Simultaneous thyroglossal duct cyst with parathyroid cyst: A case report

BACKGROUND Thyroglossal duct cysts(TDC)are common congenital deformities.Most of them are cysts formed by the thyroglossal ducts that do not disappear and degenerate in the early embryonic stage.TDC exists alone and is rarely complicated by other congenital embryonic malformations.Only a few reports of TDC with branchial cleft cysts,thyroid cancer,thyroid hematoma,and epidermoid cysts have been reported.Therefore,we report a patient with TDC and parathyroid cyst(PC),a rare disease that has never been reported.CASE SUMMARY A 47-year-old woman presented to clinic in April 2021 with a neck tumor which she had noticed 5 d earlier.We perfected the relevant examinations,such as ultrasound and computed tomography,and resected the tumor.After surgical treatment,the pathology revealed a cervical thyroglossal duct cyst and a left lobe parathyroid cyst.The patient was followed up for 1 year without significant recurrence.CONCLUSION We report a patient with a simultaneous TDC and a PC to explore the correlation between the two congenital anomalies.

Diseases of bile duct in children

Several diseases originate from bile duct pathology.Despite studies on these diseases,certain etiologies of some of them still cannot be concluded.The most common disease of the bile duct in newborns is biliary atresia,whose prognosis varies according to the age of surgical correction.Other diseases such as Alagille syndrome,inspissated bile duct syndrome,and choledochal cysts are also time-sensitive because they can cause severe liver damage due to obstruction.The majority of these diseases present with cholestatic jaundice in the newborn or infant period,which is quite difficult to differentiate regarding clinical acumen and initial investigations.Intraoperative cholangiography is potentially necessary to make an accurate diagnosis,and further treatment will be performed synchronously or planned as findings suggest.This article provides a concise review of bile duct diseases,with interesting cases.

Bile duct cyst in adults:Interventional treatment,resection,or transplantation?

Cystic dilatations of the bile ducts may be found along the extrahepatic biliary tree,within the liver,or in both of these locations simultaneously.Presentation in adults is often associated with complications.The therapeutic possibilities have changed considerably over the last few decades.If possible,complete resection of the cyst(s)can cure the symptoms and avoid the risk of malignancy.According to the type of bile duct cyst,surgical procedures include the Roux-en-Y hepaticojejunostomy and variable types of hepatic resection.However,the diffuse forms of Todani type Ⅴ cysts(Caroli disease and Caroli syndrome)in particular remain a therapeutic problem,and liver transplantation has become an important option.The mainstay of interventional treatment for Todani typeⅢbile duct cysts is via endoscopic retrograde cholangiopancreatography.The diagnostic term"bile duct cyst"comprises quite different pathological and clinical entities.Interventional therapy,hepatic resection,and liver transplantation all have their place in the treatment of this heterogeneous disease group.They should not be seen as competitive treatment modalities,but as complementary options.Each patient should receive individualized treatment after all of the clinical findings have been considered by an interdisciplinary team.

A rare case of bile duct cyst

Choledochal cyst is an uncommon disease usually seen in young women and can be divided into five types. We report a 66-year-old woman who was diagnosed with types and bile duct cyst simultaneously after surgery, which is a rare type of bile duct cyst.

A case of peribiliary cysts accompanying bile duct carcinoma

A rare case of peribiliary cysts accompaying bile duct carcinoma is presented. A 54-year-old man was diagnosed as having lower bile duct carcinoma and peribiliary cysts by diagnostic imaging. He underwent pylorus preserving pancreatoduodenectomy. As for the peribiliary cysts, a course of observation was taken. Over surgery due to misdiagnosis of patients with biliary malignancy accompanied by peribiliary cysts should be avoided.

Preoperative Diagnosis of Thyroglossal Duct Cancer: A Case Report and Literature Review

Objective: To clarify the preoperative diagnostic rate and elucidate the morphological features of thyroglossal duct cancer through a literature search on cases reported in Japan. Methods: A search of a medical database (Japan Medical Abstracts Society) identified 40 studies on thyroglossal duct cancer in Japanese patients between 1976 and 2014. A total of 47 cases, including the present case, are summarized herein. Patient characteristics, preoperative diagnosis, and morphological features were reviewed and analyzed. Morphological features of the internal portions in the cystic lesions were classified using the previously reported Yokosuka Kyosai Hospital criteria for ultrasonography findings of thyroid cystic tumors. Results: Preoperative diagnosis was described for 43 of the 47 cases. Malignancy was suspected in 18 (41.9%) of the 43 cases on the basis of fine needle aspiration (FNA) cytology (presence of suspected papillary carcinoma cells) and imaging studies (presence of calcifications), 12 and 6 cases, respectively. Preoperative FNA was performed in 24 cases with a correct diagnosis obtained in only 12 (50%) cases. Morphological features were evaluated by preoperative imaging studies and/or postoperative histopathology. We found 6 cases (15%) with solid lesions, 32 cases (80%) with cystic lesions containing a solid part, and 2 cases (5%) with solo cystic lesions, respectively. Calcification was observed in 28 (72.5%) cases. We further examined the internal morphology of 32 cases with cystic lesions according to the criteria for ultrasonography findings of thyroid cystic tumors described in Methods. Of the 32 cases, 25 (62.5%) and 7 (17.5%) were classified as “eccentric acute angle type (Ea)” and “multiseptate type (M)”, respectively. The boundary between the solid part and the cystic part was irregular in all 7 “M” cases. No “eccentric and blunt angle type (Eb)” or “concentric type (C)” lesions were observed. Conclusions: The preoperative diagnostic rate for thyroglossal duct cancer using FNA is low, and it is important that diagnosis be performed in conjunction with imaging findings. The presence of solid parts or calcified lesions classified as “Ea” or “M with irregular boundaries” on the basis of imaging findings is suggestive of malignancy.

The Extra-and Intra-Hepatic Ducts of Congenital Choledochal Cyst in Infants and Children

Congenital choledochal cyst is frequently seen ininfants and children in China. The extra-hepatic ductalchanges have been well described, but the changes in theintra-hepatic ducts in choledochal cyst are less well known.This report is composed of 2 groups of patients: thirty-four cases who were operated upon between 1971 and1982 were followed post-operatively by plain abdominalfilm and barium meal examination and a group of 26cases receiving PTC between 1982 and 1984. In this lattergroup, both extra-and intra-hepatic ducts were shownsatisfactorily by PTC. In 23 cases (88.5%) besides thedilatation of the extra-hepatic duct, there were differentdegree and different forms of dilatation of the intra-hepatic ducts. In 10 cases(38.5%)the branches peripheralto the dilated main intra-hepatic ducts were found to benormal, in the other 10 cases (38.5%) the more peripheralbranches abruptly narrowed or were obliterated. In one case(3.8%) the entire intra-hepatic ductal system were dilatedwith a bead-like appearance. In only 3 cases were theintra-hepatic ducts normal (11.5%). Moreover the dilata-tion of the intra-hepatic ducts were found to persist longafter the obstruction was relieved in 28 cases (82.3%) ofthe 34 post-operative cases. Due to the frequent associationof intra-hepatic ductal dilatation with choledochal cyst,the various forms of dilatation and persistance of dilata-tion after relief of the obstruction, the term congenital biliary dilatation is suggested for this disease.

Thyroglossal Duct Anomalies in Pediatric and Adult Population: A 10-Year Experience in a Tertiary Care Hospital

Introduction: Thyroglossal duct cyst is a well-recognized congenital midline neck swelling observed in early childhood and rarely in adults. It may reveal itself as a painless cyst, abscess, or as fistula. Several studies have been conducted across the world, but the literature is scarce on its presentation and complications in the Middle East. This indexing study aims to report a 10-year experience with thyroglossal duct cyst (TGDC) presentation, excision, and recurrence at a teaching hospital in Saudi Arabia (KSA). Methods: A retrospective chart review was conducted at the Armed Forces Hospital Southern Region, KSA from December 2008 to December 2018. Data were retrieved from the electronic medical record system of the hospital and validated with the histopathology records. A total of 48 patients diagnosed as TGDC, sinus or fistula were identified. Stata ver. 16.1 was used to analyze the data and results formulated using regression model and Pearson’s chi-square test. Results: The majority of our patients were female (60.4%), and the most common presentation was a midline neck swelling which moved with tongue protrusion. Surgical excision via Complete Sistrunk procedure was the operation of choice in 60.5% followed by excision of the cyst with tract and sinus tract. Previous infection and surgical history contributed to complications in our patients, but no association of age or gender was observed. Patients presenting with infected and discharging cysts were found to be much more likely to develop a recurrence (9 patients). Cysts deep to the hyoid showed more recurrence [n = 7 (78%)] compared to superficial cysts [n = 2 (22%)] and posterior and multi-tract lesions also showed significant recurrence. Conclusion: Despite being a common cause of neck swelling, thyroglossal duct cyst is often missed on physical exams. To reduce complications, timely diagnosis and treatment are necessary.

Common Bile Duct Cysts Leading to Cholestasis and Jaundice: A Rare Case Report

Cystic dilatation of the common bile duct constitutes a rare congenital malformation prevalent in people of Asian origin with a female predominance. Its classification follows that of Todani. The commonest form, found in 80% of cases, is type I. Common bile duct cysts are often diagnosed in 2 out of 3 cases, during childhood with adult forms often rare. We hereby report the case of a cystic dilatation of the bile duct in a 75-year-old patient without significant history of disease.

Impact of previous cyst-enterostomy on patients' outcome following resection of bile duct cysts

AIM:To analyze the impact of previous cyst-enterostomy of patients underwent congenital bile duct cysts(BDC)resection.METHODS:A multicenter European retrospective study between 1974 and 2011 were conducted by the French Surgical Association.Only Todani subtypes I and IVb were included.Diagnostic imaging studies and operative and pathology reports underwent central revision.Patients with and without a previous history of cystenterostomy(CE)were compared.RESULTS:Among 243 patients with Todani types I and IVb BDC,16 had undergone previous CE(6.5%).Patients with a prior history of CE experienced a greater incidence of preoperative cholangitis(75%vs 22.9%,P<0.0001),had more complicated presentations(75%vs 40.5%,P=0.007),and were more likely to have synchronous biliary cancer(31.3%vs 6.2%,P=0.004)than patients without a prior CE.Overall morbidity(75%vs 33.5%;P<0.0008),severe complications(43.8%vs 11.9%;P=0.0026)and reoperation rates(37.5%vs 8.8%;P=0.0032)were also significantly greater in patients with previous CE,and their Mayo Risk Score,during a median follow-up of 37.5 mo(range:4-372 mo)indicated significantly more patients with fair and poor results(46.1%vs 15.6%;P=0.0136).CONCLUSION:This is the large series to show that previous CE is associated with poorer short-and longterm results after Todani types I and IVb BDC resection.

An Unusual and Previously Unreported Association between Tyrosinemia Type 1 and an Extremely Rare Variation of Congenital Cystic Dilatation: TODANI’s VI Cystic Duct Cyst: Report of a Case

Cystic duct cysts are rare lesions, and type VI of TODANI’s modified classification is the rarest subtype with only sporadic case reports in the literature. The following report describes the coexistence of this entity and type 1 tyrosinemia in a one month-old infant referred to our department for etiological investigations of prolonged neonatal cholestasis. To the best of our knowledge, we report herein the first case in the literature describing this association. Cystic duct abnormalities should be considered in the differential diagnosis of neonatal cholestases, however further investigations should be performed to exclude associated life-threatening conditions such as metabolic disorders including tyrosinemia.

Cystic low-grade collecting duct renal carcinoma with liver compression—A challenging diagnosis and therapy: A case report

BACKGROUND A collecting duct carcinoma is a very rare, malignant renal epithelial tumor.Distant metastases are present in one third of cases at the time of diagnosis. It is known to have a poor prognosis.CASE SUMMARY A 42-year-old male was sent to our surgery clinic for removal of a 119.2 mm ×108.3 mm encapsulated cystic mass, which was localized in the 8th segment of the right liver lobe. The lesion was first identified on ultrasonography. A computed tomography scan confirmed the presence of a Bosniak type Ⅲ cystic lesion,which affected the liver and convexity of the right kidney. Surgical intervention involved a right nephrectomy, with removal of the cystic mass. The patient was mobilized on the first postoperative day and was discharged after 7 d. The histological and immunohistochemical examination revealed a low-grade collecting duct renal carcinoma, which is a rare variant of papillary carcinoma,with low malignant potential. The patient did not receive chemotherapy and after 21 mo of follow-up, a radiological examination and laboratory analyses showed normal aspects. No relapse or other complications were reported.CONCLUSION To manage renal tumors properly, a correct histopathological diagnosis is crucial,as is early diagnosis and correct surgical treatment.

Thoracic Duct Cyst of the Anterior Mediastinum

Mediastinal thoracic duct cyst is a rare benign cystic disease. The lesion is generally in the post-erior or superior mediastinum, where the thoracic duct passes. We herein report an extremely rare case of surgically resected anterior mediastinal thoracic duct cyst. A thoracic duct cyst should be considered as an uncommon differential diagnosis of an anterior mediastinal lesion.

直线切割吻合器在儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中的应用

目的探讨直线切割吻合器应用于儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中的有效性、安全性及可行性。方法本研究为前瞻性研究,选取2020年1月至2023年1月湖南省儿童医院接受腹腔镜胆总管囊肿根治术Roux-en-Y吻合的34例患儿作为研究对象,按照随机数字表法进行分组,采用直线切割吻合器实施Roux-en-Y吻合术的患儿纳入观察组(n=17),采用传统缝合法实施Roux-en-Y吻合术的患儿纳入对照组(n=17)。记录两组患儿手术时长、术中出血量、术后肠道功能恢复时间、首次进食流质时间、拔除引流管时间、术后住院时间、总住院费用和术后并发症发生率。结果34例均顺利完成手术,无一例中转开放手术。观察组与对照组手术时长[(130.43±31.32)min比(141.51±30.39)min]、术中出血量[(55.45±20.73)mL比(58.62±22.13)mL]差异均无统计学意义(P>0.05);观察组与对照组患儿术后肠道功能恢复时间[(4.03±0.42)min比(4.91±1.13)min]、首次进食流质时间[(3.95±0.61)d比(4.88±1.09)d]、拔除引流管时间[(5.95±0.68)d比(6.65±1.28)d]、术后住院时间[(8.29±2.17)d比(10.33±2.18)d]均短于对照组,差异均有统计学意义(P<0.05);观察组与对照组患儿总住院费用[(34948.17±1019.57)元比(35151.91±1151.15)元]、并发症发生率(1/17比2/17)差异无统计学意义(P>0.05)。结论直线切割吻合器在儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中与传统缝合吻合技术的有效性和安全性无明显差异,可促进患儿术后恢复,值得临床推广应用。

甲状舌管癌的CT影像学表现:11例初步分析

目的探讨甲状舌管癌(TDCa)的CT影像学表现,提高对该肿瘤的认识。方法回顾分析11例经手术病理证实的TDCa的CT平扫及增强图像,并复习相关文献,总结影像学特征。结果11例TDCa均表现为颈前中线区肿块,边界欠清,8例位于舌骨下方水平,3例位于舌骨水平。11例病灶内均见实质性软组织成分,9例伴微钙化灶。10例病灶呈囊实性肿块,增强扫描囊壁及附壁结节中等-明显强化。1例病灶呈实性肿块,侵袭破坏舌骨,增强扫描明显强化。1例伴双侧颈部肿大淋巴结,病理证实为淋巴结转移。结论CT发现颈前中线区肿块伴有如囊性病灶内出现实性附壁结节、囊壁或内部分隔增厚、微钙化灶、舌骨侵袭性破坏或颈部肿大淋巴结影像学特征,应考虑TDCa的诊断。

内镜逆行胰胆管造影治疗先天性胆总管囊肿切除术后胆总管残端结石

目的 评估内镜逆行胰胆管造影术(ERCP)治疗胆总管残端结石的有效性及安全性。方法 收集2019年1月至2023年12月山东省立第三医院8例因腹痛入院诊断为先天性胆总管囊肿切除术后胆总管残端结石、再行内镜治疗的患者临床资料。分析ERCP操作成功率、结石取净率、并发症发生率、腹痛缓解率、结石复发率、癌变率。结果 8例患者结石直径(1.12±0.35)cm,结石数为(1.03±0.25)个,总操作成功率100%(8/8),一次结石取净率87.5%(7/8),总结石取净率100%(8/8)。术后1例患者出现轻度ERCP术后出血,8例患者腹痛均有不同程度缓解。术后随访6个月~2年,期间1例患者复发结石;1例患者复查发现早期壶腹肿瘤,行外科手术治疗。结论 ERCP治疗先天性胆总管囊肿切除术后胆总管残端结石是安全有效的。

内镜逆行胰胆管造影联合胆管支架治疗胆总管囊肿切除术后慢性胰腺炎

目的 评估内镜逆行胰胆管造影(ERCP)联合胆管支架治疗胆总管囊肿切除术后慢性胰腺炎(CP)的效果。方法 回顾性分析2019年1月至2023年12月复旦大学附属浦东医院普通外科及同济大学附属东方医院胆石病中心采取ERCP治疗胆总管囊肿切除术后CP的35例患者临床资料,总结治疗体会。结果35例CP患者中,经ERCP诊断为高位胰胆合流异常(PBM)27例,其中胆总管残端结石合并胆管括约肌狭窄20例,单纯性胆管括约肌狭窄5例,胰管狭窄2例;经ERCP诊断为低位PBM 8例,其中乳头括约肌狭窄5例,胰管括约肌狭窄2例,胰管括约肌狭窄并胰管结石1例。35例先行ERCP治疗,结石取净2例,未取净19例;狭窄解除8例,未解除27例。后置入胆管支架,其中22例狭窄置入全覆膜金属支架(FCMS),5例狭窄置入塑料支架。术后腹痛缓解率100%(35/35),急性胰腺炎发生率5.7%(2/35),高淀粉酶血症发生率14.3%(5/35)。27例支架留置3~7个月后均成功取出,狭窄解除率92.6%(25/27),其中FCMS狭窄解除率100%(22/22),塑料支架狭窄解除率60%(3/5);19例结石取净率100%(19/19),其中结石消失率63.2%(12/19),结石溶解率100%(19/19)。术后随访4~63个月,胰腺炎复发率11.4%(4/35),再次接受ERCP治疗,均存在胰管狭窄,重新留置胰管支架。结论 结石和狭窄是胆总管囊肿切除术后CP的主要病因,ERCP置入FCMS不仅能解除狭窄,还能促进结石的溶解和排出。

输卵管卵巢脓肿特征性CT表现的分析

目的探讨输卵管卵巢脓肿在MSCT检查中对诊断有价值的特征性表现。方法选取经手术病理证实的输卵管卵巢脓肿患者56例,术前均行CT增强扫描检查,分析临床及影像学资料。结果输卵管卵巢脓肿患者中单独右侧发病28例(50%),单独左侧发病18例(31.14%),双侧发病10例(17.85%)。管道型输卵巢卵巢脓肿26例(46.43%),串珠型为16例(28.57%),多囊型为12例(21.42%),单囊型2例(3.57%)。各种类型的输卵管卵巢脓肿灶的短径比较,差异有统计学意义(P=0.016),长径/短径的比较差异有统计学意义(P=0.024),线性囊灶出现于60.71%的输卵管卵巢脓肿,在管道型与其他各分型中所占比例差异有统计学意义(P=0.014)。输卵管卵巢脓肿的囊壁厚度介于0.21~0.35 cm之间,增强扫描厚壁及分隔可见中重度强化,静脉期达到峰值,平均强化程度为43~51HU。结论通过对输卵巢卵巢脓肿CT征象的观察,管道型结构和线性囊灶的出现可提示诊断输卵管卵巢脓肿,对提高影像科医师的准确诊断有一定帮助。

泪腺导管囊肿影像表现及临床特点分析

目的探讨分析泪腺导管囊肿的CT、MRI影像表现特征及其临床特点,提高对该病的影像诊断正确率。方法回顾性病例研究。分析我院2017年1月至2023年2月经手术病例证实的18例(18只眼)泪腺导管囊肿的临床特点、病理学、CT和MRI影像表现等资料。结果18例泪腺导管囊肿均为单侧发病,均为首发患者,有眼部病史患者4例,伴发眼部疼痛、肿胀、眼磨等不适症状患者12例,右眼眶13例,左眼眶5例,15位于泪腺睑部,1例位于泪腺眶部,1例位于上睑穹隆部,1例位于泪囊窝,18例均为单侧发病。18例行CT平扫,低密度(CT值030HU)13例,软组织密度(CT值3080HU)5例,其内均未见钙化。18例行MRI平扫及增强扫描,其中T1WI呈低信号者13例,等信号者5例,DWI均未见受限改变,增强扫描13例未见强化,5例可见囊壁稍增厚、毛糙、强化。病理提示18例泪腺导管囊肿中,3例可见炎性细胞。结论泪腺导管囊肿好发于中老年患者,男性稍多见,临床症状多以眼部肿胀、疼痛、眼磨多见,CT低密度、MRI呈长T1长T2、增强无强化是泪腺导管囊肿的特征影像表现。

全覆膜金属支架在胆总管囊肿切除术后胆总管残端结石治疗中的应用

目的 评估全覆膜金属支架(FCMS)在胆总管囊肿切除术后胆总管残端结石治疗中的应用价值。方法 回顾性分析2019年1月至2022年12月同济大学附属东方医院采取内镜逆行胰胆管造影(ERCP)置入FCMS治疗的22例胆总管囊肿切除术后胆总管残端结石患者的临床资料,观察FCMS首次置入成功率、FCMS二次置入成功率、FCMS留置时间、并发症发生率、胆总管狭窄解除率、FCMS取出成功率,胆总管残端结石消失率、溶解率及清除率,以及结石复发率。结果 FCMS首次置入成功率为72.7%(16/22)、二次置入成功率为100.0%(6/6),FCMS留置92~205 d,中位时间176 d,术后未发生急性胰腺炎、出血、支架移位等并发症,狭窄解除率为90.9%(20/22),FCMS取出成功率为100%(22/22),胰管结石消失率为68.2%(15/22),胰管结石溶解率为85.7%(6/7),胰管结石清除率为100%(7/7)。随访16~50个月,胆总管残端结石复发率为4.5%(1/22),再次行ERCP成功取出结石。结论 FCMS治胆总管囊肿切除术后胆总管残端结石安全、有效,在解除胆总管狭窄的同时可引起结石的溶解、消失,进而提高结石清除率。