Ingrowing thyroglossal duct cyst presenting as a throat mass: A clinical pearl illustrated in two adult patients.

INTRODUCTION AND IMPORTANCE: Thyroglossal duct cyst (TGDC) is the most common congenital neck cyst and typically presents as an upper midline neck mass. Rarely, the cyst may present as a pharyngolaryngeal mass by forming posterior to the hyoid without an external palpable component and can present in adults with symptoms that mimic that of oropharyngeal or laryngeal malignancies.

CASE PRESENTATION: We evaluated two adult male patients for a chief complaint of dysphagia and globus sensation. Both patients had exophytic submucosal masses arising from the vallecula or hypopharynx, raising concern for neoplasm. Incisional biopsy was frustrated by the submucosal location and found to be negative on pathologic examination. However, a diagnosis of intralaryngeal and intralingual TGDC was made radiographically after reviewing the post-biopsy imaging.

CLINICAL DISCUSSION: Eventually both patients underwent the Sistrunk procedure, yielding definitive diagnosis and resolution of their symptoms.

CONCLUSION: Our cases serve as a reminder that for any cystic mass involving the hyoid bone, presentation in a very specific subset of adult patients may show physical exam findings that would lead to workup of an upper aerodigestive tract malignancy, however TGDC should be considered especially after imaging is thoroughly reviewed.