Thyroglossal Duct Cyst Recurence. A case report

Thyroglossal duct cyst is a congenital malformation that occurs due to incomplete closure of the thyroglossal duct. The cyst typically appears along the midline of the neck on the ventral surface. Apart from being a quiescent embryological remnant, it presents itself clinically at any age and often requires surgical excision. It is the most common congenital tumor neck mass and occurs in 7% of the population. The thyreoglossal cyst may be located in the intralingual, suprahyoid, thyrohyoid or suprasternal region. Its position in the hyoid bone is extremely rare. There are a few differences between thyroglossal duct cysts (TGDCs) expression in children and adults. The lesion mostly found in children but adult population also possesses this anomaly. Position is almost similar in both age groupswith midline and infrahyoid location while laterality is seen mostly in adults. Size of Cyst is found to be larger in adults. The recurrence and post-operative complication rates between children and adults usually are not significantly different. Malignant transformation is rare and can be diagnosed only after histologic examination of a biopsy specimen.We present a clinical case of a 25 year old female patient, with previoussurgery in childhood (at the age of 7) due to thyroglossal duct cyst. She came to the ENT clinic complaining of painful tumor mass at the middle of her neck 3 centimeters large. Thyroglossal duct cyst recurrence with inflammation was discovered. The patient underwent antibiotic treatment for 10 days as a start and after a week a surgery was performed as a method of definitive treatment

Primary thyroglossal duct cyst papillary carcinoma. Case report and literature review

Aim: Primary papillary carcinoma in a thyroglossal duct cyst (PTGDPC) is a rare pathological condition diagnosed in only 1–2% of the cases of midline neck cysts. Diagnosis is most commonly made postoperatively after the cyst is dissected by Sistrunk’s operation. There is a lot of controversy over the definitive management of PTGDPC and the proper therapeutic approach to it especially when we consider using total thyroidectomy and subsequent adjuvant radioiodine therapy in the treatment. We report a case of papillary carcinoma in a thyroglossal duct cyst and review the relevant literature to clarify what algorithm should a clinician apply in such cases.Materials and methods: We present a case of a 38-year-old woman with papillary carcinoma arising from a cyst in ductus thyroglossus which was histologically identified after Sistrunk’s operation. We discuss also the pathogenesis of papillary carcinoma in a thyroglossal duct cyst and the need to perform thyroidectomy.Results: The patient (T. C.) was a 38-year-old woman hospitalized in the Clinic of Otorhinolaryngology at St. George University Hospital in Plovdiv with a diagnosis of midline neck cyst confirmed by neck computed tomography and ultrasound. Sistrunk’s procedure was used for the patient who was shown by postoperative histology and repeat verification to have papillary carcinoma. The patient’s thyroid was examined scintigraphically yielding inconclusive evidence for neoplasm and then removed by thyroidectomy. No synchronous papillary carcinoma in the thyroid gland was identified. The histology showed nodular colloid goitre. The patient received postoperatively radioactive iodine (I-131) therapy and hormone-replacement therapy with L-thyroxin.Conclusions: We have found total thyroidectomy to be rather controversialapproach to managing papillary carcinoma in a thyroglossal duct cyst. Accurate identification of a possible primary focal area in the thyroid gland followed by total thyroidectomy in conjunction with I-131 ablation and hormone replacement therapy seem far more appropriate in such cases

Clinical aspects of satellite diseases and cricoarytenoid joint involvement. Arthritis of the cricoarytenoid joint. Clinical case.

Introduction: Laryngeal involvement in rheumatoid arthritis is a rarely mentioned complication in clinical practice. In the literature over the last 10 years, single articles on the subject have been published, presenting a small number of clinical cases. Cricoarytenoid arthritis is a life-threatening condition requiring timely anesthesia and otorhinolaryngological intervention, where the tracheostomy has an important therapeutic place.Aim: With the presentation of our clinical case we aim to expand the knowledge about systemic diseases and their possible acute manifestation in otorhinolaryngological practice. Materials and methods: We present a clinical case of patient M.S., 63 years old, female, with a long medical history of rheumatoid arthritis. She was admitted to the clinic with a tracheostomy cannula placed for acute laryngeal dyspnea. Physical examination with a fibrolaryngoscope revealed bilateral paresis of the vocal folds, in a medial position, without phonatory and respiratory activity. Computer tomography of the neck, chest, with a focus on the mediastinum – without clinical data on tumor processes. Laboratory tests reveal a repeatedly elevated rheumatoid factor.Results: MRI revealed a collapse of the larynx, with pronounced fatty degeneration of the thyroarytenoid and cricoarytenoid muscles. The patient was referred to a rheumatologist to control the chronic exacerbation process, with a definitive tracheostomy cannula.Conclusion: Pathological changes in the cricoarytenoid joint in patients with rheumatoid arthritis, as well as scleroderma, lupus, Felty’s syndrome, Tiez syndrome and other systemic diseases, are a common finding, although diagnosed in the past at autopsy. It can be acute, subacute and chronic, but in otorhinolaryngological practice it occupies an important clinical place in emergencies

Mucocele Originating from the Blandin-Nuhn Glands. A Case Report

Mucocele is a common, benign, mucous containing cystic lesion of the minor salivary glands in the oral cavity, resulting from the retention or extravasation of mucous into the surrounding tissues of lamina propria. They occur in various anatomical locations but the occurrence in the ventral aspect of tongue is rarely seen.We present a clinical case of mucocele of the glands of Blandin-Nuhn in a 12-year-old boy – the path to the diagnosis and management

Pleomorphic adenoma in the parapharyngeal space – diagnosis and therapeutic approach (case report)

Introduction: Pleomorphic adenoma (PA) is the most common benign salivary gland tumor, accounting for up to 60% of all tumors of the salivary gland. . It has a slow but progressive growth pattern and if untreated can become greatly enlarged in size.Material and Method: We present a clinical case of a 29-year-old female with diagnosed pleomorphic adenoma which was with size 12 centimeters. The formation occupied the right parapharyngeal space.Results: After the histological diagnosis was set, the patient underwent surgical intervention – tumor total excision with excellent result. We achieved full recovery of the patient with no recurrences

Case report of 24 years old patient with branchial cleft cyst

Branchial cleft cysts are the most commonly encountered congenital anomalies in clinical practice of otorhinolaryngology. Arising on the lateral part of the neck from a failure of obliteration of the second branchial cleft in embryonic development, they can present difficulty in diagnosis and surgical management. In this article, we report a clinical case of a 24 years old patient, who presented with swelling located on the left side of the neck, asymptomatic. The cyst was excised and hystopatholgy showed a characteristic finding of branchial cleft cyst

Carcinosarcoma of the palatine tonsil – diagnostic and therapeutic approach. Literature review. Clinical case

Introduction: Carcinosarcoma of the head and neck is an very rare pathology < 1%. This is a mixed tumor with epithelial and mesenchymal components. It is characterized by high recurrence, metastasis, and mortality rates.Aim: The sporadic nature of carcinosarcomas of the oral cavity, sinonasal tract, larynx, and hypopharynx causes difficulties with the diagnostic and therapeutic approach. Our clinical case is an example of a rare localization of carcinosarcoma, which allows for a detailed examination thereof.Materials and methods: We present a clinical case of a 67 year-old male, admitted to the Otorhinolaryngology Clinic of University Hospital „Sv. Georgi“ EAD – Plovdiv, presenting with difficulty swallowing and a lump on the right side of the neck for several months. Computer tomography was performed and a tumor found involving the right palatine tonsil. The tonsil was surgically removed. The histopathological result showed a biphase tumor with epithelial and mesenchymal components – carcinosarcoma.Results: Following the monotonsillectomy, the patient was referred to radiotherapy. The local status does not indicate any progression and infiltration into soft tissue.Conclusion: Carcinosarcoma is a malignant mixed tumor with high recurrence, metastasis, and mortality rates. It is difficult to diagnose due to the non-typical location and the need for immunohistochemistry testing, which is not always possible. The therapy for carcinosarcoma of the head and neck is delivered under a squamous cell carcinoma protocol due to the lack of a specific one

Rare case of multiple symmetric lipomatosis – Madelung's disease

Multiple symmetric lipomatosis is a rare disease characterized by a symmetrical accumulation of massive adipose tissue on the neck, superior part of the trunk, and limbs1. We report an exclusively rare for our practice case of multiple symmetric lipomatosis in a 51-year old male, who presented with diffuse lipomatosis – face and neck engagement, bilateral breast enlargement, upper parts of the arms and ankle involvement was seen too – typical engagement for Madelung’s disease. There was no serious deviations in his blood tests. No family history was found also. During gathering information alcohol abuse was discovered

Severe Laryngeal Obstruction Caused by Laryngeal Cyst (Case report)

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Challenges in the topic diagnosis of cerebrospinal leak rhinorrhea. Case report

Introduction: The leak of cerebrospinal fluid in the nose and paranasal cavities is a pathological condition, associated with defects in the skull base. The rhinoliquorrhea may occur spontaneously and may be hidden for a long time, wrongly treated due to the complexity and difficulty of diagnosis. This condition may be linked to serious life treating illnesses, with ascending bacterial infections from the non-sterile nasal cavity to the subarachnoid space – meningitis, meningoencephalitis, brain abscess, etc. The topical diagnosis of rhinoliquorrhea is truly important for the surgeon, because it defines the operative approach and the technic that will be used.Materials and methods: Seven cases of rhinoliquorrhea where diagnosedand treated from 2015 to 2017 in the ENT department in University Hospital St George, Plovdiv. Laboratory tests such as glucose test of the nasal secretion and beta 2 transferrin were made. Computer tomography (CT), Magnetic resonance (MRI) and cisternopgraphy were also performed. In one of the cases we localized endoscopically the CSF defect without imaging preoperative confirmation.Results: In six of the patients preoperatively was confirmed the presence and the localization of the defect. In one of the cases the topical diagnosis of the rhinoliquorrhea with positive beta 2 transferrin test wasn’t possible. A defect in the area of the olfactory rhyme was localized intra-operatively, via an endoscopic approach. The postoperative period lasted for 5 days without complications. In all of the patients an endoscopic repair of the defect was applied.Conclusion: The topical diagnostics of rhinoliquorrhea is a challenge. When the defects of rhino base are bigger, the timely diagnosis is of utmost importance given the risk of fatal consequences. The incorrect localization of the defect of the rhino base may cause difficulties for the surgeon when using endoscopic approach, given the complex anatomy of the nose and the sinuses, as well the complex structural communication and delicate sights(cribriform plate, the spheno-palatines arteries, the anterior etmoidals arteries, the carotid artery, optical nerv, etc). The diagnosis of a present rhynoliquorrhea and the topic of the defect are of utmost importance giving the fact of possible complications that may occur such as infections of central nerve system, disturbance in consciousness, persistant headache and it is also related to the precise surgical repair to the skull base