Congenital Neck Masses

There are many possible causes of congenital neck masses, with the most common ones being thyroglossal duct cysts, branchial cleft anomalies, and vascular malformations. Most congenital neck masses are asymptomatic in the neonatal period, but depending on the location and the size, they can cause airway obstruction and serious complications at birth. Proper diagnosis is important for optimal treatment planning, and if the airway is compromised, multidisciplinary teamwork is critical for proper airway management. This review summarizes the clinical features, etiology, diagnosis, management, and prognosis of different types of congenital neck masses.

[Congenital cysts and fistulas on the neck in adults]

Cervical congenital malformations are relatively common in children. They can also be found in adults. The embryological development of the cervical region is closely related to the branchial clefts. This must be a diagnosis made by elimination; a cervical tumor must evoke the diagnosis of cancer. A cutaneous fistula or a cervical tumor, chronic or recent appearance in an inflammatory context, are the clinical signs. The thyroglossal duct cysts and the second branchial clefts cysts are the most common causes of median and lateral cervical cysts, respectively. Imaging contributes greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is initially based on antibiotic therapy and then on complete surgical excision, away from an infectious episode, the sole guarantee for the absence of local recurrence.

Congenital cystic lesions of the head and neck

This article presents clinical characteristics and radiologic features of congenital cervical cystic masses, among them thyroglossal duct cysts, cystic hygromas, branchial cleft cysts, and the some of the rare congenital cysts, such as thymic and cervical bronchogenic cysts. The imaging options and the value of each for particular masses, as well as present clinical and radiologic images for each, are discussed.

Congenital neck masses in children and their embryologic and clinical features

Congenital neck masses in children and their embryologic and clinical features. Neck masses of congenital origin can be diagnostic and therapeutic challenges for internists, paediatricians and surgeons. Treatment modalities of congenital neck masses are different depending on their nature, symptoms and location. Differential diagnosis includes a variety of diseases that can cause cervical masses such as infectious and neoplastic neck tumours. Our objective is to review the embryologic and clinical features of some of the most common congenital neck masses such as the haemangioma, branchial cleft anomalies, thyroglossal duct cyst, ectopic thyroid, congenital midline cervical cleft, congenital cervical teratoma, lymphangioma, cervical thymic cyst, dermoid cyst and congenital muscular torticollis.

Hereditary thyroglossal duct cysts

Thyroglossal duct cysts are one of the most commonly encountered benign neck lumps found in the paediatric population. Despite their relative frequency, reports of familial inheritance are rare. A total of 21 patients with hereditary thyroglossal duct cysts from seven families worldwide have been reported. The most common inheritance pattern is dominant, with a minority possibly representing a recessive aetiology. We describe a further instance of dominantly inherited thyroglossal duct cysts in two generations.

A thyroglossal duct cyst causing apnea and cyanosis in a neonate

This is a case of a 3-week-old male who presented to the emergency department with intermittent apnea and cyanosis. While in the emergency department, he had respiratory compromise with stress and required intubation. Further evaluation confirmed the diagnosis of a thyroglossal duct cyst. Congenital lesions causing extrinsic airway compression should be considered in all neonates with apnea, cyanosis, and respiratory compromise. Knowledge of pediatric airway anatomy and physiology is important in all cases where obstructive apnea is suspected.

[Congenital cysts and fistulas of the neck]

On the base of literature and their own 123 patients the authors present the frequency, diagnostics and treatment of congenital neck fistulas and cysts. We had 9 congenital fistulas: 6 median and 3 lateral. We treated 114 patients with neck cysts.: 29 median and 85 lateral, from which 50 were at the right side. The disease mainly manifested in 10-19 year-old patients--25 cases and in 30-39 year-old patients--21 cases. We divided the lateral neck cysts according to Bailey's--the most frequent of which were of III type--44.7%, II type--32.94%, IV type 16.58% and I type 5.88%. All patients were radically operated on-that is they had totally enucleated fistula or cyst. In the case of median fistulas or cysts we didn't extirpate the body of the hyoid bone but in the case of duct going to caecal foramen of the tongue, we elevated the hyoid bone and with Storz lupe we prepared the duct to the root of the tongue. We didn't have any recurrence resulting from this kind of treatment. We had a recurrence in one patient (0.81%) with median cyst of the neck which was localised in the lower part of the neck and was connected with thyroid. We reoperated this patient and we had a complete recovery.

Pathological analysis of congenital cervical cysts in children: 20 years of experience at Chang Gung Memorial Hospital

BACKGROUND

Congenital cervical cysts are frequently encountered in pediatric populations, and constitute one of the most intriguing areas of pediatric pathology. This report analyzes cervical cysts in Taiwanese children diagnosed at Chang Gung Memorial Hospital (CGMH) over the past 20 years. The pathologic and clinical findings are reviewed.

METHODS

Files on 331 patients under the age of 18 years, with a diagnosis of congenital cervical cyst at CGMH from January 1, 1983 to June 30, 2002, were retrieved from the Department of Pathology. There were 204 boys and 127 girls. We reviewed the histology of all cases and correlated it with clinical information in the medical records.

RESULTS

Thyroglossal duct cysts, the most common congenital neck cyst, accounted for 54.68% of all cases, followed by cystic hygromas (25.08%), branchial cleft cysts (16.31%), bronchogenic cysts (0.91%), and thymic cysts (0.30%). Nine cases (2.72%) remained unclassified.

CONCLUSIONS

This is the largest series regarding pediatric cervical cysts in the literature to date. Thyroglossal duct cysts were the most common congenital cervical cyst encountered. Our experience indicates that each type of cyst has its unique location in the neck and is highly associated with its embryonic origin. Complete and precise clinical information is a prerequisite in order for pathologists to make accurate diagnoses of congenital cervical cysts.

Management of congenital anomalies of the neck

This article, although not exhaustive, highlights the most common congenital anomalies of the neck. The diagnostic possibilities for a neck mass are extensive, and congenital malformations account for a minority of neck masses. The misdiagnosis and inappropriate treatment of a neck mass may have serious consequences for the patient. Therefore, a standardized and complete approach to the evaluation of neck masses is required. As stressed in this article, a thorough history and physical examination form the cornerstones of such an evaluation. The fact that congenital lesions of the neck have varied manifestations and may present at any age should always be considered.

Morphology of the human thyroglossal tract: a histologic and macroscopic study in infants and children

The anatomic development of thyroglossal tract remnants is not understood at present. For analysis of morphology and growth patterns of thyroglossal tract remnants, we used histologic whole organ serial sections to determine developmental changes through the first years of life. Larynges of 58 infants and children ages 1 month to 13 years were obtained in whole organ serial step-sections in an axial plane. The slides were stained with hematoxylin and eosin, Alcian blue, and periodic acid-Schiff stains. Altogether, 3,247 histologic slices were examined. The resulting data were then correlated with the age and sex of the specimens. We found, in 24 cases (41.3%), remnants of the thyroglossal tract or ectopic thyroid tissue. In 4 specimens (16.6%), a complete thyroglossal tract could be observed that presented a ventral path in relation to the hyoid bone with no contact with the perichondrium of the cartilage. Hormonal activity of ectopic thyroid tissue was proven in 20 cases (34.5%). Thyroid follicles were located in 2 cases (3.5%) in the hyoid bone. The thyroglossal ducts revealed a modest tendency for a left-sided pathway, whereas thyroid follicles were located more on the right paramedian side. Morphometric data on the development and structure of the thyroglossal tract and the thyroid follicles during infancy and childhood are presented. The study provides quantitative data of clinical interest that elucidate the anatomy of thyroglossal tract remnants. In addition, our investigation supports Sistrunk's operative approach for avoiding recurrences in the treatment of thyroglossal duct cysts.

Congenital cysts and fistulas of the neck

This retrospective study describes a series of 191 children treated for congenital cysts and fistulas of the neck between 1984 and 1999 in the pediatric ORL Department of La Timone Children's Hospital. Preauricular fistulas and cystic hygromas were not included. The anomalies in this series were classified as either malformations of the midline or malformations of laterocervical region. Malformations of the midline included the thyroglossal duct cysts (n=102) and dermoid cysts (n=21). The most common malformations of the laterocervical region were cysts and fistulas of the second cleft (n=37) followed by those of the first cleft (n=20),those of the fourth pouch (n=7), and thymic cysts (n=4). Diagnosis of malformations of the midline is usually straightforward. However, diagnosis of malformation of the laterocervical region can be problematic. Misdiagnosis often leads to inadequate treatment with recurrence and functional as well as cosmetic sequelae.

Breath-holding-like spells in an infant: an unusual presentation of lingual thyroglossal duct cyst

The authors report the case of an infant with a lingual thyroglossal duct cyst who presented with breath-holding-like spells, which actually represented life-threatening ball-valve obstruction of the larynx, leading to hypoxemia and transient cerebral dysfunction. When evaluating apparent breath-holding spells in young infants, physicians should include dynamic, episodic upper airway obstruction in the differential diagnosis.

[Congenital cervical deformities]

The paper deals with the survey of 66 congenital neck malformations (27 thyroglossal cysts and 32 branchial plus 7 lymphatic anomalies) surgically treated in the last 5 years term. Thyroglossal cysts presented in children and young people, in the middle line, and 92.6% of them were infrahyoid. Recidivation appeared in 7.4% of all cases, always in connection with previous infections. Branchial malformations presented on the neck's side of middle age persons were related to the 2nd. cleft (97%). Lymphatic anomalies presented in children under 3 years, in these instances the dissection sheaths were not spared and the neighboring structures altered.

Thyroglossal duct remnant penetrating the hyoid bone--a case report

Examination of the thyroglossal duct (TGD) in a senile patient with a thyroglossal duct cyst (TGDC), as well as in children, is very valuable in understanding the pathology of TGDC. The precise anatomy of TGDC was studied in a specimen obtained from a 59-year-old man using three-dimensional reconstruction. The authors found the TGD penetrated the hyoid bone. This pathological evidence has not previously appeared in the literature. Penetration of the hyoid bone by the TGD is the result of a forward growth of the hyoid bone after development of a TGD, which had appeared ventral to the hyoid bone. In this gradual forward growth, the hyoid bone had first started to press against, before eventually engulfing, the TGD.

Evaluation of neck masses in children

Neck masses in children may be inflammatory, neoplastic or congenital. Although most of these masses are benign inflammatory nodes, an asymptomatic neck mass is the most common presentation of head and neck malignancies in children. Cystic lesions are usually pharyngeal cleft remnants or vascular malformations, whereas solid lesions are generally inflammatory or neoplastic. While the history and the physical examination are the most important parts of the evaluation of neck masses in children, biopsy may be necessary to establish the diagnosis.

Thyroglossal duct cysts: variability of sonographic findings

OBJECTIVE

The purpose of this study was to describe the sonographic features of thyroglossal duct cysts, emphasizing the variable sonographic appearances, and determine if the presence of infection or inflammation influences the sonographic appearance.

MATERIALS AND METHODS

We reviewed the sonograms in 12 children (2 months-16 years old) with pathologically proven thyroglossal duct cysts (TDCs). The cysts were evaluated for location, size, cystic versus solid features, echogenicity, and wall thickness. The sonographic features then were compared with the pathologic findings.

RESULTS

Sonograms of the 12 lesions showed that nine were midline at or near hyoid bone; two were to the right of midline in the submandibular region; and one was located to the left of midline in the neck. Cysts were from 0.5 cm to 4 cm in diameter. Five lesions were anechoic with no perceptible wall thickness. Seven lesions were hypoechoic. Two of the seven were homogeneously hypoechoic with thin borders. The remaining five lesions were hypoechoic but heterogeneous (complex). One lesion was hypoechoic with small anechoic spaces. Four lesions were largely cystic with dense internal echoes and thick walls. The presence of thick walls and internal echoes did not correlate with the presence or absence of inflammation on pathologic examination. No lesions in our series were hyperechoic.

CONCLUSION

Our results indicate that TDCs have a variable sonographic appearance. Anechoic, homogeneously hypoechoic, and heterogeneous (complex) lesions occur. We found no correlation between the pathologic findings of infection and inflammation and the sonographic appearance of TDCs. Awareness of the variable sonographic appearance of the TDC is helpful when a midline lesion is encountered in the neck.

Familial thyroglossal duct cyst

Thyroglossal duct cysts are common congenital abnormalities or developmental field defects, usually detected in early childhood. Despite their frequent occurrence, familial patterns are rare. We report on two new families with thyroglossal duct cysts. In the first family three siblings were involved, while in the second one, father and son were affected. This trait may be autosomal recessive or possibly multifactorial, as the first family would indicate, and also autosomal dominant, as the second family would suggest.

Thyroglossal duct and second branchial cleft anomalies in adults

Definitive treatment is surgical removal of the cyst and any tract, with care taken to preserve vital structures. TDCs and BCCs are congenital cervical lesions that are encountered in adults. Experiences at the Eye and Ear Hospital of Pittsburgh are reviewed. Forty-five patients with TDCs and 59 patients with BCCs were treated between 1983 and 1988. Clinical findings are discussed and principles for diagnosis are detailed.

Unusual patterns of congenital neck masses in children

Congenital neck masses--thyroglossal duct cysts (TDC) and branchial cleft cysts (BCC)--are frequently encountered in any pediatric surgical practice. While their diagnosis is usually straightforward, unusual or combined presentations may occur. We report eleven cases of unusual patterns of congenital neck masses in children. Two patients underwent resection of a BCC with a sinus tract extending through the carotid bifurcation. Both patients subsequently presented with a new mass near the previous scar, which was thought to be a recurrence but was found at surgery to have TDCs with sinus tracts extending through the hyoid bone. In one patient, a lateral neck mass (presumed to be a BCC) was found at surgery to be a TDC. In all three cases the diagnoses were confirmed histologically. Eight patients presented with a solitary thyroid nodule. Six of these had intrathyroid branchial cleft remnants, and two had intrathyroid TDCs. The diagnosis became apparent at operation in six patients, while in two it was made by the pathologist after hemithyroidectomy. Ages at presentation ranged from 16 months to 14 years. The embryology of these neck structures is closely related. It should not come as a surprise that errors in their development may occur, at times paralleling the occurrence of intrathyroid location of parathyroid glands. The possibility of an embryologic rest in the neck should therefore be kept in mind with all clinically evident neck masses. TDCs and BCCs may coexist in the same patient. The histologic differentiation may be difficult in the presence of inflammation, but differences in structure are often characteristic.(ABSTRACT TRUNCATED AT 250 WORDS)

Congenital neck masses

Neck masses are frequently encountered in children. Although they are most often due to past infections, they may be of congenital origin. A neck mass in an adult may also be benign and of congenital origin. Common congenital neck masses include thyroglossal duct cysts, branchial anomalies, cystic hygromas and hemangiomas. Cysts, sinuses and fistulas may arise from the branchial apparatus.

Thyroglossal duct cysts. A thirty year experience with emphasis on occurrence in older patients

A total of 79 patients (39 female and 40 male) underwent the Sistruck procedure for thyroglossal duct cysts. Twenty-eight percent of the patients were over 50 years of age and 10 percent were over 60. The age range was 16 months to 82 years. Three patients had thyroidectomies, two of which were for carcinoma, along with resection of a thyroglossal duct cyst. Two patients, one diagnosed preoperatively by needle biopsy, had papillary carcinoma in thyroid tissue of the cyst wall. The length of time from cyst discovery to surgery was the same for patients over 10 years of age. We suggest needle biopsy of all neck masses and also elective operation in a patient of any age, once a diagnosis of thyroglossal duct cysts is made. The Sistrunk procedure is the operation of choice.

The neck mass. 1. General concepts and congenital causes

A carefully taken history and thorough physical examination are the first steps in establishing the cause of a neck mass. Location, size, consistency, and mobility of the mass provide clues and are useful for comparison during follow-up. Further studies are ordered on the basis of the impressions gathered from this evaluation. Congenital neck masses can be found in patients of any age. Thyroglossal duct and branchial cleft cysts and fistulas are formed by incomplete obliteration of the thyroglossal duct and branchial clefts during embryonic development. Other congenital causes include lymphangiomas, cystic hygromas, dermoid cysts, and hemangiomas. Laryngoceles are acquired cysts that arise from an anatomic remnant, the laryngeal ventricle. Treatment for these neck masses is nearly always surgical removal.

Branched and polycystic thyroglossal duct anomaly

An unusual thyroglossal duct anomaly characterized by a branched tract terminating in two separate cysts is described. The patient presented with a long-standing fistula following previous incomplete excision. Thyroglossal cysts are common congenital anomalies (Moussatos and Baffes, 1963; Allard, 1982), which do not usually present any diagnostic difficulty. However, they may sometimes present with unusual clinico-pathological features. In this report we describe a branching and polycystic thyroglossal duct abnormality occurring in a young woman with a history of previous surgery for a midline cervical mass.

Computer-tomographic appearance of branchial cleft and thyroglossal duct cysts of the neck

The usefulness of computer tomography (CT) in the evaluation of a congenital neck mass has received little attention in the literature. We present the CT findings in two relatively common congenital neck masses - the thyroglossal duct cyst and the branchial cleft cyst. These cysts present a relatively common CT appearance of a mass with an enhancing capsule and a lucent center measuring between 20 and 35 Houndsfield Units. The branchial cleft cyst commonly occurs along the lateral border of the neck, anterior to the sternocleidomastoid muscle, while the thyroglossal duct cyst occurs along the midline of the neck. CT is excellent for determining the location, size, extent and character of these two common congenital neck masses.