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type:Original Article, identifier:http://igakkai.kms-igakkai.com/wp/wp-content/uploads/1986en/12(3)139-143.1986.pdf

Most cervical midline tumors are benign. The most common are the remnants of the thyroglossal duct, whhich can occur at any age. Malignancy is rare (1%) and they are usually well differentiated papillary thyroid carcinomas. We describe an unusual finding. Case description: We present a 70 year old patient, operated years before of a total thyroidectomy with a benign outcome. She is reported because of a tumor measuring 4 cm at the hyoid level, which is diagnosed as a follicular thyroid carcinoma afther surgical resection. Discussion: The prevalence of differentiated thyroid carcinoma in thyroglossal cysts is very low, and its diagnosis is usually postoperative, most frequently with papillary histology. The follicular carcinoma is an exceptional finding. The treatment is surgical excision and although there is some discussion, usually total thyroidectomy is also indicated according to the standard management of differentiated thyroid gland tumors. Conclusion: Although midline cervical tumors are usually benign and most often correspond to thyroglossal duct cysts, malignancy should be suspected in bulky lesions or those with an aggressive behavior., La mayoría de las tumoraciones cervicales de la línea media son benignas. Las más frecuentes son los remanentes del conducto tirogloso, que pueden presentarse en cualquier etapa de la vida. La malignización de estas lesiones es rara (1%) y casi siempre son carcinomas tiroideos bien diferenciados de estirpe papilar. Se describe un hallazgo inhabitual. Descripción del caso: Presentamos el caso de una paciente de 70 años de edad, intervenida años antes de tiroidectomía total con resultado de benignidad. Consulta por una tumoración de 4 cm a nivel hioideo, con diagnóstico de carcinoma folicular de tiroides tras su exéresis. Discusión: La prevalencia de los carcinomas diferenciados de tiroides sobre quistes tiroglosos es muy baja, y su diagnóstico suele ser postoperatorio, con histología más frecuentemente papilar. Es excepcional el hallazgo de carcinomas foliculares. El tratamiento es la exéresis quirúrgica y aunque existe cierta discusión, habitualmente se indica también la tiroidectomía total según el manejo estándar de los tumores diferenciados de tiroides. Conclusión: Aunque las tumoraciones de la línea media cervical son habitualmente benignas y corresponden más frecuentemente a quistes del conducto tirogloso, en lesiones muy voluminosas o de comportamiento agresivo debe sospecharse malignidad.

BackgroundGeneral surgery (GS) residents in ACGME programs log cases performed during their residency. We reviewed designated pediatric surgery (PS) cases to assess for changes in performed cases over time.MethodsThe ACGME case logs for graduating GS residents were reviewed from academic year (AY) 1989-1990 to 2010-2011 for designated pediatric cases. Overall and designated PS cases were analyzed. Data were combined into five blocks: Period I (AY1989-90 to AY1993-94), Period II (AY1994-95 to AY1998-99), Period III (AY1999-00 to AY2002-03), Period IV (AY2003-04 to AY2006-07), and Period V (AY2007-08 to AY2010-11). Periods IV and V were delineated by implementation of duty hour restrictions. Student t-tests compared averages among the time periods with significance at P < .05.ResultsOverall GS case load remained relatively stable. Of total cases, PS cases accounted for 5.4% in Period I and 3.7% in Period V. Designated pediatric cases declined for each period from an average of 47.7 in Period I to 33.8 in Period V. These changes are due to a decline in hernia repairs, which account for half of cases. All other cases contributed only minimally to the pediatric cases. The only laparoscopic cases in the database were anti-reflux procedures, which increased over time.ConclusionsGS residents perform a diminishing number of designated PS cases. This decline occurred before the onset of work-hour restrictions. These changes have implications on the capabilities of the current graduating workforce. However, the case log does not reflect all cases trainees may be exposed to, so revision of this list is recommended.

PURPOSE: To determine the rate of recurrence following surgical treatment of thyroglossal duct cysts (TDGCs) in children. METHODS: A search of electronic databases (Pubmed and MEDLINE) was performed in order to identify studies concerning surgical treatment of TGDCs in children published between 1980 and 2012. The following terms were used: "thyroglossal duct cysts", "recurrent", "recurrence", "children", "pediatric". RESULTS: Sixteen articles were selected with the majority published during the last decade. The total number of included subjects was 1233. The mean (95% confidence interval (CI)) rate of recurrences was 10.7% (9.1%-12.6%). Eleven studies involving 751 subjects reported the frequency of recurrences separately for primary cases. The mean (95% CI) rate of recurrences was 10.8% (8.7%-13.3%). Five studies reported separately results of surgery for secondary cases. The mean (95% CI) rate of recurrences was 20.0% (12.2%-30.8%). Eight of the sixteen studies reported data on risk factors for recurrence. The use of the Sistrunk technique is a protective factor, whereas children who experienced repeated episodes of infection prior to surgery are exposed to a higher risk of recurrence. CONCLUSION: Recurrences after surgery for TDGCs remain a clinically relevant issue. One of ten operated children experiences a recurrence. Available data support the use of the Sistrunk technique but further studies aimed at improving the clinical management of TDGCs are required.

An extremely rare case of papillary carcinoma is described arising in a submental-intralingual thyroglossal duct cyst. A 27-year-old male presented with a painless swelling in the submental region extending to the tongue which had gradually been increasing in size over the last three months. Upon examination of the neck, a tender right paramedian mass was found in the submental region just above the hyoid bone, it was mobile upon swallowing without clinical evidence of cervical nodes. The Sistrunk surgical technique, extended to the submental and intra lingual region was used to radically remove the mass. The occurrence of carcinoma of the thyroglossal duct cyst, even though rare and unexpected, should always be considered an option, and histologically ruled out mainly on account of the atypical localization, such as the submental-intralingual reported herein. The two different surgical approaches reported in the literature, one more conservative and the other more aggressive, apparently alternatives, are, instead, complementary and adequate when strict diagnostic criteria and adequate follow-up, are observed.