • We also perform all general paediatric ENT surgery, with the exception of: surgery for children under the age of two complex craniofacial disorders genetic conditions with complex pathophysiology.[lnwh.nhs.uk]
  • Synonyms: thyroglossal duct cyst Thyroglossal cysts (TGCs) represent the most common congenital anomaly of the neck. [ 1 ] They account for 2-4% of all neck masses. [ 2 ] Origin and pathophysiology TGCs arise from a persistent epithelial tract, the thyroglossal[patient.info]
  • […] cyst from the median Can be dislocated due to inflammation / fibrosis or previous surgery ( Int J Pediatr Otorhinolaryngol 2003;67:1285 ) Diagrams / tables Images hosted on other servers: Thyroglossal tract Thyroglossal duct cyst Management algorithm Pathophysiology[pathologyoutlines.com]
  • Pathophysiology Branchial system anomalies can manifest as a sinus, fistula, or cyst. Branchial cleft sinuses with external openings are usually associated with the first and second branchial cleft arches.[emedicine.com]

Prevention

  • Prevention of Thyroglossal Cysts As thyroglossal cysts are a birth defect, there is no preventive strategy in avoiding the occurrence of this condition in a person. However, the prevention can be carried out in terms of preventing the complications.[lecturio.com]
  • This case highlights the importance of the Sistrunk procedure, (the removal of the entire thyroglossal tract) for preventing not only cyst recurrence, sinus and fistula formation, but also the occurrence of carcinoma.[ncbi.nlm.nih.gov]
  • Your child’s surgeon will most likely place a small drain which will remain in place overnight to prevent fluid from building up underneath the skin. Your child will be monitored in the hospital overnight and able to return home the following day.[nationwidechildrens.org]
  • Prevention & Risk Assessment Prevention & Risk Assessment What causes a thyroglossal duct cyst? A thyroglossal duct cyst is a congenital (present from birth) defect.[childrensnational.org]

References

Article

  1. Koeller KK, Alamo L, Adair CF, Smirniotopoulos JG. Congenital cystic masses of the neck: radiologic-pathologic correlation. Radiographics. 1999;19(1):121-146.
  2. Moore KL, Persaud TVN. The pharyngeal apparatus. Moore KL, Persaud TVN. The developing human: clinically oriented embryology. 7th edition. Philadelphia: Saunders; 2003. 202-240.
  3. Prasad KC, Dannana NK, Prasad SC. Thyroglossal duct cyst: an unusual presentation. Ear Nose Throat J. 2006;85(7):454-456.
  4. Acierno S, Waldhausen J. Congenital Cervical Cysts, Sinuses and Fistulae. Otolaryngol. Clin N Am. 2007;40:161–176.
  5. Batsakis JG. Tumors of the head and neck: clinical and pathological considerations. 2nd ed. Baltimore: Williams & Wilkins; 1979. pp. 233–239.
  6. Allard RH. The thyroglossal cyst. Head Neck Surg. 1982;5(2):134-46.
  7. Plaza CPR, Lopez MED, Carrasco CEG, et al. Management of well-differentiated thyroglossal remnant thyroid carcinoma: time to close the debate? Report of five new cases and proposal of definitive algorithm for treatment. Annals of Surgical Oncology. 2006; 13 (5):745–752.
  8. Boswell WC, Zoller M, Williams JS, Lord SA, Check W. Thyroglossal duct carcinoma. Am Surg. 1994;60(9):650-655.
  9. Heshmati HM, Fatourechi V, van Heerden JA, Hay ID, Goellner JR. Thyroglossal duct carcinoma: report of 12 cases. Mayo Clin Proc. 1997;72(4):315-319.
  10. Zander DA, Smoker WR. Imaging of ectopic thyroid tissue and thyroglossal duct cysts. Radiographics. 2014;34(1):37-50.
  11. Renard TH, Choucair RJ, Stevenson WD, Brooks WC, Poulos E. Carcinoma of the thyroglossal duct. Surg Gynecol Obstet. 1990; 171(4):305-308.
  12. Yanagisawa K, Eisen RN, Sasaki CT. Squamous cell carcinoma arising in a thyroglossal duct cyst. Arch Otolaryngol Head Neck Surg.1992; 118(5):538-541.
  13. Tharmabala M, Kanthan R. Incidental thyroid papillary carcinoma in a thyroglossal duct cyst. management dilemmas. International Journal of Surgery Case reports. 2013;4:1:58-61.
  14. Huoh KC, Durr ML, Meyer AK, Rosbe KW. Comparison of imaging modalities in pediatric thyroglossal duct cysts. Laryngoscope. 2012;122(6):1405-1408.
  15. Lee M, Lee YK, Jeon TJ, et al. Frequent visualization of thyroglossal duct remnant on post-ablation 131I-SPECT/CT and its clinical implications. Clin Radiol. 2015;70 (6):638-643.
  16. Aculate NR, Jones HB, Bansal A, Ho MW. Papillary carcinoma within a thyroglossal duct cyst: significance of a central solid component on ultrasound imaging. Br J Oral Maxillofac Surg. 2014;52 (3):277-278.
  17. Reede D, Bergeron R, Som P. CT of Thyroglossal Duct Cysts. Radiology. 1985;157:121–125.
  18. King AD, Ahuja AT, Mok CO et al. MR imaging of thyroglossal duct cysts in adults. Clin Radiol. 1999;54 (5): 304-308.

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Last updated: 2019-06-28 11:50