An investigation of the thyroglossal tract using the radioisotope scan

Thyroglossal duct carcinoma: presentation and management, including eight cases reports

Although thyroglossal duct cysts represent a common developmental abnormality of the thyroid gland, malignant transformation is rare and occurs in only 1%. This article describes eight patients who were referred to the Royal Marsden Hospital between 1956 and 1991. There were five males and three females, aged from 14 to 71 years (mean 44.6). There were seven papillary carcinomas and one follicular carcinoma. Patients were followed for between 6 and 41 years (mean 16.5). Management comprised: surgical excision only in four patients; surgical excision plus thyroidectomy followed by radioiodine in three; and radioiodine following only biopsy in one patient with lingual thyroid carcinoma. Multifocal carcinoma of the thyroid was found in one patient and a single focus of carcinoma in the thyroid gland in another; lymph node metastases were found in only one patient. There was no history of previous exposure to ionizing radiation.

An unusual case of intermittent upper airway obstruction

Thyroglossal duct cyst is an unusual cause of intermittent upper airway obstruction and rarely produces obstructive symptoms in adults. Previous reports discuss airway obstruction in small children and infants and point out the complications of such cysts, including thyroid carcinoma, adenoma, thyroiditis, and thyrotoxicosis, as well as inflammation and infection. Diagnosis should be considered in all cases of midline neck masses and is usually aided by diagnostic imaging. Treatment may involve airway maintenance and surgical excision of the cyst and its entire tract.

Atypical thyroglossal duct cyst

Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.

The thyroglossal cyst

The thyroglossal cyst is the most common nonodontogenic cyst in the neck. This cyst may also occur in the lingual or submental areas, though more rarely. Malignant changes have been described. Clinically, no differentiation between a benign cyst and a malignancy can be made. The literature is reviewed regarding the embryology, epidemiology, etiology, symptomatology, radiology, histology, and treatment of this cyst and its malignant counterpart.

Postirradiation carcinoma in a thyroglossal duct remnant: follicular variant of papillary thyroid carcinoma

A case of carcinoma in a thyroglossal duct remnant is presented. The tumor was a rare follicular variant of the papillary type of thyroid carcinoma. The patient had received external beam radiation to the head and neck both as a child and as an adolescent. The recently reported increased incidence of thyroid carcinoma is believed to be related to the former practice of irradiating cervical thymic and lymphoid tissue in children. Since it is normal thyroid tissue that remains in the thyroglossal duct tract, this ectopic tissue presumably has the same malignant potential as that in the thyroid gland. Therefore, more cases of carcinoma in a thyroglossal duct remnant may be seen as those patients who underwent head and neck irradiation in childhood mature.

Ultrasonic and fluorescent scanning: A combined noninvasive diagnostic approach to extrathyroidal neck lesions

Thirteen patients with suspected extrathyroidal neck masses were investigated with the combination of fluorescent scanning and echography. Iodine content, the solid or cystic consistency of the lesion, and the position of the lesion with respect to the thyroid were determined preoperatively to estimate thyroidal origin and benignity or malignancy of the lesions. Pathologic diagnoses correlated well with these totally noninvasive studies of extrathyroidal neck masses.

Thyroglossal duct carcinoma

Primary carcinoma of the thyroglossal duct is rare. This discussion reports two cases and reviews the 50 previously reported in the literature. The criteria for diagnosis include evidence of a thyroglossal duct remnant and a normal thyroid gland. The differentiation from cystic metastases to lymph nodes is pointed out. The histologic types parallel those of carcinoma of the thyroid gland, papillary carcinoma being the most common and having a generally favorable prognosis. The clinical presentation of these tumors is similar to that with benign cysts and thus is of limited value in the diagnosis.