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Follicular cells surrounding colloid and admixed with a neutrophilic infiltrate
62%
49/79
Cyst-like structure lined by stratified squamous epithelium and containing mucoid material
25%
20/79
Randomly oriented papillae with fibrovascular cores and empty-appearing nuclei
3%
2/79
Diffuse hyperplasia and hypertrophy of follicular cells
9%
7/79
Stratified squamous epithelium associated with hair follicles and sebaceous glands
0%
0/79
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This preschool-aged patient with a midline infrahyoid neck mass that elevates with swallowing most likely has an infected thyroglossal duct cyst, which is characterized histologically by follicular cells surrounding colloid admixed with a neutrophilic infiltrate. Thyroglossal duct cysts are the most common type of congenital neck mass. They are caused by persistence and dilation of the thyroglossal duct and generally present as a midline neck mass near the hyoid bone. The masses often go unnoticed until they get infected in association with an upper respiratory tract infection. Infected thyroglossal duct cysts will typically have an epithelial lining with thyroid follicles in the cyst in addition to signs of infection such as neutrophilic infiltrate. Incorrect Answers: Answer 2: Branchial cleft cysts are congenital epithelial cysts that often arise on the lateral aspect of the neck due to a failure of the second branchial cleft to obliterate. Histological examination of branchial cleft cysts may reveal a cyst-like structure lined by stratified squamous epithelium with keratinous debris or mucoid material within the cyst. Answer 3: Papillary carcinoma of the thyroid gland generally presents as a neck mass in older individuals. Histological examination of papillary carcinoma may reveal papillae lined by cuboidal cells with “Orphan Annie” nuclei and psammoma bodies. Answer 4: Graves’ disease is an autoimmune hyperthyroid disorder that typically affects adult females. Histological examination of Graves’ disease may reveal diffuse thyroid hyperplasia and hypertrophy with retention of the lobular thyroid architecture. Answer 5: Dermoid cysts are rare skin tumors caused by separation of cutaneous tissues along embryonal lines of closure. They are commonly found on the face or neck. They have a unique histologic appearance as they are characterized by stratified squamous epithelium associated with hair follicles and/or sebaceous glands. Bullet Summary: Thyroglossal duct cyst usually presents as a midline neck mass that is characterized histologically by an epithelial lining with thyroid tissue in the cyst or duct wall.
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