RESUMO
BACKGROUND: Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient. CASE PRESENTATION: a 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk's procedure to avoid future complications and anesthesia. CONCLUSIONS: even if TDC is a common lesion of pediatric patients, anecdotical neonatal cases were described in the literature, all of them symptomatic. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk's procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.
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Achados Incidentais , Intubação Intratraqueal , Cisto Tireoglosso , Humanos , Cisto Tireoglosso/diagnóstico , Cisto Tireoglosso/cirurgia , Cisto Tireoglosso/diagnóstico por imagem , Masculino , Intubação Intratraqueal/efeitos adversos , Recém-Nascido , UltrassonografiaAssuntos
Cisto Mediastínico , Cisto Tireoglosso , Humanos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Cisto Tireoglosso/patologia , Cisto Mediastínico/diagnóstico por imagem , Cisto Mediastínico/cirurgia , Cisto Mediastínico/complicações , Tomografia Computadorizada por Raios X , Feminino , Masculino , Coristoma/diagnóstico por imagem , Coristoma/cirurgiaRESUMO
Thyroglossal duct cysts (TGDCs) are congenital and developmental abnormalities in infants and young children. This retrospective case series study examined the characteristics of 7 patients <3 years (mean age, 1.9 years) with TGDC complicated with a parapharyngeal mass treated at one hospital between January 2019 and 2022. Four patients had a painless mass around the neck, 2 had a painless mass associated with snoring, and 1 presented repeated swelling and pain. B-ultrasound suggested 6 cases of TGDC and 1 possible lymphangioma. All patients were treated with Sistrunk surgery to remove the TGDC. Six patients had no cyst recurrence during follow-up (6 months to 2 years). In conclusion, TGDC complicated with a parapharyngeal mass has complex and variable clinical manifestations. Completely removing the cyst while sparing thyroid cartilage and surrounding vascular and neuroanatomical structures is important to avoid complications. The patients are likely to be free from recurrence after surgery.
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Cisto Tireoglosso , Criança , Lactente , Humanos , Pré-Escolar , Cisto Tireoglosso/complicações , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Estudos Retrospectivos , Prognóstico , Pescoço , UltrassonografiaRESUMO
ABSTRACT: Thyroglossal duct cyst is the most common congenital neck mass, but the incidence of malignancy within a thyroglossal duct cyst is rare, estimated at 1%. Most cancers arising within thyroglossal duct cysts are incidentally detected after surgical excision. We present the preoperative radiologic findings of 8 patients with papillary thyroid cancer arising within a thyroglossal duct cyst, as evaluated on ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography scan.
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Carcinoma Papilar , Cisto Tireoglosso , Neoplasias da Glândula Tireoide , Humanos , Carcinoma Papilar/patologia , Cisto Tireoglosso/complicações , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Câncer Papilífero da Tireoide/complicações , Câncer Papilífero da Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/métodosRESUMO
This retrospective study aimed to investigate clinical diagnostic and management characteristics of double thyroglossal duct cyst (TDC) cases. Seventy-eight patients diagnosed with TDCs who were admitted to the inpatient ward of the Department of Otolaryngology, Dalian Central Municipal Hospital from June 2008 to October 2021 were included in the study. Ultimately, 67 of these patients were diagnosed with single TDCs and 11 patients with double TDCs. Each patient underwent computed tomography and color doppler ultrasound imaging of their neck masses, thyroid color doppler ultrasound imaging, and surgical cyst removal through the classic Sistrunk procedure. All surgically excised specimens were sent to the pathology lab for examination and were confirmed to contain TDCs. Two of the 67 patients with single TDCs experienced postoperative complications related to infections within the operative area, whereas no patients with double TDCs experienced postoperative infection, excessive bleeding, or other surgical complications. All cases were followed up for 1 to 3 years after surgery with no cyst recurrence observed. Double TDCs may present on physical examination as unilateral neck masses that interfere with tongue extension and movement and swallowing that can be identified using imaging methods. Correct clinical diagnosis and complete surgical removal of cysts are key measures for ensuring successful treatment outcomes for patients with TDCs.
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Cisto Tireoglosso , Humanos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Estudos Retrospectivos , Glândula Tireoide/cirurgia , Resultado do Tratamento , Complicações Pós-OperatóriasRESUMO
INTRODUCTION: Midline neck swellings are very common in children and mostly caused by thyroglossal duct cysts (TGDCs) or dermoid cysts (DCs). Since DCs can undergo simple excision, whilst TGDCs demand more thorough resection via Sistrunk procedure, it is important to differentiate between both pre-operatively. Previous studies have suggested an ultrasound-score (SIST) based on presence of septae, wall irregularity and solid components could do so. This study aims to evaluate the diagnostic accuracy of this score. METHODS: All patients (≤18â¯years) undergoing surgery between 2006 and 2018 for a midline neck mass at our tertiary centre with a histopathological diagnosis of TGDC or DC were retrospectively included. The pre-operative ultrasound was evaluated by an experienced radiologist and the SIST as well as location, tract, echogenicity, margin and multilocularity were scored. RESULTS: We included 97 children, of whom 67 (69â¯%) with TGDCs. The SIST showed a sensitivity of 37â¯%, specificity of 97â¯%, a positive predictive value of 96â¯% and a negative predictive value of 35â¯% for the SIST-score in detecting TGDCs, which resulted in an AUC of 0.67. In addition, internal echogenicity (Pâ¯<â¯0.01) and margin definition (Pâ¯<â¯0.01) were significantly associated to TGDC diagnosis whilst location and multilocularity were deemed insignificant following Bonferroni correction. CONCLUSION: We conclude that the SIST-score seems very capable to rule in TGDC. However, the SIST-score is far from making a clear distinction between DC and TGDCs preoperatively. The addition of other ultrasound variables, such as margin definition and echogenicity, might increase the diagnostic accuracy and demands further research.
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Cisto Dermoide , Cisto Tireoglosso , Criança , Humanos , Estudos Retrospectivos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Cisto Dermoide/diagnóstico por imagem , Cisto Dermoide/cirurgia , Cisto Dermoide/patologia , Ultrassonografia/métodos , Glândula Tireoide/patologiaRESUMO
OBJECTIVE: To validate and compare novel ultrasound scoring systems for dermoid cysts and thyroglossal duct cysts among pediatric patients. STUDY DESIGN: Retrospective study. SETTING: Tertiary care children's hospital. METHODS: An electronic medical record query of patients younger than 18 years old who underwent primary excision of a neck mass between January 2005 and February 2022, who underwent preoperative ultrasound, and had final histopathologic diagnosis of either thyroglossal duct cysts or dermoid cysts. This generated 260 results, of which 134 patients met the inclusion criteria. Charts were reviewed for demographic data, clinical impressions, and radiographic studies. Radiologists blindly reviewed ultrasound for SIST score (septae + irregular walls + solid components = thyroglossal), and 4S algorithm (Septations, depth relative to Strap muscles, Shape, Solid parts). Statistical analyses were performed to determine the accuracy of each diagnostic modality. RESULTS: Of 134 patients, 90 (67%) had a final histopathologic diagnosis of thyroglossal duct cysts, and 44 (33%) were dermoid cysts. The accuracy of clinical diagnosis was 52%, and preoperative ultrasound report accuracy was 31%. The 4S and SIST accuracies were each 84%. CONCLUSION: Both the 4S algorithm and SIST score provide increased accuracy of diagnosis relative to standard preoperative ultrasound assessment. Neither scoring modality was determined to be superior. Further research is warranted in improving the accuracy of preoperative assessments for pediatric congenital neck masses.
Assuntos
Cisto Dermoide , Cisto Tireoglosso , Criança , Humanos , Adolescente , Estudos Retrospectivos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Cisto Dermoide/diagnóstico por imagem , Cisto Dermoide/cirurgia , UltrassonografiaRESUMO
Objective:To provide reference for preoperative diagnosis and treatment of thyroglossal duct cyst by studying the morphological changes of hyoid body. Methods:The CT dataï¼midsagittal imageï¼ of congenital thyroglossal duct cystï¼TGDC groupï¼ diagnosed by pathology and the control groupï¼C groupï¼ were collected from January 2016 to October 2021. The differences of hyoid body heightï¼HBHï¼, hyoid body widthï¼HBWï¼, hyoid bone thicknessï¼HBTï¼, HBW/HBH, HBT/HBH between the two groups were compared. HBH, HBW and HBT were analyzed by t-test; The HBW/HBH and HBT/HBH were analyzed by Mann-Whitney U test. Results:Twenty-nine cases were included in the TGDC group and 58 in the C group. The HBH in the TGDC group wasï¼8.93 ±0.22ï¼ mm and that in the C group wasï¼8.94±0.12ï¼ mm, there was no significant difference between the two groupsï¼P>0.05ï¼. The HBW in the TGDC group and the C group wereï¼5.09±0.21ï¼ mm andï¼4.48±0.11ï¼ mm, and the HBT wereï¼3.84±0.12ï¼ mm andï¼3.13±0.08ï¼ mm, respectively, the difference between the two groups was statistically significantï¼P<0.05ï¼. The average rank sum of HBW/HBH in the TGDC group and the C group was 53.95 and 39.03, respectively, and the average rank sum of HBT/HBH was 59.90 and 36.05, respectively, the difference between the two groups was statistically significantï¼P<0.05ï¼. Conclusion:The morphological changes of hyoid body of thyroglossal duct cyst may be helpful for preoperative diagnosis, and it also suggests that hyoid body resection may reduce the possibility of postoperative recurrence.
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Cisto Tireoglosso , Humanos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/patologia , Cisto Tireoglosso/cirurgia , Osso Hioide/diagnóstico por imagem , Diagnóstico por ImagemRESUMO
OBJECTIVE: To discuss our institutional experience with endoscopic management of intralingual thyroglossal duct cyst (TGDC) and review cases in the published literature in a systematic review. METHODS: Pediatric patients with intralingual TGDC treated with endoscopic surgery at our institution from 2009-2019 were identified. Metrics from our case series were then compared to those in the literature in a systematic review to assess pooled outcomes of endoscopic or transoral management. Patient demographics, age of presentation, presenting symptomatology, size of cyst on imaging, type of surgery, and post-operative outcomes were assessed. RESULTS: We identified 5 institutional cases of intralingual TGDC and 48 cases of intralingual TGDC described in the literature. The average age of presentation was 20.36 months. 69.8% (N=37) of patients presented with at least one respiratory symptom, 22.6% (N=12) presented with dysphagia, 9.4% (N=5) presented with an identified mass in the oropharynx, and 15.1% (N=8) had the cyst discovered as an incidental finding. Three patients required revision surgeries due to prior incomplete TGDC excisions and one patient experienced a recurrence >6 months after primary excision requiring a second procedure. Our data pooled with published case series in systematic review confirms that endoscopic or transoral management are excellent options for definitive management of intralingual TGDC. CONCLUSIONS: Intralingual TDGC is a potentially life-threatening variant of TGDC. Our results pooled with published series in a systematic review suggest that endoscopic or transoral management of intralingual TGDC are excellent minimally invasive treatments with a low risk of recurrence. Postoperative surveillance up to one year is recommended.
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Transtornos de Deglutição , Cisto Tireoglosso , Criança , Humanos , Lactente , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Endoscopia , Reoperação , Transtornos de Deglutição/cirurgiaRESUMO
The unobliterated portion of embryological thyroglossal duct may present as cystic swelling later in life and may contain functional thyroid follicles. This cyst requires excision along with the entire thyroglossal duct remnant and adjacent portion of hyoid bone. At times, the excised specimen could demonstrate a focus of carcinomatous change inside the cyst wall. Very rarely, this thyroglossal duct cyst carcinoma could be associated with malignancy of native thyroid gland. This case report illustrates an interesting case of synchronous carcinoma of thyroglossal duct cyst and native thyroid gland. It also sheds light on the controversies related to the pathophysiology of such association and the dilemmas surrounding the management of thyroglossal duct cyst carcinoma, with or without concurrent carcinoma of thyroid gland.
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Carcinoma Papilar , Carcinoma , Cisto Tireoglosso , Neoplasias da Glândula Tireoide , Humanos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Cisto Tireoglosso/complicações , Carcinoma Papilar/cirurgia , Neoplasias da Glândula Tireoide/patologia , Carcinoma/cirurgia , Carcinoma/complicaçõesAssuntos
Carcinoma Papilar , Cisto Tireoglosso , Neoplasias da Glândula Tireoide , Feminino , Gravidez , Humanos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Cisto Tireoglosso/patologia , Carcinoma Papilar/diagnóstico por imagem , Carcinoma Papilar/cirurgia , Carcinoma Papilar/patologia , Gestantes , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
A clinical case of ectopic thyroid carcinoma in front of hyoid bone was reported in this paper. The patient, a 17-year-old female, presented with an enlarging neck mass of 1-week history. Physical examination revealed a 3 cm×2 cm neck mass in front of the hyoid bone. Ultrasonographic depicted as a cystic solid mixed echogenic mass with punctate strong echogenicity. CT scan showed a cystic-solid mass in front of the hyoid bone with punctate calcifications. The patient was misdiagnosed as a thyroglossal duct cyst and underwent surgery. The final pathological diagnosis was papillary thyroid carcinoma with cyst formation.
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Carcinoma Papilar , Carcinoma , Lesões do Pescoço , Cisto Tireoglosso , Neoplasias da Glândula Tireoide , Adolescente , Carcinoma Papilar/patologia , Erros de Diagnóstico , Feminino , Humanos , Osso Hioide/diagnóstico por imagem , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/patologia , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
OBJECTIVES: Lingual thyroglossal duct cysts (LTGDCs) are clinically rare and easily misdiagnosed as epiglottic cysts. Misdiagnosis leads to mistreatment; thus,simple diagnosis is important. This study aimed to investigate the characteristics of LTGDCs with flexible laryngoscopy and imaging, improve their diagnosis and explore surgical methods for patients undergoing an initial operation and patients with recurrence. METHODS: In total, 10 patients with LTGDCs were admitted from April 2014 to December 2020.By reviewing the diagnosis and treatment of the first typical case, the characteristics of LTGDC under flexible laryngoscopy were summarized. According to these characteristic manifestations, a clinical diagnosis of LTGDC was made correctly in the other 9 patients. All 10 patients underwent preoperative CT of the neck and sagittal reconstruction and thyroid ultrasound. RESULTS: Of the 10 patients, the first 2 patients had recurrent LTGDCs after several operations and underwent Sistrunk surgery. The remaining 8 patients were newly diagnosed and underwent endoscopic radical resection with low-temperature coblation; of these patients, 7 had no recurrence, and 1 underwent Sistrunk surgery after developing short-term recurrence. All patients were followed up for 5 months to 6 years after the last operation and were without recurrence. CONCLUSION: LTGDCs are easily misdiagnosed as epiglottic cysts in the clinic. A correct clinical diagnosis can be made based on the characteristics according to flexible laryngoscopy. To determine the relationship between the cyst and hyoid bone, CT was performed. The surgical method was chosen based on the relationship between the cyst and hyoid bone and history of recurrence.
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Cisto Tireoglosso , Humanos , Osso Hioide/diagnóstico por imagem , Osso Hioide/cirurgia , Laringoscopia/métodos , Recidiva Local de Neoplasia/cirurgia , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , LínguaRESUMO
This article presents a case of an epidermoid cyst that mimicked a thyroglossal duct cyst in a pediatric patient. An 8-year-old boy was referred for evaluation of a volumetric increase in the median cervical region with an evolution of about 4 years. The skin in the submental region was healthy and normal colored. Palpation revealed a mobile, well-circumscribed nodular lesion of soft consistency. Computed tomography of the neck showed an expansive hypodense formation extending from the base of the tongue to the upper portion of the hyoid bone, suggesting a thyroglossal duct cyst. Considering the diagnostic hypothesis, cystic enucleation via the Sistrunk procedure was planned. However, no ductal structure was identified during the surgical procedure, and the lesion was only near, but not attached to, the hyoid bone. Simple excision of the lesion was therefore performed. At the most recent follow-up examination, about 3 months postoperatively, the patient demonstrated satisfactory clinical progress. The epidermoid cyst close to the hyoid bone presented diagnostic difficulty due to its similarity to a thyroglossal duct cyst. Computed tomography provides limited information for diagnosing this type of lesion, and ultrasonography is the preferred test. In view of the uncertain diagnosis in this case, the extent of the excision was determined during the surgery, and simple excision was a satisfactory treatment associated with a good prognosis.
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Cisto Epidérmico , Cisto Tireoglosso , Criança , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/cirurgia , Humanos , Osso Hioide/diagnóstico por imagem , Osso Hioide/cirurgia , Masculino , Pescoço , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , LínguaRESUMO
BACKGROUND: Thyroglossal duct cysts (TGDCs) are the most common congenital midline cystic lesions in the neck, and they are often evaluated by fine-needle aspiration. Recognizing the cytomorphologic features of TGDCs and their mimics is important for clinical management. METHODS: This study examined the clinical, radiological, and cytopathological features of 86 ultrasonography-guided fine-needle aspiration (US-FNA) specimens from clinically suspected TGDCs or malignancies arising from TGDCs and correlated the findings with surgical follow-up and/or imaging studies. RESULTS: According to ultrasound examinations of 66 lesions, 17 (25.8%) were cystic, 8 (12.1%) were cystic with septations, 21 (31.8%) were cystic with solid nodules, and 20 (30.3%) were solid or cystic with internal debris. Cytopathologically, 81 lesions (94%) were categorized as benign, 2 (2%) were categorized as atypical, and 3 (3%) were categorized as malignant. In benign lesions, proteinaceous material (63%), histiocytes (63%), colloid (37%), squamous cells (35%), columnar cells (32%), follicular cells (15%), inflammatory cells (9%), and multinucleated giant cells (9%) were noted. Diagnoses in the benign category included TGDC in 64 patients (75%), TGDC or mimics (colloid nodule/epidermoid cyst) in 14 patients (17%), a colloid nodule in 1 patient, and thyroiditis in 1 patient. Surgical resection, performed in 23 patients, confirmed TGDCs in 12, benign mimics in 7, and carcinoma in 4. CONCLUSIONS: Cytopathological features, in conjunction with imaging, allowed a definite diagnosis of TGDC in most patients (75%). The presence of mature squamous cells, thyroid follicular cells, with or without colloid and/or lymphocytes alone allowed a differential diagnosis of TGDC and its mimics in 17%. US-FNA findings could not distinguish primary carcinomas arising from TGDCs from metastatic tumors.
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Carcinoma Papilar , Cisto Tireoglosso , Neoplasias da Glândula Tireoide , Carcinoma Papilar/patologia , Humanos , Encaminhamento e Consulta , Estudos Retrospectivos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
PURPOSE: The purpose of this study was to evaluate thyroglossal duct cyst (TGDC) volumes before and after treatment with ultrasound (US) in patients who underwent ethanol ablation (EA). Besides, the usability of cosmetic scoring in TGDC cases was investigated by comparing cosmetic scores pre-treatment and after EA. MATERIALS AND METHODS: 28 TGDC cases who had EA in one session and had complete US data and cosmetic scores were included in the study. US data including TGDC diameters and volumes obtained at the pre-treatment, 3rd, 6th, and 12th month after EA were noted, respectively. Cosmetic scoring was performed pre-treatment and after EA using the WHO grading system simultaneously with US. RESULTS: At the 12th month after EA, there was 85.2% reduction in mean diameter and 95.1% reduction in mean volume in TGDC cases (p < 0.001). The mean cosmetic score pre-treatment was 2.7 ± 0.8 and the mean cosmetic score at the 12th month was 1 (p < 0.001). When the changes in TGDC volumes and cosmetic scoring after EA were compared according to gender and age, there was no statistically significant difference (p > 0.05). CONCLUSION: The current study demonstrated that EA can be used safely to reduce TGDC sizes and is an alternative treatment option to surgery.
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Cisto Tireoglosso , Adulto , Etanol/uso terapêutico , Humanos , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , UltrassonografiaRESUMO
INTRODUCTION: Lingual thyroglossal duct cysts (LTGDC) are a rare kind of thyroglossal duct cyst. However, Sistrunk surgery is not very suitable for this type of cyst. This study aimed to explore the efficacy of transoral excision of LTGDC by plasma coblation. METHODS: The present study reviewed 11 patients, comprising seven males and four females, who had been diagnosed with LTGDC preoperatively by computed tomography (CT) and fibre-optic electronic laryngoscopy. Of those patients, two had recurrence after surgery of epiglottic cysts. All these patients underwent transoral excision by plasma coblation. Then, we collected preoperative data of the patients, observed the effect of surgery, and analysed factors relevant to LTGDC, including the estimated bleeding amount, postoperative hospitalisation, complications and recurrence rates. RESULTS: The connection between LTGDC and hyoid was tapered on sagittal images of CT, which was vital evidence for the diagnosis of LTGDC. Surgery was performed successfully for all 11 patients, and all recovered without complication. There was no evidence of recurrence after surgery, during follow up for 3-43 months. CONCLUSIONS: Transoral surgery for LTGDC can be performed successfully by plasma coblation, which is an effective and safe surgical treatment. Fibre-optic electronic laryngoscopy and CT are essential to the diagnosis of LTGDC in order to avoid missing detection and misdiagnosis.
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Eletrocirurgia/métodos , Cisto Tireoglosso/cirurgia , Adolescente , Adulto , Perda Sanguínea Cirúrgica , Eletrocirurgia/efeitos adversos , Feminino , Humanos , Laringoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Boca , Recidiva , Cisto Tireoglosso/diagnóstico por imagemRESUMO
Thyroglossal duct cyst (TGDC) is a congenital neck malformation, with a rate of approximately 7% in paediatric patients. TGDC is rarely detected in infants aged younger than 1 year. Even though TGDC is histologically benign, it is associated with preterm delivery or sudden infant death due to airway obstruction, with a mortality rate of 30% to 40%. We report a rare case of a neonate who presented with a large left lateral neck mass. At 7 to 8 months of gestation, magnetic resonance imaging of the foetal neck showed that there was a high possibility of a cervical cystic lymphangioma. The patient had normal vital signs and was afebrile. She was immediately transferred to our Ear, Nose, and Throat Department for further diagnosis and treatment. A computed tomography scan confirmed a large cystic mass that was positioned against a thyroglossal duct. Excision of the mass in the left neck was performed under general anaesthesia without resecting part of the hyoid bone. A histopathological examination confirmed the diagnosis of a TGDC. Follow-up at 1 year showed no recurrence.
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Linfangioma Cístico , Cisto Tireoglosso , Idoso , Criança , Feminino , Humanos , Osso Hioide , Lactente , Recém-Nascido , Linfangioma Cístico/diagnóstico por imagem , Linfangioma Cístico/cirurgia , Pescoço/diagnóstico por imagem , Pescoço/cirurgia , Recidiva Local de Neoplasia , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgiaRESUMO
OBJECTIVE: 1) To assess reproducibility of the previously established SIST score. 2) To determine inter-observer agreement in using ultrasound (US) characteristics to differentiate thyroglossal duct cyst (TGDC) from dermoid cysts (DC) 3) Improve the method used to pre-operatively differentiate TGDC from DC. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary care pediatric hospital. SUBJECTS AND METHODS: An electronic medical record was queried to identify children with midline neck masses who underwent pre-operative neck US and had a histopathologic diagnosis of either TGDC or DC. Two pediatric radiologists, blinded to the pathologic diagnosis, evaluated the US images and documented the presence of pre-determined characteristics of each mass. Potential differentiating factors were analyzed for their predictive power. The SIST (septations, irregular walls, solid components = TGDC) score was determined as well as inter-observer agreement. Using the characteristics that had significant predictive power, we used the data to develop an algorithm to improve predicting cyst type. RESULTS: Pathologically, there were 47 TGDC and 25 DC. The inter-observer agreement about the pathologic diagnosis between the two radiologists was substantial, K = 0.66. Overall, the SIST score predicted the correct diagnosis 67% of the time. Radiologist 1 and radiologist 2 were more accurate than the SIST score alone, making the correct diagnosis 96% and 86% of the time, respectively. In our study, we found that the most important US characteristics in differentiating TGDC and DC are: internal Septations, depth relative to Strap muscles, Shape and Solid parts (4 S algorithm). The SIST score criteria were individually shown to be significant and sensitive in recognizing DC, however, they were not specific and often misclassified TGDC as DC. We developed a new sequential filtering algorithm that more accurately differentiates cysts. This new algorithm uses step-wise filtering of characteristics, first for Septations, then for depth to Straps, then Shape of the cyst and lastly Solid parts (4 S algorithm). This algorithm correctly categorized cyst type in 100% of patients in our study. CONCLUSIONS: Pre-operatively differentiating TGDC and DC continues to be a challenge. Using our 4 S algorithm, we can more definitively differentiate TGDC from DC compared to the SIST score. All SIST score characteristics were significant and sensitive in detecting dermoid cysts, however, not very specific. The radiologists' judgment and accuracy was better than the SIST score. The 4 S algorithm uses sequential filtering of important characteristics: Septations, depth to Straps, Shape of cyst and lastly Solid parts to improve diagnostic accuracy.