Curious Case of an Anterior Neck Swelling

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Curious Case of an Anterior Neck Swelling

Shaikh Mohd Shaad1*, Mehta Keshavi1, Gajghate Nayan1 and Sanjay Chatterjee2

1Post Graduate Student, Department of General Surgery, Bombay Hospital & Institute of Medical Sciences, Mumbai, India
2A Assistant Professor, Maharashtra University of Health Sciences, Nashik Postgraduate Teacher, Bombay Hospital Institute of Medical Sciences, Bombay Hospital Avenue, New Marine Lines, Mumbai, India

*Corresponding author: Chatterjee S, Post Graduate Student, Department of General Surgery, Bombay Hospital & Institute of Medical Sciences, Mumbai, India.

Citation: Shaad SM, Keshavi M, Nayan G, Chatterjee S. (2023) Curious Case Of An Anterior Neck Swelling. Genesis J Surg Med. 2(2):1-6.

Received: November 06, 2023 | Published: November 22, 2023

Copyright© 2023 genesis pub by Shaad SM, et al. CC BY-NC-ND 4.0 DEED. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License. This allows others distribute, remix, tweak, and build upon the work, even commercially, as long as they credit the authors for the original creation.

Abstract

A Thyroglossal cyst is amongst the most commonly encountered anterior painless neck swelling. Its usual presentation is seen in childhood and rarely it can present in adulthood. The management for Thyroglossal cyst is, the Sistrunk’s Operation. The etiology is explained by the fetal development of the thyroglossal duct and its failure to disappear after birth. We present the case of a 45-year-old man with a painless midline neck swelling for 6 years. Onset of the swelling was insidious and gradually increased in size over the years. Patient did not give any history suggestive of an infection or thyroid gland dysfunction. MRI of the neck revealed a fluid filled cystic lesion below the hyoid bone. MRI of the Neck revealed a 3.5 x 3 x 3.5 cm well-defined lesion in the anterior neck suggesting a Thyroglossal Cyst. Patient was worked up for a Sistrunk’s procedure. Histopathology revealed a well-differentiated Papillary Thyroid Carcinoma.

Keywords

Thyroglossal cyst; Thyroglossal duct; Sistrunk’s procedure; Papillary thyroid carcinoma; Malignancy

Introduction

Thyroglossal duct cyst (TDC) is on the most common midline swelling of the neck which arises from a unobliterated thyroglossal duct which is present in the embryonic period [3]. It represents the embryonic pathway of descent of the thyroid gland. As it is a congenital disease it presents most commonly in the childhood period and seldom presents in adulthood. Hence, most of the data available on this subject have a focus on management of this condition in the childhood period.

Sistrunk’s Procedure is the procedure of choice for this disease and is accepted globally as the standard of care [4]. The operation includes the excision of the cyst with excision of the central part of the hyoid bone and coring of the tract till the foramen cecum. This is driven by the knowledge of the embryonic development of the Thyroglossal duct and its intimate relation with the Hyoid bone. Data available reveals a satisfactory cure rate with Sistrunk’s Operation for Thyroglossal cyst occurring in childhood and very few cases are reported in adult age group and hence less data is available for comparison [6].

Case Report

Here we present a case of a 45-year-old gentleman with no comorbidities, who presented with a painless midline neck swelling since 6 years, the swelling was first noticed by the patient 6 years ago when it was the size of a pea gradually it progressed to the current size of a lemon. Patient did not give any history of Fever, Pus discharge from swelling. No history suggestive of thyroid dysfunction or difficulty in swelling/breathing/change of voice. Examination revealed a 4 cm x 4 cm midline neck swelling, moving with deglutition and protrusion of tongue, smooth surface with rounded edges, no tenderness or rise of local temperature. Thyroid gland not palpable. No cervical lymph nodes palpated.

Figure 1: Movement with tongue protrusion.

Figure 2: Midline neck swelling.

MRI Neck revealed well defined T1 hyper intense swelling in the infra hyoid region with multiple blooming spots suggestive of thyroglossal cyst with calcifications.

Figure 3: MRI neck in sagittal view.

Figure 4: Antero-posterior view showing close relation the hyoid bone.

CECT of Neck revealed a well-defined peripherally enhancing cystic structure in midline upper neck infra hyoid in location measuring 3.6 cm x 2.9 cm x 3.5 cm with foci of calcification.