Sonography and magnetic resonance tomography in monitoring of recurrent cysts lesions of the neck

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Юнусова L., Аояма T., Амануллаев R., Ризаев J., Икрамов G., Сакамото J., Халманов B., & Мамараджабов S. (2021). Sonography and magnetic resonance tomography in monitoring of recurrent cysts lesions of the neck. in Library, 21(2), 131–134. извлечено от https://inlibrary.uz/index.php/archive/article/view/14182
Тору Аояма, Йокогамский городской университет

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Аннотация

Сysts of the neck are congenital cystic lesions of the neck, often presenting in childhood. Complete surgical excision is the treatment of choice for these lesions. Recurrence of cystic lesions of the neck after incomplete excision is fraught with complications due to the need for a second surgery and complications of the recurrent cyst itself. We herein report the de-tails of recurrent cysts of the neck presenting at 3, 6, 12 and 18 months postoperatively.

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131

Sonography and magnetic resonance tomography of neck cysts

Ann. Cancer Res. Ther. Vol. 29, No. 2, pp. 131-134, 2021

Introduction

Neck cystic masses are fairly frequent developmental

defects, and surgery is the only method of treatment, with

early intervention usually recommended to avoid com-

plications

1)

. As a rule, in surgical practice, there are three

surgical approaches to excising cysts: surgical excision of

the thyroglossal duct, simple excision of the cyst alone, or

excision in accordance with the Sistrunk procedure. The

Sistrunk procedure was introduced by W. E. Sistrunk

in 1920 and involves resection of the cyst, tract, median

part of the hyoid bone, and cuff surrounding the base of

the tongue musculature.

Magnetic resonance imaging (MRI) is an estab-

lished method of monitoring and evaluating the treat-

ment of cystic neck formations in everyday practice.

Postoperative scars can also become inflamed, repre-

senting one cause of recurrent neck cysts

2-5)

. The most

frequent complication of such cysts is an infection, which

in most cases leads to complete and incomplete fistulas,

abscesses neck, abscesses, and low-current pyoinflam-

matory processes, such as local infiltration and lymph-

adenitis

3)

. There are typically anatomical variants of

thyroglossal cysts (TGCs), which necessarily have their

own internal fistula, and are the main cause of recurrence

of TGCs of the neck. However, while such a definition is

easy for operating surgeons to comprehend, it is not quite

accurate with regard to the topographic anatomy

2)

.

Monitoring neck cysts is important for predicting the

appropriateness of a given treatment and determining the

likelihood of recurrence. Ultrasound provides a simple

and cost-effective solution to this problem, but it is im-

portant to take into account the presence of the distal

parts of the internal ducts of the neck cyst. As ultrasound

lacks the ability to obtain a three-dimensional image, it

is in many ways inferior to MRI.

In this study, the utility of sonography and MRI for

monitoring recurrence of cystic formations of the neck

was evaluated.

Material and methods

Ultrasound and MRI were used to monitor for recur-

rence of cystic formations of the neck in 19 patients at 3,

6, 12 and 18 months after an operation. TGCs were veri-

fied in 15 (78.9%) patients, and branchiolic cysts of the

neck were noted in 4 patients (21.1%).

Relapse in 7 (36.8%) patients occurred after non-radi-

cal surgery in the volume of only the removal of the cys-

tic cavity itself, without resection of the hyoid bone div,

confirmed earlier by morphological examination-TGCs.

Sonography and magnetic resonance tomography

in monitoring of recurrent cysts lesions of the neck

Lalita Yunusova

1)

, Toru Aoyama

2)

, Rustam Amanullayev

1)

, Jasur Rizaev

1)

, Gayrat Ikramov

1)

,

Junichi Sakamoto

3)

, Bakhodir Halmanov

1)

, Sobirjon Mamarajabov

4)

1)

Tashkent State Dental Institute, Uzbekistan

2)

Department of Surgery, Yokohama City University, Japan

3)

Tokai Central Hospital, Japan

4)

Samarkand State Medical Institute, Uzbekistan

Abstract

Сysts of the neck are congenital cystic lesions of the neck, often presenting in childhood. Complete surgical excision is

the treatment of choice for these lesions. Recurrence of cystic lesions of the neck after incomplete excision is fraught with

complications due to the need for a second surgery and complications of the recurrent cyst itself. We herein report the de-

tails of recurrent cysts of the neck presenting at 3, 6, 12 and 18 months postoperatively.

Keywords: Сysts of the neck, ultrasound, MRI, recurrence, complications

(Received April 7, 2021; Accepted September 8, 2021)

Corresponding Author

: Toru Aoyama, Department of Surgery, Yokohama City

University, 3-9 Fukuura Kanazawa-ku, Yokohama, Japan. E-Mail: t-aoyama@lilac.

plala.or.jp


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Annals of Cancer Research and Therapy Vol. 29 No. 2, 2021

The period until recurrence ranged from several months

to 18 months, and in 3 (15.7%) patients, the process could

be regarded as after an operation of inadequate volume,

since the infiltrate under the scar was determined already

in the postoperative period. Two (10.5%) patients were

admitted to the clinic after a second recurrence of a TGC

of the neck.

Sonography was used to diagnose cystic neoplasms

in the pre-operative period (56 patients) and to monitor

for recurrent cystic neoplasms (6 patients). The studies

were carried out using SLE-501 and Affiniti-70 (Philips,

Amsterdam, Holland) devices with linear sensors of 7.5

and 12 MHz, respectively. MRI was performed at 0.2

Tesla (Magnetom OPEN VIVA; Siemens Healthineers,

Erlangen, Germany) using a parallel imaging technique

at a 4-mm slice thickness with a 1-mm gap and an axial

field of view (FOV) of 20 cm and a coronal field of view

of 26 cm. Axial with fat suppression T2-weighted fast

spin echoes (TR/TE, 4102-4269/90; 7150/134), axial with

fat suppression T1-weighted spin echoes (TR/TE, 679-

827/9-15), T2-weighted coronal with fat suppression spin

echo (TR/TE, 3983-5283/80-90), and coronal uncom-

pressed T1-weighted spin echo (TR/TE, 400-713/10-14;

432/27) images were obtained in all patients.

Results

Table 1 showed the background of 19 patients.

Ultrasound in 7 patients revealed cavity formation above

the area of the postoperative scar, with clear, uneven

contours; dimensions of 1.5±07 cm and homogeneous

anechoic content. We observed 13 incomplete median

fistulas; 1 was iatrogenic in origin, and 7 after non-

radical removal of the median cyst of the neck-operations

were performed without resection of the hyoid bone div

(Table 2). The frequency of relapse of cystic neck forma-

tions within six months after surgery is shown in the

Table. In two patients, recurrence of cystic formation was

observed twice. Six patients had a complete external fis-

tula of cystic formation, and in 13 patients, there was an

internal duct of cystic formation of the neck.

TGCs are often prone to relapse, and such relapse

was noted in 15 of our 19 patients. In four cases, relapse

occurred in patients with Type II branchial cysts. The

localization of TGC relapse differed, but for branchial

cysts, the relapse localization was similar. In 8 of the

19 patients, drainage of the cystic cavity was observed

in the anamnesis due to infection of the postoperative

scar (Table 3). In 7 of the 19 patients with recurrent neck

cysts, sonography showed unsatisfactory postoperative

removal of cysts, i.e. the formation of a recurrent cyst. In

other cases, results that were suggestive of infiltration of

the postoperative scar were seen.

On ultrasound, the presence of a small subcutaneous

emphysema, soft tissue edema made it difficult to fully

visualize the postoperative period of the wound, and this

cause of the fracture area during ultrasound examination.

This prevented control from being achieved in 3 (15.7%)

patients, the process could be regarded as after an opera-

tion of inadequate volume, since the infiltrate under the

scar was determined already in the postoperative period.

The vast majority of cases of recurrent neck cysts in

our study were TGCs, which show hypointensive signal-

ing on T1-weighted imaging (T1WI) and hyperintensive

signaling on T2WI. In the 12 (63.2%) patients with slight

infiltration and heterogeneity of the cyst, the intensity of

T1 and T2 signals was determined. Using MRI, recurrent

cystic formation of the neck was determined to be due

Table 1 Background of 19 patients

Patient

Number

Age

Sizes

Contours

Shape

Cyst walls

Internal

structure

Regional

LAP

Type of resection

1

12 y/o

1.5×1.2×1.8 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

2

36 y/o

2.3×1.5×1.2 Smooth, clear Awry

Thickened

Homogeneous

/−

Conventional cystic cavity resection

3

52 y/o

2.1×0.8×1.5 Smooth, clear Awry

Thickened

Homogeneous

/−

Conventional cystic cavity resection

4

12 y/o

0.8×0.5×1.0 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

5

10 y/o

0.5×0.7×0.9 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

6

12 y/o

1.2×1.5×0.8 Smooth, clear Awry

Thickened

Homogeneous

/−

Conventional cystic cavity resection

7

26 y/o

0.5×0.6×1.2 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

8

10 y/o

0.3×1.2×0.8 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

9

18 y/o

2.8×1.4×1.5 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

10

25 y/o

2.0×1.8×1.3 Smooth, clear Awry

Thickened

Homogeneous

/−

Conventional cystic cavity resection

11

20 y/o

1.3×0.8×1.6 Smooth, clear Awry

Thickened

Homogeneous

/−

Conventional cystic cavity resection

12

29 y/o

0.8×1.4×1.2 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

13

13 y/o

0.6×0.9×1.1 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

14

14 y/o

0.5×.08×.1.0 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

15

12 y/o

1.8×1.6×0.9 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

16

12 y/o

1.4×1.3×1.1 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

17

11 y/o

1.0×1.1×1.0 Smooth, clear Awry

Thickened

Homogeneous

/−

Conventional cystic cavity resection

18

14 y/o

1.8×1.5×1.1 Smooth, clear Awry

Thickened

Homogeneous

/−

Conventional cystic cavity resection

19

12 y/o

0.6×.0.9×1.1 Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk


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Sonography and magnetic resonance tomography of neck cysts

Table 2 Demographic and clinical factors preceding the recurrence of cystic neck lesions

Relapse

3 month

6 month

12 month

18 month

Age (average value)

6 ± 0.2

12 ± 0.5

16 ± 0.6

21 ± 1.2

Sex:

• F

• М

3

1

6

3

2

1

2

1

Preoperative diagnosis:

• Median cysts

• Lateral cysts

3 (15.7%)

1 (5.2%)

2 (10.5%)

1 (5.2%)

5 (26.3%)

1 (5.2%)

5 (26.3%)

1 (5.2%)

Localization:

• Intralingual

• Supra-lingual

• Sublingual

• On the side of the neck

1 (5.2%)

2 (10.5%)

1 (5.2%)

2 (10.5%)

2 (10.5%)

2 (10.5%)

2 (10.5%)

-

1 (5.2%)

1 (5.2%)

1 (5.2%)

2 (10.5%)

2 (10.5%)

Drainage of the cystic cavity:

• Yes

• No

2 (10.5%)

-

-

-

2 (10.5%)

1 (5.2%)

2 (10.5%)

1 (5.2%)

Type of resection:

• Conventional cystic cavity resection

• Resection by Sistrunk

7 (36.8%)

12 (63.2%)

Postoperative infection

7 (36.8%)

to incomplete radical removal of the cystic cavity in pre-

ceding lateral cysts of the neck in 4 (21%) cases, simple

resection of the cystic cavity itself in 7 (36.8%) cases and

incomplete identification and elimination of the internal

ducts of the neck cysts with Sistrunk surgery in 8 (42.1%)

cases (Table 4).

Table 3 Ultrasound and MRI are signs of recurrent cystic formations of the neck

Features

US

MRI

Localization

Median cysts 5 (26.3%)

Lateral cysts 2 (10.5%)

Median cysts 15 (78.9%)

Lateral cysts 4 (21.1%)

Sizes (max. diameter)

1.5 ± 0.7 cm

3.8 ± 2.0

Contours:

• Smooth, clear

• Rough, fuzzy

2 (10.5%)

5 (26.3%)

7 (36.8%)

12 (63.2%)

Shape:

• Awry

• Rounded

7 (36.8%)

7 (36.8%)

12 (63.2%)

Cyst walls

• Normal (1–2mm)

• Thickened

5 (71.5%)

2 (28.5%)

100%

Internal structure:

• Homogeneous

• heterogeneous

5 (26.3%)

2 (10.5%)

7 (36.8%)

12 (63.2%)

The presence of internal septae

-

-

Invasion of surrounding structures

-

-

Cause of relapse

not detected

detected in 100%

Regional LAP

3 (15.7%)

12 (63.2%)

Type of resection:

• Conventional cystic cavity resection

• Resection by Sistrunk

5 (26.3%)

2 (10.5%)

7 (36.8%)

12 (63.2%)

Table 4 Background of 8 patients

Age

Sizes

Contours

Shape

Cyst walls

Internal

structure

Regional

LAP

Type of resection

1

36 y/o

0.7×1.2

Rough, fuzzy Rounded

2 mm

Homogeneous

/−

Conventional cystic cavity resection

2

52 y/o

0.8×1.5

Rough, fuzzy Rounded

2 mm

Homogeneous

/−

Conventional cystic cavity resection

3

18 y/o

1.4×1.5

Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

4

25 y/o

2.0×1.8

Smooth, clear Rounded

2 mm

Homogeneous

/−

Conventional cystic cavity resection

5

12 y/o

1.2×1.8

Rough, fuzzy Rounded

Thickened

heterogeneous

/+

Resection by Sistrunk

6

12 y/o

1.3×1.1

Rough, fuzzy Rounded

2 mm

Homogeneous

/+

Conventional cystic cavity resection

7

14 y/o

1.8×1.5

Smooth, clear Rounded

2 mm

Homogeneous

/−

Conventional cystic cavity resection


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Annals of Cancer Research and Therapy Vol. 29 No. 2, 2021

Discussion

The recurrence rate of TGCs after complete excision

using the Sistrunk procedure is reported to be 2.6%–5%,

whereas simple excision of the cyst can result in recur-

rence rates as high as 38%–70%. Previous authors

6-11)

have reported just 2 cases of recurrence in a series of 62

patients. Swaid et al.

11)

reported a recurrence rate of 10%

in a series of 270 patients, with most recurrences occur-

ring when the middle third of the hyoid was left intact. A

recurrence rate of 3.4% was reported in a series of 29 pa-

tients who underwent the Sistrunk procedure

12, 13)

, while

recurrence rates ranging from 1% to 30% have been re-

ported in a few other series

1, 2)

.

The most common cause of recurrence is rupture of

the cyst intraoperatively or leaving a part of the wall be-

hind. Various methods have been used to treat branchial

cleft cysts. Complete surgical excision of the cyst is the

treatment of choice for these cysts. Incision and drainage

are most commonly used to treat infected branchial cleft

cysts, but the associated recurrence rate is high

6)

. Open

complete surgical removal of fistulous tract in case of

branchial fistula is therefore preferred due to the low as-

sociated recurrence rate (5% at 2 years’ follow-up)

2)

.

In the series conducted by Hazenberg et al., the post-

operative recurrence rate was 3%

4)

. In another retrospec-

tive series by Prasad et al., among 34 cases, the incidence

of branchial fistula was 20 (58.82%), while branchial cyst

was found in 14 (41.17%) cases

7, 8)

. The low recurrence

rate of 1.2% was believed to be due to the good identifi-

cation of the fistulous tract with the aid of methylene blue

dye, good magnification with magnification loops and a

microscope and wide excision of the tract along with the

surrounding tissue.

Generally, the etiology for the increased recur-

rence might be postulated to be an extension of the cyst

through the carotid bifurcation, as might be expected

due to suggested origin from second branchial arch rem-

nants

1, 2)

.

Conclusion

As our studies have shown, on sonograms, cystic

formation manifests in the form of an anechoic, weakly

hypoechoic structure formed in the scar area, leaving the

cause somewhat unclear. MRI allows for the identifica-

tion of even the smallest cystic areas, which contributes

to its utility in monitoring for the recurrence of neck

cysts.

Acknowledgments:

This study is supported, in part, by the nonprofit organization

Epidemiological and Clinical Research Information Network

(ECRIN).

References

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Khasanov A, Sakamoto J, Baykhodjaeva E. Differentiation of cys-

tic lesions of neck. Ann. Cancer Res. Ther. 2020. 28:129–132. doi:

https://doi.org/10.4993/acrt.28.129

2) Yunusova L, Aoyama T, Ikramov G, Halmanov B, Sakamoto J,

Kurbanbaeva H. Ultrasound imaging of thyroglossal cysts of the

neck to the hyoid bone. Ann. Cancer Res. Ther. 2021. 29:30–33.

doi: https://doi.org/10.4993/acrt.29.30

3) Yunusova L, Aoyama T, Khalmatova M, Djakhangirova D,

Ortikbaeva S, Mamarajabov S, Sakamoto J, Abduxalik-Zade N.

Methods of the tomographic visualization of complicated cysts of

the neck. Ann. Cancer Res. Ther. 2020. 28:152–155. doi: https://doi.

org/10.4993/acrt.28.152

4) Hazenberg AJC, Pullmann LM, Henke R-P, Hoppe F. Recurrent

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Otol 2010. 124:1325–1328.

5) Paladino NC, Scerrino G, Chianetta D, Di Paola V, Gulotta G,

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port. Ann Ital Chir. 2014. 85(1):69–74.

6) Nicoucar K, Giger R, Jaecklin T, Pope HG, Dulguerov P.

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8) Amarjothi JMV, Amudhan A, Bennet D, Anand L, Babu Ol

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nuses: a 20-year Los Angeles experience and lessons learned. Int J

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11) Swaid AI, Al-Ammar AY. Management of thyroglossal duct cyst.

Open Otorhinolaryngol J 2008. 2:26–28.

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cision is independent of presenting age or symptomatology. Int J

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Библиографические ссылки

Yunusova L, Aoyama T, Khodjibekova Y, Mamarajabov S, Khasanov A, Sakamoto J, Baykhodjaeva E. Differentiation of cystic lesions of neck. Ann. Cancer Res. Ther. 2020. 28:129-132. doi: https://doi.org/10.4993/acrt.28.129

Yunusova L, Aoyama T, Ikramov G, Halmanov B, Sakamoto J, Kurbanbaeva H. Ultrasound imaging of thyroglossal cysts of the neck to the hyoid bone. Ann. Cancer Res. Ther. 2021. 29:30-33. doi: https://doi.org/10.4993/acrt.29.30

Yunusova L, Aoyama T, Khalmatova M, Djakhangirova D, Ortikbaeva S, Mamarajabov S, Sakamoto J, Abduxalik-Zade N. Methods of the tomographic visualization of complicated cysts of the neck. Ann. Cancer Res. Ther. 2020. 28:152-155. doi: https://doi. org/10.4993/acrt.28.152

Hazenberg AJC, Pullmann LM, Henke R-P, Hoppe F. Recurrent neck abscess due to a bronchogenic cyst in an adult. J Laryngol Otol 2010. 124:1325-1328.

Paladino NC, Scerrino G, Chianetta D, Di Paola V, Gulotta G, Bonventre S. Recurrent cystic lymphangioma of the neck. Case report. Ann Ital Chir. 2014. 85(l):69-74.

Nicoucar K, Giger R, Jaecklin T, Pope HG, Dulguerov P. Management of congenital third branchial arch anomalies: a systematic review. Otolaryngol Head Neck Surg. 2010. 142(l):21-28. e2.

Prasad SC, Azeez A, Thada ND, Rao P, Bacciu A, Prasad KD. Branchial anomalies: diagnosis and management. Int J Otolaryngol. 2014. 237015:01-09.

Amarjothi JMV, Amudhan A, Bennet D, Anand L, Babu O1 N. Recurrent Branchial Cleft Cyst with Symptomatic Cervical Oesophageal Diverticulum in Adult. -An interesting presentation of incomplete branchial cleft cyst excision J Clin Disgnostic Res 2018. 12(3):PD01-PD03.

Mitall MK, Malik A, Sureka B. Cystic masses of neck: a pictorial review. Indian J Radiol Imaging 2012. 22:334-343.

Geller KA, Cohen D, Koempel JA. Thyroglossal duct cyst and sinuses: a 20-year Los Angeles experience and lessons learned. Int J Pediatr Otorhinolaryngol 2014. 78:264-267.

Swaid Al, Al-Ammar AY. Management of thyroglossal duct cyst. Open Otorhinolaryngol J 2008. 2:26-28.

Shah R, Gow K, Sobol SE. Outcome of thyroglossal duct cyst excision is independent of presenting age or symptomatology. Int J Pediatr Otorhinolaryngol 2007.71:1731-1735.

Shifrin A, Vernick J. A thyroglossal duct cyst presenting as a thyroid nodule in the lateral neck. Thyroid. 2008. 18:263-265.

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