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Multiple endocrine neoplasia: Pathology review
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Thyroglossal duct cyst
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A thyroglossal duct cyst, sometimes just called a thyroglossal cyst, is a congenital disorder where the thyroglossal duct, which is a tiny canal connecting the thyroid gland with the tongue during fetal development, grows in size and fills up with mucus, which forms a cyst.
Through development, the thyroid gland tissue migrates downward as it grows, but it still stays connected by a tiny canal called the thyroglossal duct.
The walls of the thyroglossal duct are lined by lymphoid cells, as well as epithelial cells which secrete mucus into the cavity.
Normally, once the thyroid gland has reached its final resting position, it stretches out a bit and the walls of the thyroglossal duct stick to each other, obliterating the canal.
Over time the thyroglossal duct starts to disintegrate and by the third month of fetal development, the duct is usually gone.
In some people, though, the thyroglossal duct doesn’t close completely, and instead parts of it widen to form pockets, or cysts.
The cysts get filled with mucus secreted by the epithelial cells in its walls.
These mucus filled thyroglossal duct cysts stick around as the fetus develops, and then they can cause a few problems.
For example, when there’s an infection of the respiratory tract, it can easily spread to the thyroglossal duct cyst since there are lymphoid, aka immune cells in the walls of the cyst.
A thyroglossal cyst is an irregular neck mass or a lump that had developed from cells and tissues left over after the formation of the thyroid gland during developmental stages. As the thyroid gland descends during development a tiny thyroglossal duct forms. If the thyroglossal duct doesn't close in on itself, it can start to fill up with mucus which creates cysts anywhere along its tract. These cysts are usually midline on the neck, just above or below the hyoid bone, and can be surgically removed.
The most common location for a thyroglossal duct cyst is in the midline of the neck, just below the hyoid bone. The cyst may be small or large and can be moveable or fixed. It may be painless or tender, and in some cases, it can become infected or cause difficulty swallowing or breathing if it grows large enough to press on nearby structures. The diagnosis of a thyroglossal duct cyst is usually done with an imaging study like an ultrasound or CT scan and confirmed with fine needle aspiration. Treatment involves surgical removal of the entire thyroglossal tract, which may be accompanied by antibiotics if an infection is present.
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