Thyroglossal cyst in elderly: a rare cause of inspiratory stridor

<p class="abstract">Thyroglossal cyst is the most common congenital anterior neck swelling in childhood. Commonly present as painless swelling in the 2nd decade of life but the cases are reported in the elderly age group also. It represents the persistent epithelial tract from the foramen cecum to the thyroid gland. Clinically can be diagnosed and can be differentiated with other mid-line swelling by movement with the protusion of tongue. It is usually related to the hyoid bone and may be supra-hyoid, infra-hyoid, lower part of the midline or rarely lingual in position. Ultrasonography is the investigation of choice for this cystic condition. It is safe, economical and easily available investigation among all the radiological study. MRI is helpful to diagnose cervical extension and lingual cyst. Inspite of close relation to the laryngeal structure it rarely present as laryngeal mass and causes stridor or sleep apnea as in our case. Classic Sistrunk procedure is the treatment of choice for the condition. Endoscopic CO2 Laser is useful in situation where only intraoral cyst present without cervical extension. Marsupialization is reserved for lingual cyst especially in Neonate. We are reporting this case which was present in the elderly and reported with long standing anterior neck swelling with inspiratory stridor on lying down position.</p>

A Locally Advanced Papillary Thyroid Carcinoma in a Thyroglossal Duct Cyst Presenting as a Benign Cervical Mass: A Case Report

Thyroglossal duct cyst is the most commonly encountered midline and upper cervical mass that can also be a rare form of malignancy of about <1%. This is a rare case without well-defined management and staging criteria and as such, it has been a cause of debates regarding optimal management as well as the extent of completeness of surgery from Sistrunk procedure only to Sistrunk procedure with total thyroidectomy. Conclusion: This is a case report of a rare occurrence of a locally advanced papillary thyroid carcinoma of thyroglossal duct cyst presenting as a benign cervical mass. The management dilemma and ultimate surgical approach was carefully drawn with the patient.

Thyroglossal duct cyst anterior to the sternum: a novel presentation of a common lesion

Thyroglossal duct cysts (TDCs) arise in roughly 7% of the general population and are typically diagnosed in childhood within the first decade of life. Typically, patients present with a painless, midline neck mass in close proximity to the hyoid bone which classically elevates with deglutition and tongue protrusion. We present a case of TDC found anterior to the sternum, a major deviation from the classical understanding of this lesion. The patient was treated successfully with modified Sistrunk procedure. This case underscores the need for clinicians to maintain a wide differential while working up paediatric patients presenting with neck masses. Furthermore, we emphasise that TDC must always be considered in cases of midline paediatric neck masses, even when found in unusual locations such as presented here.

Management of the Thyroid Gland in Papillary Carcinoma of the Thyroglossal Cyst: A Case Report

Carcinoma arising in a thyroglossal cyst is rare. We present a case of anterior neck swelling diagnosed to be thyroglossal cyst clinically which turns out to be a papillary carcinoma arising in thyroglossal cyst. She underwent sistrunk procedure with total thyroidectomy and diseasefree on follow up evaluation. Even though preoperative ultrasonography had shown thyroid nodule, the final histology did not show malignancy. There is a paucity of clear-cut guidelines in the management of the thyroid gland in a thyroglossal cyst carcinoma. In thyroglossal cyst carcinoma cases, we recommend thyroidectomy only when there is a thyroid nodule with high-risk features.

MON-438 Papillary Thyroid Carcinoma Arising in a Thyroglossal Duct Cyst: A Case Report

Introduction: Thyroglossal duct cysts (TGDCs) are uncommon benign congenital entities. Rarely, thyroid carcinoma can arise from a TGDC; the most common being papillary thyroid carcinoma (PTC). Similar to TGDC, carcinomas originating within them can present as an asymptomatic midline neck mass. Signs of malignancy include dysphagia, dysphonia, weight loss, and rapid growth. Given the rarity of TGDC carcinomas, clinical management remains controversial, particularly regarding the requirement for total thyroidectomy. Case: A 52-year-old female with history of an anterior central neck mass initially noted in 2017. A 0.3-cm left lobe mid-segment cyst and a complex thyroglossal avascular simple cyst measuring 2.4 × 1.1 × 1.8 cm was observed during ultrasound (US). She presented to the endocrinology clinic in April 2019 due to progressive enlargement of the mass. Repeat thyroid US revealed that the cystic structure had become complex with a peripheral solid component and measured 3.3 × 2.1 × 2.2 cm. FNA was performed and found to be suspicious for PTC (Bethesda category V) and positive for the BRAF V600E mutation. Patient was referred for surgical evaluation. Physical examination revealed a midline anterior 10-cm, painless, and fixed mass above the thyroid that moved with deglutition and tongue protrusion. Contrast computed tomography scan showed a large multiloculated cystic structure measuring 4.1 × 4.4 × 5.9 cm. A lobulated soft tissue mass measuring 2.2 × 2.4 × 3.0 cm was noted internally along the inferior margin of the cyst. She underwent en-block resection of the TGDC in addition to a total thyroidectomy. Histopathological examination identified a 7.5 × 5.5 × 5.0 cm cystic mass with fluctuation and a firm, solid area in the lower portion measuring 2.6 × 2.4 cm. Thyroid gland examination was otherwise unremarkable. No areas of extension of the mass into the thyroid tissue were clearly identified and no other gross lesions were observed. The solid area within TGDC contained a tumor with findings characteristic of PTC. Postoperatively, she was placed on thyroid hormone replacement therapy. Conclusion: The main difficulty encountered with cancer developing from TGDC is that the diagnosis is usually made during surgery and from definitive pathological samples. The most common surgical procedure used is the Sistrunk procedure. Some studies have suggested that this procedure alone is an adequate therapy, but others advocate the need for total thyroidectomy. The Sistrunk procedure is considered to be appropriate for low-risk patients, but high-risk patients must undergo total thyroidectomy. The decision to perform a total thyroidectomy in this patient was based on her high-risk classification due to: age, sex, cyst size, and a positive FNA for malignancy. Follow-up includes an annual physical examination, thyroglobulin levels, and an US every 6 months during the first year and annually thereafter.