thyroglossal duct cyst

甲状舌管嚢胞

WordNet

1. a continuous tube formed by a row of elongated cells lacking intervening end walls
2. an enclosed conduit for a fluid
3. a bodily passage or tube lined with epithelial cells and conveying a secretion or other substance; "the tear duct was obstructed"; "the alimentary canal"; "poison is released through a channel in the snakes fangs" (同)epithelial duct, canal, channel
4. a closed sac that develops abnormally in some body structure

PrepTutorEJDIC

1. 送水管;(建物・船などの)通気管;(地下ケーブルなどの)ダクト / (体液を運ぶ)導管,(植物が水・空気を運ぶ)導管
2. 胞嚢(ほうのう)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/13 06:57:13」(JST)

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Thyroglossal cyst
Classification and external resources
Thyroglossal cyst
ICD-10	Q89.2
ICD-9	759.2
OMIM	188455
DiseasesDB	13070
eMedicine	ent/283
MeSH	D013955

A thyroglossal cyst is a fibrous cyst that forms from a persistent thyroglossal duct.

Presentation

It usually presents as a midline neck lump (in the region of the hyoid bone) that is usually painless, smooth and cystic, though if infected, pain can occur. There may be difficulty breathing, dysphagia (difficulty swallowing), or dyspepsia (discomfort in the upper abdomen), especially if the lump becomes large.

The most common location for a thyroglossal cyst is midline or slightly off midline, between the isthmus of the thyroid and the hyoid bone or just above the hyoid bone. A thyroglossal cyst can develop anywhere along a thyroglossal duct, though cysts within the tongue or in the floor of the mouth are rare.

A thyroglossal cyst will move upwards with protrusion of the tongue.

Thyroglossal cysts are associated with an increased incidence of ectopic thyroid tissue. Occasionally, a lingual thyroid can be seen as a flattened strawberry-like lump at the base of the tongue.

Embryology

The thyroglossal tract arises from the foramen cecum at the junction of the anterior two-thirds and posterior one-third of the tongue. Any part of the tract can persist causing a sinus, fistula or cyst. Most fistulae are acquired following rupture or incision of the infected thyroglossal cyst. A thyroglossal cyst is lined by pseudostratified, ciliated columnar epithelium while a thyroglossal fistula is lined by columnar epithelium.

Symptoms

Thyroglossal duct cysts most often present with a palpable asymptomatic midline neck mass below the level of the hyoid bone. The mass on the neck moves during swallowing or on protrusion of the tongue because of its attachment to the tongue via the tract of thyroid descent. Some patients will have neck or throat pain, or dysphagia.

The persistent duct or sinus can promote oral secretions, which may cause cysts to become infected. Up to half of thyroglossal cysts are not diagnosed until adult life. The tract can lie dormant for years or even decades until some kind of stimulus leads to cystic dilation. Infection can sometimes cause the transient appearance of a mass or enlargement of the cyst, at times with periodic recurrences. Spontaneous drainage may also occur. Differential diagnosis are ectopic thyroid, enlarged lymph nodes, dermoid cysts and goiter.

Clinical features

Clinical features can be found in the subhyoid portion of the tract and 75% present as midline swellings. The remainder can be found as far lateral as lateral tip of the hyoid bone.

Typically, the cyst will move upwards on protrusion of the tongue, given its attachment to the embryonic duct.

Treatment

Treatment for a thyroglossal cyst is called the Sistrunk procedure: surgical resection of the duct to the base of the tongue and removal of the medial segment of the hyoid bone.

Although generally benign the cyst will be removed if the patient exhibits difficulty in breathing or swallowing, or if the cyst is infected. Even if these symptoms are not present the cyst may be removed to eliminate the chance of infection or development of a carcinoma, or for cosmetic reasons if there is unsightly protrusion from the neck.

The Sistrunk procedure involves excision not only of the cyst but also of the path's tract and branches. A removal of the central portion of the hyoid bone is indicated to ensure complete removal of the tract. It is unlikely that there will be a recurrence after such an operation. The original Sistrunk paper is available on-line with a modern commentary. At times antibiotics can be indicated if there is sign of infection.

Thyroid scans and thyroid function studies are ordered preoperatively; this is important to demonstrate that normally functioning thyroid tissue is in its usual area.

See also

• Cutaneous columnar cyst
• Branchial cleft cyst
• Cystic hygroma
• Preauricular sinus and cyst
• Ranula

References

• Brewis C, Mahadevan M, Bailey CM, Drake DP (2000). "Investigation and treatment of thyroglossal cysts in children". Journal of the Royal Society of Medicine 93 (1): 18–21. PMC 1288046. PMID 10700841. 
• http://www.doctoronline.nhs.uk/masterwebsite1Asp/targetpages/testandprocedures/surgery/thyroglo.asp

UpToDate Contents

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• 1. 甲状舌管嚢胞および異所性甲状腺 thyroglossal duct cysts and ectopic thyroid
• 2. 頚部腫瘤の鑑別診断 differential diagnosis of a neck mass
• 3. 新生児および幼児における皮膚結節 skin nodules in newborns and infants
• 4. 嚢胞性甲状腺結節 cystic thyroid nodules
• 5. 小児における先天性および後天性の甲状腺腫 congenital and acquired goiter in children

English Journal

• Endolaryngeal extension of thyroglossal duct cyst.

• Bando H, Uchida M, Matsumoto S, Ushijima C, Dejima K.SourceDepartment of Otolaryngology-Bronchoesophagology, Kyoto Second Red Cross Hospital, Kyoto, Japan; Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
• Auris, nasus, larynx.Auris Nasus Larynx.2012 Apr;39(2):220-3. Epub 2011 May 28.
• Thyroglossal duct cysts are the most common congenital neck masses that develop during childhood, The masses develop from remnants of thyroglossal ducts, and typically appear as midline neck masses. Endolaryngeal extension of thyroglossal duct cysts has been reported mostly as midline neck swelling.
• PMID 21621356

• Uncommon thyroglossal duct cyst with inward tendency: A recommendation regarding ingrowth type.

• Zhang LC, Kang HY, Zhang TY, Sha Y, Chi FL, Tan LT, Fu YY, Jin L.SourceDepartment of Otorhinolaryngology, Shanghai Eye, Ear, Nose & Throat Hospital, Fudan University (formerly Shanghai Medical University), 83 Fenyang Rd, Xuhui District, Shanghai 200031, PR China.
• International journal of pediatric otorhinolaryngology.Int J Pediatr Otorhinolaryngol.2012 Mar;76(3):322-6. Epub 2012 Jan 21.
• OBJECTIVE: There has been a growing number of case reports on uncommon thyroglossal duct cyst (TDC) extending into the oropharynx and/or laryngopharynx, which has often been misdiagnosed. We therefore examined the unfamiliar radiological and clinical characteristics of the cases in question so that
• PMID 22266168

• Papillary Thyroid Carcinoma Arising from a Primary Thyroglossal Duct Cyst with Cervical Node Metastases.

• Kwon JK, Lee SM, Lee HM, Lee JC.SourceDepartment of Otorhinolaryngology, Ulsan University Hospital , University of Ulsan College of Medicine, Ulsan, Republic of Korea.
• Thyroid : official journal of the American Thyroid Association.Thyroid.2012 Feb 2. [Epub ahead of print]
• PMID 22300249

• Lingual thyroglossal duct cysts--a review.

• Sameer KS, Mohanty S, Correa MM, Das K.SourceDepartment of Neonatal and Paediatric Surgery, St. John's Medical College Hospital, St. John's National Academy of Health Sciences, Bangalore 560034, India.
• International journal of pediatric otorhinolaryngology.Int J Pediatr Otorhinolaryngol.2012 Feb;76(2):165-8. Epub 2011 Dec 20.
• OBJECTIVES: Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors' series and review existing literature on the entity.METHODS: A 12 year retrospective survey of all cases of
• PMID 22192899

Japanese Journal

• Adenosquamous Carcinoma Arising in a Thyroglossal Duct Cyst : Report of a Case

• KINOSHITA NAOE,ABE KUNIKO,SAINOO YUZURU,KUMAGAMI HIDETAKA,TAKAHASHI HARUO,HAYASHI TOMAYOSHI
• Surgery today : the Japanese journal of surgery 41(4), 533-536, 2011-04-01
• NAID 10029046733

• 小児の甲状舌管癌例

• 今吉 正一郎,笹村 佳美,川田 和己,長友 孝文,菊池 恒,市村 恵一
• 小児耳鼻咽喉科 32(1), 34-37, 2011-03-01
• NAID 10028052280

• 遺残甲状舌管に生じた乳頭癌例

• 古川 孝俊,太田 伸男,稲村 博雄,小池 修治,櫻井 真一,渡辺 知緒,石田 晃弘,阿部 靖弘,鈴木 祐輔,青柳 優
• 耳鼻咽喉科臨床. 補冊 = Practica otologica. Suppl. (130), 184-189, 2011-03-01
• NAID 10027794697

• 甲状舌管囊胞に伴う異所性甲状腺癌例

• 南 和彦,中尾 一成,深谷 卓
• 耳鼻咽喉科臨床 104(11), 817-820, 2011
• … A 57-year-old man had an anterior neck tumor diagnosed in computed tomography (CT) as a thyroglossal duct cyst. … The tissue was surgically resected using the Sistrunk’s procedure when ectopic thyroid papillary carcinoma was identified within the cyst. …
• NAID 130001330577

Related Links

• Thyroglossal cyst - Wikipedia, the free encyclopedia

Thyroglossal duct cysts most often present with a palpable (able to be felt) asymptomatic midline neck mass below the level of the hyoid bone. The mass on the neck moves during swallowing or on protrusion of the tongue because of its ...

• PICTURES OF THYROGLOSSAL DUCT CYST ...

6 Jun 2011 ... Pictures of Thyroglossal Duct Cysts. Thyroglossal duct cysts are remnants of the embryonic thyroglossal duct that may occur anywhere from the base of the tongue to the thyroid gland.

Related Pictures

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★リンクテーブル★

リンク元	「甲状腺」「甲状舌管嚢胞」
関連記事	「duct」

「甲状腺」

　　[★]

英

thyroid gland

ラ

glandula thyroidea

関

甲状腺ホルモン、副甲状腺(上皮小体)

喉頭

• 図：N.24(全面の筋),25(全面の筋),70(血管),71(血管)

解剖学

部位

• 胸骨舌骨筋と胸骨甲状筋の裏で、輪状軟骨の下部に位置する。
• C5-T1椎体の高さ

性状

• 成人の正常重量15-25g、女性の方が少し重い。妊娠中や性周期で重量が変化する。分泌期初期（early secretary phase排卵後2-5日目）には50%も重量が増加する。

大きさ

よくわかる甲状腺疾患のすべて　永井書店 (2004/01)　ISBN 481591673X

単位はmm？

	n	峡部	横断厚	横径	縦経(右)	縦経(左)
男性	34	1.8±0.6	18±3.0	48±4.8	49±3.7	49±3.8
女性	16	1.3±0.8	16±2.2	46±3.6	45±6.0	46±3.0

血管

動脈

• 上甲状腺動脈
• 下甲状腺動脈
• 最下甲状腺動脈

静脈

• 上甲状腺静脈
• 中甲状腺静脈
• 下甲状腺静脈

神経

声帯を支配する神経が甲状腺の裏側を通過 N.71

• 上喉頭神経
• 反回神経

画像

• 超音波検査

• (高エコー)筋肉＞甲状腺＞気道(低エコー)　　←　要確認

• びまん性腫大、等エコー～低エコー：グレーブス病
• 低エコー・高エコーの混在：甲状腺癌
• 不均一な粗い低エコー：橋本病
• 炎症部位は低エコーとなる：亜急性甲状腺炎

組織学

濾胞上皮細胞 follicular cell

• 甲状腺ホルモンを産生、分泌。

C細胞 C cell

• 成人甲状腺全体の0.1%を占める
• カルシトニン産生細胞、HEでは判別困難。
• 銀染色(Glimerius)、免疫組織化学（chromogranin A、synaprophysin, carcitoninなど）により明らかとなる。
• 電顕では、electron dense な顆粒を有する（神経内分泌顆粒）。

機能

• 濾胞上皮細胞で甲状腺濾胞ホルモン(甲状腺ホルモン)を産生・分泌。甲状腺刺激ホルモンが刺激となる。
• 傍濾胞細胞でカルシトニンを産生・分泌

発生

• 甲状腺は舌盲孔で咽頭底の上皮性増殖として出現
• 舌盲孔で陥入し、咽頭腸の前を2葉に分かれて下降する。
• 甲状腺が陥入してできた管を甲状舌管という。
• 発生学的由来：咽頭底の上皮性上皮、内胚葉

神経支配

• 上頚部交感神経節、中頚部交感神経節。交感神経神経線維は濾胞近傍に終末し、分泌に影響を及ぼす。

臨床関連

診察所見と疾患

• びまん性に腫大しており、柔らかい：グレーブス病、単純性甲状腺腫
• 硬い：橋本病
• 圧痛あり：亜急性甲状腺炎、急性化膿性甲状腺炎、橋本病の急性増悪、一部の甲状腺嚢胞

非腫瘍性疾患

• 1. 遺伝疾患、発達傷害

• a) 無形成 Agenesis
• b) 低形成 Hypoplasia
• c) 異所性甲状腺：異残物

• 2. 甲状舌管嚢胞 (thyroglossal duct cyst)：異残物
• 3. 薬剤の影響：

• mynocyclineによるblack thyroid：消耗性色素リポフスチンと他の物質（lipid-drug complexによりlysosomeに色素が沈着する）。

• 4. 感染

• a) 急性甲状腺炎
• b) 亜急性甲状腺炎

• 5. 自己免疫性甲状腺疾患

• a) 橋本病
• b) Basedow病 (Graves病）
• c) 限局性リンパ球性甲状腺炎 focal lymphocytic thyroiditis
• d) 浸潤性線維性甲状腺炎 invasive fibrous thyroiditis, Riedel's thyroiditis

• 6. 甲状腺腫 goiter

• a) simple and multinodular nontoxic goiter
• b) ホルモン合成傷害性甲状腺腫 dyshormonogenetic goiter
• c) toxic multinodular goiter (Plummer病）
• d) amyloid goiter

• 7. C細胞過形成 C-cell hyperplasia

腫瘍性疾患 (甲状腺腫瘍)

• 1. 良性腫瘍

• a) 濾胞腺腫 follicular adenoma

• 2. 悪性腫瘍（甲状腺癌） 悪性腫瘍中の頻度

• a) 乳頭癌 papillary carcinoma　88%
• b) 濾胞癌 follicular carcinoma 4.2%　甲状腺濾胞癌 thyroid follicular carcinoma
• c) 低分化癌 poorly differentiated carcinoma
• d) 未分化癌 undifferentiated carcinoma 1.5%
• e) 髄様癌(C細胞癌) medullary carcinoma, C-cell carcinoma 1.4%
• f) 悪性リンパ腫 malignant lymphoma 3.5%

Henry Gray (1825-1861). Anatomy of the Human Body. 1918.
Henry Gray (1825-1861). Anatomy of the Human Body. 1918.
Henry Gray (1825-1861). Anatomy of the Human Body. 1918.

分類

• 七條分類

「甲状舌管嚢胞」

　　[★]

英

thyroglossal duct cyst, thyrolingual cyst, thyroglossal cyst (L)

同

正中頚嚢胞 正中頸嚢胞 median cervical cyst

国試

• 102A045

-正中頚嚢胞

「duct」

　　[★]

• n.

• 管、(植物)導管

関

canal、conduit、ductal、ductus、meatus、pipe、tubal、tube、vas、vessel