Skip to main content

Advertisement

SpringerLink
Log in

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

  • Original Paper
  • Published:
Head and Neck Pathology Aims and scope Submit manuscript

Abstract

The clinical features of thyroglossal duct remnant cysts (TGDC) have been well described, however the histopathologic aspects of these lesions have not been addressed in a detailed manner. In particular, there has been no large community practice based series evaluating TGDC histologically compared with management outcomes. A retrospective review of all TGDC diagnosed between 2005 and 2015 was performed. Six hundred eighty-five patients were identified (344 males; 341 females). Age at presentation was bimodal (first and fifth decades) and ranged from 0.8 to 87 years (mean 31.3 years). Males predominate in children (150:111); females in adults (230:194). Patients presented most frequently with a mobile midline neck mass in an infrahyoid location. An associated skin fistula (n = 67) was twice as common in pediatric as adult patients. The average cyst size was 2.4 cm (range 0.4–9.9 cm) by imaging studies and 2.6 cm (range 0.2–8.5 cm) by pathologic examination; pediatric patients had smaller cysts (mean 2.1 cm) than adults (mean 2.8 cm). Histologically, 257 (38 %) TGDC were lined by respiratory epithelium alone, 68 (10 %) squamous epithelium alone, 347 (51 %) exhibited both respiratory and squamous epithelium, and 13 (1 %) had no identifiable epithelial lining. Four hundred eighty-four (71 %) TGDC had associated thyroid gland tissue present within the cyst wall (n = 282), skeletal muscle (n = 71), adipose tissue (n = 34), or a combination of these sites (n = 97). The hyoid bone was identified in 647 (grossly and/or histologically), and absent in 38. Surgical management consisted of Sistrunk procedure (n = 647), cystectomy (n = 31), or thyroidectomy/thyroid lobectomy (n = 7). Treatment related complications were observed in 6 patients, which included vocal cord damage, seroma, and hematoma. Recurrences developed in 20 (3 %) patients, 14 of whom were managed initially by cystectomy. Papillary thyroid carcinoma was identified in 22 (3.2 %) TGDC. In summary, TGDC show a bimodal peak in the 1st and 5th decades, commonly presenting as a midline cervical lesion below the hyoid bone, associated with a skin fistula in 10 %. Histologically TGDC are most commonly lined by a combination of respiratory and squamous epithelium. Thyroid gland tissue is identified in 71 % of cases (0.45 cm mean size), although not limited to the cyst wall, but present in the surrounding soft tissues. Rare TGDC may harbor malignancy (3.2 %). TGDC are most effectively managed by Sistrunk procedure rather than excision, which carries low rates of complications (1 %) and recurrence (3 %).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Brintnall ES, Davies J, Huffman WC, Lierle DM. Thyroglossal ducts and cysts. AMA Arch Otolaryngol. 1954;59(3):282–9.

    Article  CAS  PubMed  Google Scholar 

  2. Mandell L, Baurmash H. Thyroglossal tract abnormalities. Oral Surg Oral Med Oral Pathol. 1957;10(11):1131–44.

    Article  Google Scholar 

  3. Allard RH. The thyroglossal cyst. Head Neck Surg. 1982;5(2):134–46.

    Article  CAS  PubMed  Google Scholar 

  4. Mondin V, Ferlito A, Muzzi E, Silver CE, Fagan JJ, Devaney KO, Rinaldo A. Thyroglossal duct cyst: personal experience and literature review. Auris Nasus Larynx. 2008;35(1):11–25.

    Article  PubMed  Google Scholar 

  5. Chou J, Walters A, Hage R, Zurada A, Michalak M, Tubbs RS, Loukas M. Thyroglossal duct cysts: anatomy, embryology and treatment. Surg Radiol Anat. 2013;35(10):875–81.

    Article  PubMed  Google Scholar 

  6. Koeller KK, Alamo L, Adair CF, Smirniotopoulos JG. Congenital cystic masses of the neck: radiologic-pathologic correlation. Radiographics. 1999;19(1):121–46 quiz 152-3.

    Article  CAS  PubMed  Google Scholar 

  7. Nicollas R, Guelfucci B, Roman S, Triglia JM. Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 2000;55(2):117–24.

    Article  CAS  PubMed  Google Scholar 

  8. Kuroda T, Iwasa T, Miyakawa M, Makiuchi M, Furihata R. Clinicopathological studies on thyroglossal duct remnant. Jpn J Surg. 1979;9(1):32–6.

    Article  CAS  PubMed  Google Scholar 

  9. Katz AD, Hachigian M. Thyroglossal duct cysts. A thirty year experience with emphasis on occurrence in older patients. Am J Surg. 1988;155(6):741–4.

    Article  CAS  PubMed  Google Scholar 

  10. Brousseau VJ, Solares CA, Xu M, Krakovitz P, Koltai PJ. Thyroglossal duct cysts: presentation and management in children versus adults. Int J Pediatr Otorhinolaryngol. 2003;67(12):1285–90.

    Article  PubMed  Google Scholar 

  11. Lin ST, Tseng FY, Hsu CJ, Yeh TH, Chen YS. Thyroglossal duct cyst: a comparison between children and adults. Am J Otolaryngol. 2008;29(2):83–7.

    Article  PubMed  Google Scholar 

  12. Ren W, Zhi K, Zhao L, Gao L. Presentations and management of thyroglossal duct cyst in children versus adults: a review of 106 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011;111(2):e1–6.

    Article  PubMed  Google Scholar 

  13. de Tristan J, Zenk J, Künzel J, Psychogios G, Iro H. Thyroglossal duct cysts: 20 years’ experience (1992–2011). Eur Arch Otorhinolaryngol. 2015;272(9):2513–9.

    Article  PubMed  Google Scholar 

  14. Sade J, Rosen G. Thyroglossal cysts and tracts. A histological and histochemical study. Ann Otol Rhinol Laryngol. 1968;77(1):139–45.

    Article  CAS  PubMed  Google Scholar 

  15. Hawkins DB, Jacobsen BE, Klatt EC. Cysts of the thyroglossal duct. Laryngoscope. 1982;92(11):1254–8.

    Article  CAS  PubMed  Google Scholar 

  16. Hoffman MA, Schuster SR. Thyroglossal duct remnants in infants and children: reevaluation of histopathology and methods for resection. Ann Otol Rhinol Laryngol. 1988;97(5 Pt 1):483–6.

    Article  CAS  PubMed  Google Scholar 

  17. Sprinzl GM, Koebke J, Wimmers-Klick J, Eckel HE, Thumfart WF. Morphology of the human thyroglossal tract: a histologic and macroscopic study in infants and children. Ann Otol Rhinol Laryngol. 2000;109(12 Pt 1):1135–9.

    Article  CAS  PubMed  Google Scholar 

  18. Chandra RK, Maddalozzo J, Kovarik P. Histological characterization of the thyroglossal tract: implications for surgical management. Laryngoscope. 2001;111(6):1002–5.

    Article  CAS  PubMed  Google Scholar 

  19. Ali AA, Al-Jandan B, Suresh CS, Subaei A. The relationship between the location of thyroglossal duct cysts and the epithelial lining. Head Neck Pathol. 2013;7(1):50–3.

    Article  PubMed  Google Scholar 

  20. Wei S, LiVolsi VA, Baloch ZW. Pathology of thyroglossal duct: an institutional experience. Endocr Pathol. 2015;26(1):75–9.

    Article  PubMed  Google Scholar 

  21. Ellis PD, van Nostrand AW. The applied anatomy of thyroglossal tract remnants. Laryngoscope. 1977;87(5 Pt 1):765–70.

    Article  CAS  PubMed  Google Scholar 

  22. Yaman H, Durmaz A, Arslan HH, Ozcan A, Karahatay S, Gerek M. Thyroglossal duct cysts: evaluation and treatment of 49 cases. B-ENT. 2011;7(4):267–71.

    CAS  PubMed  Google Scholar 

  23. Pradeep PV, Jayashree B. Thyroglossal cysts in a pediatric population: apparent differences from adult thyroglossal cysts. Ann Saudi Med. 2013;33(1):45–8.

    PubMed  Google Scholar 

  24. Rohof D, Honings J, Theunisse HJ, Schutte HW, van den Hoogen FJ, van den Broek GB, Takes RP, Wijnen MH, Marres HA. Recurrences after thyroglossal duct cyst surgery: results in 207 consecutive cases and review of the literature. Head Neck. 2015;37(12):1699–704.

    Article  PubMed  Google Scholar 

  25. Gioacchini FM, Alicandri-Ciufelli M, Kaleci S, Magliulo G, Presutti L, Re M. Clinical presentation and treatment outcomes of thyroglossal duct cysts: a systematic review. Int J Oral Maxillofac Surg. 2015;44(1):119–26.

    Article  CAS  PubMed  Google Scholar 

  26. Burkart CM, Richter GT, Rutter MJ, Myer CM 3rd. Update on endoscopic management of lingual thyroglossal duct cysts. Laryngoscope. 2009;119(10):2055–60.

    Article  PubMed  Google Scholar 

  27. Hirshoren N, Neuman T, Udassin R, Elidan J, Weinberger JM. The imperative of the Sistrunk operation: review of 160 thyroglossal tract remnant operations. Otolaryngol Head Neck Surg. 2009;140(3):338–42.

    Article  PubMed  Google Scholar 

  28. LiVolsi VA, Perzin KH, Savetsky L. Carcinoma arising in median ectopic thyroid (including thyroglossal duct tissue). Cancer. 1974;34(4):1303–15.

    Article  CAS  PubMed  Google Scholar 

  29. Heshmati HM, Fatourechi V, van Heerden JA, Hay ID, Goellner JR. Thyroglossal duct carcinoma: report of 12 cases. Mayo Clin Proc. 1997;72(4):315–9.

    Article  CAS  PubMed  Google Scholar 

  30. Plaza CP, López ME, Carrasco CE, Meseguer LM, Perucho Ade L. Management of well-differentiated thyroglossal remnant thyroid carcinoma: time to close the debate? report of five new cases and proposal of a definitive algorithm for treatment. Ann Surg Oncol. 2006;13(5):745–52.

    Article  PubMed  Google Scholar 

  31. Forest VI, Murali R, Clark JR. Thyroglossal duct cyst carcinoma: case series. J Otolaryngol Head Neck Surg. 2011;40(2):151–6.

    PubMed  Google Scholar 

  32. Zizic M, Faquin W, Stephen AE, Kamani D, Nehme R, Slough CM, Randolph GW. Upper neck papillary thyroid cancer (UPTC): a new proposed term for the composite of thyroglossal duct cyst-associated papillary thyroid cancer, pyramidal lobe papillary thyroid cancer, and Delphian node papillary thyroid cancer metastasis. Laryngoscope. 2015. doi:10.1002/lary.25824.

    PubMed  Google Scholar 

  33. Choi YM, Kim TY, Song DE, Hong SJ, Jang EK, Jeon MJ, Han JM, Kim WG, Shong YK, Kim WB. Papillary thyroid carcinoma arising from a thyroglossal duct cyst: a single institution experience. Endocr J. 2013;60(5):665–70.

    Article  PubMed  Google Scholar 

  34. Sullivan DP, Liberatore LA, April MM, Sassoon J, Ward RF. Epidermal inclusion cyst versus thyroglossal duct cyst: Sistrunk or not? Ann Otol Rhinol Laryngol. 2001;110:340–4.

    Article  CAS  PubMed  Google Scholar 

  35. Teissier N, Elmaleh-Bergès M, Ferkdadji L, François M, Van den Abbeele T. Cervical bronchogenic cysts: usual and unusual clinical presentations. Arch Otolaryngol Head Neck Surg. 2008;134(11):1165–9.

    Article  PubMed  Google Scholar 

  36. Kieran SM, Robson CD, Nosé V, Rahbar R. Foregut duplication cysts in the head and neck: presentation, diagnosis, and management. Arch Otolaryngol Head Neck Surg. 2010;136(8):778–82.

    Article  PubMed  Google Scholar 

  37. Johnston R, Wei JL, Maddalozzo J. Intra-thyroid thyroglossal duct cyst as a differential diagnosis of thyroid nodule. Int J Pediatr Otorhinolaryngol. 2003;67(9):1027–30.

    Article  PubMed  Google Scholar 

  38. Huang LD, Gao SQ, Dai RJ, Chen DD, He B, Shi HQ, Yang K, Shan YF. Intra-thyroid thyroglossal duct cyst: a case report and review of literature. Int J Clin Exp Pathol. 2015;8(6):7229–33.

    PubMed  PubMed Central  Google Scholar 

  39. Apel RL, Asa SL, Chalvardjian A, LiVolsi VA. Intrathyroidal lymphoepithelial cysts of probable branchial origin. Hum Pathol. 1994;25(11):1238–42.

    Article  CAS  PubMed  Google Scholar 

  40. Ko AB, Assaad A, Carty SE, Barnes EL, Schaitkin BM. Branchial cleftlike cysts of the thyroid. Am J Otolaryngol. 2006;27(2):146–8.

    Article  PubMed  Google Scholar 

  41. Carter E, Ulusarac O. Lymphoepithelial cysts of the thyroid gland. A case report and review of the literature. Arch Pathol Lab Med. 2003;127(4):e205–8.

    PubMed  Google Scholar 

  42. Galluzzi F, Pignataro L, Gaini RM, Hartley B, Garavello W. Risk of recurrence in children operated for thyroglossal duct cysts: a systematic review. J Pediatr Surg. 2013;48(1):222–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Woodland Hills Medical Center, Southern California Permanente Medical Group, 5601 De Soto Avenue, Woodland Hills, CA, 91364, USA

    Lester D. R. Thompson & Hannah B. Herrera

  2. Department of Pathology, Orange County-Anaheim Medical Center, Southern California Permanente Medical Group, 3440 East La Palma Avenue, Anaheim, CA, 92806, USA

    Sean K. Lau

Authors
  1. Lester D. R. Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hannah B. Herrera
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean K. Lau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sean K. Lau.

Additional information

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of Southern California Permanente Medical Group.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thompson, L.D.R., Herrera, H.B. & Lau, S.K. A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts. Head and Neck Pathol 10, 465–474 (2016). https://doi.org/10.1007/s12105-016-0724-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12105-016-0724-7

Keywords

Search

Navigation