International Journal of Otorhinolaryngology and Head and Neck Surgery

Serrano-Trejo I et al. Int J Otorhinolaryngol Head Neck Surg. 2024 Dec;10(6):729-731

http://www.ijorl.com

pISSN 2454-5929 | eISSN 2454-5937

Case Report

DOI: https://dx.doi.org/10.18203/issn.2454-5929.ijohns20243515

Large thyroglossal duct cyst with a long term evolution: a case report

Isabel Serrano-Trejo1, Zelik Luna-Peteuil2, Ana C. Naranjo-Gonzalez1, Kuauhyama Luna-Ortiz1,3*

1Department of General Surgery (Head and Neck), Hospital General Dr. Manuel Gea González, Mexico

2Universitatea De Medicinâ Si Farmacie Grigorie T. Popa, Iași, Romania

3Department of Head and Neck Surgery, Instituto Nacional de Cancerología, Mexico

Received: 23 July 2024

Accepted: 01 October 2024

*Correspondence:

Dr. Kuauhyama Luna-Ortiz,

E-mail: kuauhyama@yahoo.com.mx

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

A 57-year-old male presented with a progressively enlarging mass in the anterior cervical region, persisting for 41 years without accompanying symptoms. Physical examination revealed a well-defined, mobile, soft mass measuring 16×15×15 cm, not fixed to deep tissues, and extending from the medial edge of the sternocleidomastoid muscle. Computed tomography scan showed a cystic lesion involving the hyoid bone, suggestive of a thyroglossal duct cyst. The patient underwent a Sistrunk procedure, with dissection from the base of the tongue to the sternal notch. He was discharged six hours after surgery without any complications and had a closed drainage system removed during a subsequent outpatient visit.

Keywords: Thyroglossal duct cyst, Long-standing, Sistrunk procedure, Head and neck

INTRODUCTION

During embryogenesis, the thyroid gland descends from the foramen cecum of the tongue to a position below the thyroid cartilage. The abnormal persistence of epithelial remnants along this path results in thyroglossal duct cysts (TDC).1 These cysts are one of the most common neck lesions, with a bimodal age distribution in the first and fifth decades. Most cases (roughly 75%) appear as a mobile painless midline neck mass and one common clinical manifestation is rupture through the skin and subsequent infection.2,3 TDC typically range from 1.2 to 2.4 cm in diameter, with larger or long-standing cases being uncommon. We report a case of an unusually large and long-standing thyroglossal duct cyst.

CASE REPORT

A 57-year-old male, with no history of chronic degenerative diseases, presented with an enlarging mass in the anterior cervical region that had been growing since he was 16, without causing respiratory obstruction or dysphagia. Physical examination revealed a well-defined, mobile, soft mass measuring 16×15×15 cm, not fixed to deep tissues, and extending from the medial edge of the sternocleidomastoid muscle to the medial edge of the contralateral muscle, with no palpable lymph nodes. Computed tomography scan showed a cystic lesion involving the hyoid bone, suggestive of a thyroglossal duct cyst, though deemed inconclusive due to its 41-year evolution (Figure 1 A-D). Surgery was performed using an anterior cervical approach, starting above the sternal notch. A lesion of approximately 16×15×15 cm was found in the anterior cervical space.

The patient underwent a Sistrunk procedure, with dissection from the base of the tongue to the sternal notch (Figure 2 A-D). He was discharged six hours after surgery without any complications and had a closed drainage system removed during a subsequent outpatient visit.

Figure 1 (A-D): Computed tomography shows thyroglossal cyst clearly in relation to hyoid bone, as indicated by the arrow. CT reveals large size of thyroglossal cyst. Preop frontal view of thyroglossal cyst. Lateral view of the thyroglossal cyst.
Figure 1 (A-D): Computed tomography shows thyroglossal cyst clearly in relation to hyoid bone, as indicated by the arrow. CT reveals large size of thyroglossal cyst. Preop frontal view of thyroglossal cyst. Lateral view of the thyroglossal cyst.
Figure 2 (A-D): Frontal view after skin flap was lifted. Lateral view of large tumor size. Arrow indicates hyoid bone infiltration, which required Sistrunk procedure. Lateral view after skin flap was sutured.
Figure 2 (A-D): Frontal view after skin flap was lifted. Lateral view of large tumor size. Arrow indicates hyoid bone infiltration, which required Sistrunk procedure. Lateral view after skin flap was sutured.

DISCUSSION

TDC account for 70% of congenital neck cysts. One third of the cases occur in adults, with an average size of 2-4 cm. Larger cysts are observed in older patients due to progressive growth.3-13

Thyroglossal duct cysts generally atrophy and disappear during their descent by the tenth week of gestation. They may persist anterior to or through the hyoid bone, but exceptions exist where they can persist posterior to the hyoid bone, occurring at any point between the base of the tongue and the thyroid gland.

A thyroglossal cyst arises as a cystic expansion, although the cause of it is unknown. Many of these cysts are treated due to their increasing size or infection, with material discharge occurring on the anterior surface of the neck, usually at the hyoid bone. Many cases are never clinically detected and are discovered in postmortem studies.9

Reports of large TDC are rare; in a retrospective analysis of 685 cases over ten years, the sizes ranged from 0.2 cm to 8.5 cm, with an average size of 2.6 cm, indicating that smaller cysts are more common.14

Cases of thyroglossal duct cysts larger than ten cm (averaging 9.2-11 cm×7.6-9 cm) were found in men aged 65-85 years, who reported slow and progressive growth for up to twenty years, as shown in Table 1.

Most patients sought medical attention only when the increasing size began to interfere with their daily activities, without significant signs of airway obstruction or severe dysphagia. In the present case, the patient had lived with a large mass on the anterior surface of the neck for 41 years.

Despite its size, the mass never showed any signs of infection and grew gradually without causing any noticeable issues beyond its presence.

Recurrence of thyroglossal duct cysts is most common within the first year after surgery, so follow-up for at least this period is advised.3

Table 1: Case reports of large thyroglossal cysts.
Table reproduced from source PDF page 2, part 1 of 2
Table reproduced from source PDF page 3, part 2 of 2

CONCLUSION

The abnormal presentation of thyroglossal cysts in terms of size or age of onset poses a diagnostic challenge. It should be considered part of the differential diagnosis in patients over 65 years with slow and progressive swelling in the anterior cervical region.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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