Midline Cervical Cysts in Children: Thyroglossal Anomalies

Abstract

\s=b\ Deep, midline cervical cysts clinically diagnosed as thyroglossal duct cysts (TDCs), have been pathologically classified as dermoid cysts because of the presence of skin appendages and a squamous epithelial lining. In 75 midline cervical masses preoperatively diagnosed as TDC, we could classify only 54 as TDC, using the preexisting criteria of squamous or ciliated columnar epithelial lining associated with a tract or thyroid follicles. Eleven cysts were reclassified as dermoid, and six were called "mixed" because of features of both dermoid cysts (skin appendages) and TDC (epithelial tract or thyroid follicles). The morphological similarity of all these lesions suggests a common origin, perhaps from totipotential tissue entrapped during the descent of the embryonic thyroglossal duct from the base of the tongue. We conclude that these lesions should be grouped together under the eponym of "thyroglossal anomalies," and that treatment for all should consist of the Sistrunk procedure. (Arch Otolaryngol Head Neck Surg 1987;113:418-420) Certain midline cystic masses, clin¬ ically diagnosed as thyroglossal duct cysts (TDCs), do not fulfill the established histopathologic criteria for these lesions on microscopic exam¬ ination. The finding of skin append¬ ages in association with squamous epithelium, instead calls for the diagnosis of dermoid cyst. The treatment of choice for a TDC is the Sistrunk procedure, consisting of en bloc resec¬ tion of the midportion of the hyoid bone, while the surgical approach for a dermoid cyst is simple excision. Hitherto, the intraoperative differen¬ tiation of these midline neck cysts has been considered important because it dictates the surgical procedure to be selected. We reviewed the clinical and pathologic features of 75 midline cer¬ vical masses to determine whether the distinguishing characteristics were sufficiently clear as to warrant the different treatment protocols. PATIENTS AND METHODSA total of 75 cases with a preoperative diagnosis of TDC were retrieved from the surgical pathology files of Cardinal Glen¬ non Children's Hospital, St Louis. Patient medical records and operative notes were reviewed and information regarding depth of the cyst, attachment to bone, presence or absence of a tract, postoperative compli¬ cations, and incidence of recurrence were recorded.The surgical pathology reports and par¬ affin sections were examined, and infor¬ mation regarding the type of lining epithe¬ lium and presence or absence of skin appendages, tracts, attachment to bone, thyroid tissue, and mucous glands were recorded. Cysts lined by an epidermis with appendages, including hair, sebaceous glands, and eccrine glands, according to the criteria of Lever,1 were classified as dermoid cysts. Cysts lined by squamous or ciliated columnar epithelium, and associ¬ ated with a tract, thyroid follicles or attachment to bone, were classified as TDC. A "mixed" category was established to include those cysts fulfilling criteria for both dermoid cysts and TDC. These latter cysts were lined b...

Management of Thyroglossal Duct Cyst

“…In a study done by DeMello [20], 11 of 71 midline cysts proved histologically to be dermoid cysts even though they were not recognized preoperatively or intraoperatively to be so. At the time of surgical dissection 9 of these lesions actually demonstrated attachments to the hyoid bone and 6 had apparent midline tracts.…”

Quiste Epidermoide Gigante en Reloj de Arena del Piso de la Cavidad Oral

“…Existen múltiples teorías sobre la etiología de esta patología, la primera atribuye el origen a un crecimiento de tejido ectodérmico atrapado del primer y segundo arco branquial. La segunda, sugiere eventos quirúrgicos o accidentales que generan una implantación traumática de células epiteliales en tejidos más profundos, y una tercera teoría considera la posibilidad de que sea una variante del quiste del conducto tirogloso (De Mello et al, 1987;King et al, 1994& De Ponte, 2002.…”

“…Existen múltiples teorías sobre la etiología de esta patología, la primera atribuye el origen a un crecimiento de tejido ectodérmico atrapado del primer y segundo arco branquial. La segunda, sugiere eventos quirúrgicos o accidentales que generan una implantación traumática de células epiteliales en tejidos más profundos, y una tercera teoría considera la posibilidad de que sea una variante del quiste del conducto tirogloso (De Mello et al, 1987;King et al, 1994& De Ponte, 2002.Clínicamente, el QE se presenta como un aumento de volumen de crecimiento lento, progresivo, asintomático y de consistencia pastosa, generalmente entre la 1º y 3º décadas de vida.Su ubicación más frecuente es el piso de la cavidad oral, pudiendo tener distintas presentaciones dependiendo de su localización con respecto al músculo milohioideo. Cuando el crecimiento es por sobre este músculo, produce glosoptosis resultando potencialmente en disfagia, disfonía y disnea.…”

Intrathyroid dermoid cyst presenting as a unilateral “Cold” nodule

“…de Mello [2] referred to midline cervical lesions of the above morphology, originally classified as thyroglossal duct cysts, as dermoids. This classification remains controversial, but true midline dermoids in the cervical region are not uncommon.…”