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摘要


甲狀舌管囊腫是一種先天發育的異常,也是最常見的先天性頸部囊腫,約佔先天性頸部異常的70%。甲狀腺是胚胎時期發育的第一個內分泌腺,開始於胚胎形成第三週左右。由舌根部的盲孔開始下降,於胚胎第七週左右到達前頸正中線甲狀軟骨腹側停止。於下降期間,甲狀腺原生組織和舌根的盲孔藉由一條中空的管道相連,此管道即為“甲狀舌導管"。大多數的“甲狀舌導管"在胚胎第八至十週會逐漸萎縮並消失,但約有7%的正常人,其甲狀舌導管並未完全消失。若於甲狀腺下降的過程中,有上皮被帶進管道內,或有甲狀腺細胞殘留在甲狀舌導管的任何位置上,則管道無法閉鎖,將來就可能形成“甲狀舌管囊腫"或“異位性甲狀腺"。本科於2004年一月接到一位55歲男性病患的求助,主訴頸部中線有一膨大腫塊,吞嚥感覺異常,軟而無壓痛感,偶有輕微呼吸困難。病患早在1997年即診斷為“甲狀舌管囊腫”,曾接受“囊腫液抽取手術”,於第三度復發下至本科就醫。電腦斷層顯示出,位舌骨下方有一啞呤型囊腫,大小為5×5×5公分。甲狀腺核子掃描為正常。於“甲狀舌管囊腫”的診斷下,病患接受“甲狀舌管囊腫切除手術”(Sistrunk's operation)。病理標本呈現“纖毛性偽複屬柱狀上皮”。術後情況良好,至今未有復發情形。由於成人頸部前後徑約在10~15公分之間,就相對比例而言,此尺寸的“甲狀舌管囊腫”已屬巨大,甚至影響到吞嚥及呼吸,一般病患不至於拖到這麼晚才就醫。依照經驗及各种病例報告顯示,大部分“甲狀舌管囊腫”約在3公分以下,如此巨大尺寸者並不多見,故提出報告,並回顧相關文獻。

並列摘要


A thyroglossal duct cyst is the most common congenital neck mass, which accounts for 70% of all congenital neck anomalies. In utero, the thyroid gland begins to develop in the third week of gestation as a median outgrowth from the floor of primitive pharynx. The thyroid primordium originates at the level of the foramen cecum, and descends in the neck. By the seventh week of gestation, it reaches its final position in the inferior part of neck after descending anterior to the thyrohyoid membrane and strap muscles. The primordium of the thyroid gland is connected to the tongue by a narrow tubular structure which is the thyroglossal duct. The thyroglossal duct usually atrophies by weeks 8 to 10 of gestation, but fails to involute in 7% of the population. Failure of involution can give rise to the development of a ”thyroglossal duct cyst” or ”ectopic thyroid”. In January 2004, a 55-year-old male presented with a midline neck mass in the hyoid region. He complained of a lumpy throat, occasional mild shortness of breath. He had been diagnosed with a ”thyroglossal duct cyst” and had received cyst aspiration in 1997. He came to our out patient department for help due to the third recurrence of the cyst in 2004. The computed tomography scan showed a 5×5×5 cm dumb-bell shaped cyst below the hyoid bone. Tc 99m thyroid scan results were normal. Under the diagnosis of ”thyroglossal duct cyst”, the patient received ”Sistrunk's operation”. The pathology showed ”ciliated pseudostraitified columnar epithelium”. The outcome was good, and no further recurrence has been noted.

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