An Unexpected Midline Neck Swelling in a Young Female

Abstract

An apparently healthy 26-year-old woman presented with a two-year history of painless upper neck swelling. There were no obstructive or constitutional symptoms. She denied features of hypo or hyperthyroid states. She had no otologic or nasal features. On examination, the patient was comfortable in room air. She had a blood pressure of 110/70 mmHg, pulse rate of 68 bpm, respiratory rate of 16, and she was afebrile. A 4 × 3 cm oval or multinodular firm, mobile (in all planes), non-tender infrahyoid midline mass, with normal overlying skin, was noted. The mass was well-encapsulated and not adherent to surrounding structures with no external skin changes. Baseline blood investigations and thyroid function tests were within the normal range. A flexible nasopharyngolaryngoscopy revealed mobile vocal cords with normal supraglottic structures. Cervical ultrasonography revealed a fluid-filled mass with solid components. Additionally, bilateral thyroid glands were present. A computed tomography of the neck revealed a septated complex cystic mass arising from the floor of the mouth measuring 2.9 × 3.1 × 3.3 cm. There was focal and nodular enhancement of the septa measuring about 0.6 cm, and the mass appeared to be continuous with the geniohyoid muscles. No cervical lymphadenopathy was noted. A preliminary diagnosis of thyroglossal duct cyst was made. The patient was counseled for a Sistrunk procedure. The surgery was successful, with clear margins and no lymphovascular invasion. There were no complications postoperatively, and the patient was discharged home on oral analgesia. The histopathological examination revealed papillary thyroid carcinoma (PTC) of the thyroglossal duct cyst.

Keywords