Presentation
Referred for hyperinsulinism, currently asymptomatic. Physical examination revealed a nodule in the midline of the anterior cervical region that is mobile on swallowing.
Patient Data
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The Ultrasound study (B Mode) shows a cystic lesion with a mural nodule. On color Doppler interrogation, the mural nodule exhibits vascularity.
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Axial T1W and T2W sequences show a cystic lesion in the anterior cervical region, with a mural nodule in the posterior wall. Axial and coronal T1W post-contrast fat-saturated scans show homogeneous enhancement of the mural nodule.
Case Discussion
Key diagnostic features:
- cystic lesion with a mural nodule in the midline of the neck
- T1 variable: low signal if low protein or uncomplicated and high signal due to previous hemorrhage or infection, or high protein
- T2: typically, high signal
- T1 C+ (Gd): homogeneous enhancement of the solid component
Differential diagnosis:
- thyroglossal duct cyst without papillary carcinoma
- complicated thyroglossal duct cyst (previous hemorrhage or infection)
- ectopic thyroid
- branchial cleft cyst (three times less common, and usually well away from the midline)
Histological confirmation by FNA:
Presence of atypical cells with papillary-type changes. Follicular and papillary growth is observed, in some areas with extensive edema and dystrophic calcifications. No evidence of lymphovascular invasion. Findings compatible with papillary carcinoma in a thyroglossal cyst.
Thyroglossal duct cysts are the most common congenital cervical lesion. These cysts are usually benign, with rare occurrence of neoplastic change (about 1%), usually in individuals over 40 years old. The diagnosis is usually incidental.
Papillary carcinoma is the most common histopathological diagnosis and usually presents as an asymptomatic mass in the midline of the neck. Most of these tumors are small and confined to the cyst, although a few show capsular invasion.
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