Cervical Thymic Cyst with parathyroid tissue - a diagnostic conundrum

Cervical thymic cysts are relatively rare benign cystic lesions that tend to be diagnosed clinically as branchial cysts, which usually present as painless, enlarging neck masses. They can occur anywhere along the normal path of descent of thymic primordia from the angle of the mandible to the sternal notch, with mediastinal extension observed in approximately 50% of cases. They are usually seen in the first decade of life on the left side with a male predominance. Here we report a case of a 15-year-old boy who presented to the hospital with left-sided neck swelling for about 2 months. The neck's contrast-enhanced computed tomography (CECT) revealed a large, well-defined cystic swelling in the left neck region, showing peripheral enhancement, seen from the submandibular region to the superior mediastinum extending into the retrosternal region. Direct fine needle aspiration (FNA) was done, which showed a benign lesion with inflammatory and cystic characteristics, leading to the possibility of a branchial cyst. The cyst was completely excised surgically. Histopathology showed a thymic cyst with parathyroid tissue. The presence of thymic tissue with Hassall's corpuscles is essential for the diagnosis. Knowledge of the clinical presentation, cyto-histological findings, and differential diagnosis of cystic cervical lesions in the pediatric population is important to diagnose this rare entity. Hence, though uncommon, when one comes across a cystic cervical region mass in children, a diagnosis of cervical thymic cyst should be kept in mind. Nonetheless, a definitive diagnosis depends on imaging findings as well as intraoperative findings and histopathological examination.

Cisto branquial da 4ª fenda ­ relato de caso / Branchial cyst 4th cleft ­ case report

Introdução: Os cistos branquiais são tumores congênitos laterais, resultantes de defeitos de desenvolvimento embrionário que afetam os arcos branquiais.1 As anomalias congênitas cervicais são mais comumente diagnosticadas nos primeiros anos de vida. Objetivo: Informar, discutir e analisar condutas para tratamento desse tipo de cisto congênito. Método:Relato de caso e análise de dados, diagnósticos e conduta baseada na literatura referente a Cisto Branquial da 4° Fenda. Resultados:Os cistos podem se manifestar tardiamente, mas as fístulas são, quase sempre, diagnosticadas ao nascimento ou na infância.São extremamente raros, estima-se que 95% das anomalias das fendas branquiais sejam da 2ª fenda; das 5% restantes, quase todas são da 1ª ou 3ª fenda.O diagnóstico é primariamente clínico, mas a ultrassonografia pode auxiliar no diagnóstico diferencial de um cisto branquial. O tratamento das anomalias branquiais é a excisão cirúrgica. Lactente sexo feminino, 9 meses de idade em acompanhamento de cisto branquial com conduta conservadora. O surgimento da massa se deu logo ao nascimento, havendo drenagem espontânea do cisto para o esôfago alguns dias depois. Após nove meses paciente retorna devido aumento progressivo da lesão que correlacionando com exame físico, exames de imagem levaram ao diagnóstico de cisto de 4º fenda branquial. Realizada cirurgia para remoção de Cisto juntamente com retirada de lobo esquerdo da tireoide (tireoidectomia parcial). Conclusão:Após a exerese da lesão paciente evoluiu satisfatoriamente sendo encaminhado para enfermaria e posteriormente alta com acompanhamento ambulatorial com pediatra geral.

Introduction: Branchial cysts are congenital tumors, resulting from embryonic defects that affect the branchial arches. Congenital cervical abnormalities are usually diagnosed in the first years of life. Objective: To inform, discuss and analyze treatment approaches for this type of congenital cyst. Method: Case report and analysis of data, diagnoses and approaches based on the literature addressing Fourth Branchial Cleft Cysts. Results: Cysts can manifest late, but fistulas are almost always diagnosed at birth or in childhood. They are extremely rare: it is estimated that 95% of branchial cleft anomalies involve the second cleft; of the remaining 5%, almost all arise from the first and third clefts. There are about 45 cases of fourth cleft cysts reported in the literature. The diagnosis is primarily clinical, but the ultrasound can be used for the differential diagnosis of a branchial cyst. Computed tomography will show air-fluid level in the anterior portion of the neck, in front of the thyroid and trachea, which may compress the trachea, causing respiratory distress in childhood. The treatment of branchial anomalies is surgical excision. A 9-month old female patient was being followed up after conservative treatment of a cervical mass (branchial cyst). The cyst appeared immediately after birth, but there was there was spontaneous drainage of the cyst into the esophagus a few days later. After nine months, the patient returned due to a progressive increase of the lesion, which, after physical examination and imaging exams, led to the diagnosis of a fourth branchial cleft cyst. A surgical procedure was performed to remove the cyst along with the left thyroid lobe (partial thyroidectomy). Conclusion: After the excision of the lesion, the patient made a good recovery. She was then referred to the infirmary and later discharged with outpatient follow-up by a general pediatrician.

Branchial cleft cyst in the parotid gland in a human immunodeficiency virus-negative patient

In branchial lymphoepithelial cyst (BLEC), which is also known as branchial cleft cyst, the remnants of a branchial arch develop into a cyst, causing swelling. The first case of BLEC in the parotid gland was reported by Hildebrant in 1895. Since then, BLEC in the parotid gland has continued to be reported, but in rare cases. A 45-year-old man presented to our hospital with a swelling of the left cheek of approximately 6 months’ duration. The patient underwent a superficial parotidectomy and was pathologically diagnosed with BLEC. Of note, this was the first case of non-human immunodeficiency virus (HIV)-related BLEC of the parotid gland in South Korea. BLEC is a benign condition, but its treatment depends on the presence of HIV infection. In HIV-negative patients, BLEC does not require a further work-up to evaluate metastasis. Our case report describes the diagnosis and treatment of BLEC in a patient without HIV.

A Case of a Primary Branchiogenic Carcinoma with a Synchronous Tonsil Squamous Cell Carcinoma / 대한이비인후과학회지

Branchiogenic carcinoma (BC), which is defined as squamous cell carcinoma arising from a branchial cyst, was first described by Volkmann in 1882. This rare disease is regarded as hypothetical, and remains a controversial disease entity. Among the diagnostic criteria of BC, the key point is the histologic demonstration of a cancer developing from the wall of an epithelial-lined cyst in the lateral site of the neck. In previous literature, many authors argued that this malignancy is actually cystic metastasis from oropharyngeal squamous cell carcinoma. We report a case of a 49-year-old female who was diagnosed as a primary BC patient with a synchronous tonsillar squamous cell carcinoma. Although this case did not meet the traditional diagnostic criteria because of existing tonsil cancer, we could diagnose these diseases as primary malignancies, since the transition zone was clearly seen, and there was no lymph node component in the histopathologic examination.

A Case of the Ex Utero Intrapartum Treatment Procedure for Fetal Giant Fourth Branchial Cleft Cyst / 대한이비인후과학회지

Large neck masses in the fetus can result in neonatal hypoxia with airway obstruction during a delivery. The ex-utero intrapartum treatment (EXIT) is a procedure that would be helpful in safely securing a fetal airway when the maternal-fetal circulation is being obstructed. Branchial cleft cyst (BCC) is a relatively common congenital malformation in the neck, however, the fourth BCC is very rare. Herein, we present a case of a giant fourth BCC, which was prenatally detected on ultrasound and safely surgically treated to secure an airway with EXIT procedure during the delivery.

Cytological Features of a Lymphoepithelial Cyst Collected from Fine Needle Aspiration of the Thyroid Gland That Mimicked Papillary Thyroid Carcinoma: A Case Report

Since its first description in 1989, lymphoepithelial cyst of the thyroid gland (LEC-T) has been generally considered a branchial cleft derivative similar to its presentation in other sites, including thymus, parathyroid, and pancreas. However, its characterization has mainly focused on histologic and sonographic findings, and cytological findings are generally described simply or left out entirely. Fine needle aspiration cytology (FNAC) of our case showed large tissue fragments of epithelial cells on a background of lymphocytes. Some areas showed sheets or small nests of squamoid cells, which were closely admixed with clusters of lymphoid cells. Squamous cells contained relatively moderate to large amounts of eosinophilic cytoplasm and vesicular nuclei with occasional nuclear grooves that lacked intranuclear inclusions. Some cells demonstrated keratinization and nuclear atypia. Herein, we describe FNAC findings of LEC-T and review other possible diagnoses.

Primary papillary carcinoma originated from a branchial cleft cyst / 대한외과학회지

Although branchial cleft cysts are common, papillary carcinomas arising from them are rare. Here we report a 41-year-old woman with papillary carcinoma originating from a right lateral branchial cleft cyst without any evidence of a papillary carcinoma in the thyroid gland. The patient underwent right lateral neck dissection followed by total thyroidectomy. We then confirmed papillary carcinoma arising from the branchial cleft cyst through microscopic and immunohistochemical staining with thyroglobulin (TG), thyroid-associated transcription factor-1 (TTF-1) and p63. It is the 10th case worldwide describing papillary carcinoma in a branchial cleft cyst with a review of the literature on the features of the disease and discussion of the role of immunohistochemical staining with TG, TTF -1 and p63. In conclusion, it should be emphasized that the surgeon must be cautioned of the possibility of primary papillary carcinoma in the branchial cleft cyst.

Quiste branquial tipo I: presentación de un caso / A type-I brachial cyst: a case report

Se presenta el caso de una adolescente de 14 años de edad, raza blanca, del sexo femenino, con antecedentes de salud relativa, que se valoró en la consulta externa del Policlínico Universitario Ernesto Guevara de la Serna de Sandino, Pinar del Río, Cuba. La paciente presentó un cuadro caracterizado por el aumento de volumen superficial de la región lateral derecha superior del cuello, por debajo de la rama horizontal de la mandíbula y por delante del borde anterior del músculo esternocleidomastoideo, cerca del pabellón auricular y la parótida, de aproximadamente 4 cm. de diámetro, móvil, no doloroso, de superficie lisa y consistencia renitente, sin cambios en la coloración de la piel; al examen físico otorrinolaringológico no se encontraron otras alteraciones, posteriormente se realizó un ultrasonido en esa región. El diagnóstico dio como resultado un quiste branquial y se procedió a la exéresis quirúrgica por el equipo de autores del artículo, realizándose estudio anatomopatológico. Los autores presentan las experiencias derivadas de la atención del caso, y revisan la literatura médica sobre el tema con especial referencia al diagnóstico y tratamiento.

A Caucasian 14 year-old female adolescent having relative health history was assessed at "Ernesto Guevara de la Serna" Outpatient Clinic in Sandino, Pinar del Rio, Cuba. The patient presented a clinical chart which was characterized by an increase of the superficial volume of the right upper lateral region of neck, below the horizontal branch of the mandible and to the front of the anterior border of sternocleidomastoid muscle, near outer ear and parotid having approximately 4cm of diameter, motile, painless, smooth surface and renitent consistency, without changes in skin color; physical and ENT examinations found no other alterations, subsequently a sonographic study in that region confirmed a brachial cyst that was surgically removed performing pathological studies. The authors presented the experiences derived from this case and the medical literature about the topic was reviewed emphasizing on the diagnosis and treatment.

The First Korean Case of Cutaneous Lung Tissue Heterotopia

Cutaneous lung tissue heterotopia is a very rare disorder where mature lung tissues develop in the skin. This is only the second known report of cutaneous lung tissue heterotopia, with the first by Singer et al. in 1998. A newborn infant had a hemangioma-like, freely movable mass connected to the anterior aspect of the sternal manubrium. Pathologic findings showed mature lung tissues with bronchi, bronchioles, and alveoli through the dermis and subcutis, and it was diagnosed as cutaneous lung tissue heterotopia. Cutaneous lung tissue heterotopia is hypervascular, so grossly it looks like a hemangioma. It can be differentiated from pulmonary sequestration, teratoma, bronchogenic cyst, and branchial cleft cyst by histology and the location of the mass. We describe the clinical, radiologic, and pathologic findings of a cutaneous lung tissue heterotopia, the first reported in Korea.

Perioperative nursing of 20 newborn with branchial cysts / 中华护理杂志

This paper introduces the perioperative nursing of 20 cases of branchial cysts in newborn with cyst extraction. The nursing care focused on body position,respiratory care,diet management and wound care,which alleviated the patients' dyspnea,prevented respiratory aspiration and promoted wound healing. All the 20 newborn recovered well without recurrence in the four years after the operation.

Cisto branquial malignizado ou metástase de tumor primário? relato de caso / Malignant branchiogenic cyst or primary tumor metastasis? case report

Introdução: A existência de cisto branquial malignizado é controversa desde a época em que foi descrito pela primeira vez. A maioria dos autores acredita que, na verdade, é uma metástase cística de tumor primário de cabeça e pescoço. Objetivo: Discutir sobre a existência de cisto branquial malignizado. Relato do Caso: Paciente apresentando massa cística anterior à porção superior do músculo esternocleidomastóideo, que foi removida como um cisto branquial malignizado. Entretanto, o exame anátomo patológico sugeriu tratar-se de um tumor primário desconhecido. A paciente vem sendo seguida com exames periódicos sem evidências do primário. Considerações Finais: Provavelmente nunca saberemos se era um cisto branquial malignizado ou metástase de primário desconhecido devido a sobreposição de critérios diagnósticos.

Introduction: The existence of malignant branchiogenic cyst has been controversial since it was first described. Most authors believe that it is actually a head and neck primary tumor cystic metastasis. Objective: Discuss the existence of malignant branchiogenic cyst. Case Report: A patient with a cystic mass in front of the sternocleidomastoideus muscle superior part, which was removed as a malignant branchiogenic cyst. However, the anatomopathological examination suggested it was an unknown primary tumor. The patient has been followed-up with periodic examinations without evidences of a primary tumor. Conclusion: Probably we will never know whether it was a malignant branchiogenic cyst or an unknown primary metastasis, due to diagnostic criteria overlapping.

The value of high-frequency ultrasound in diagnosis and differential diagnosis for branchial cleft cyst / 中华超声影像学杂志

Objective To explore the value of high-frequency ultrasound in diagnosis and differential diagnosis of branchial cleft cyst.Methods Ultrasonic features of 56 cases of branchial cleft cyst confirmed by operation and pathology were analyzed and summarized retrospectively. Results In those cases,there were 7 cases of the first branchial cleft cyst,48 cases of the second branchial cleft cyst and only one case of the third branchial cleft cyst.Seven cases displayed orificium fistulae.All cysts presented as oval-shape and similar round shape,well-defined and regulative margin,raritas or intensive spot echo inside,pone echo enhancement effect.In color Doppler flow images,9 cases showed blood flow in capsula wall,and there was no blood flow in capsula space.The diagnose accordance rate was 90.1 1%(42 cases were completely correct,9 cases were roughly correct).Conclusions High frequency color Doppler ultrasonic diagnosis and differential diagnosis for branchial cleft cyst was accurate,it has an important clinical value.

The Occurrence of a Branchial Cleft Cyst in the Anterior Mediastinum: A Case Report

Branchial cleft cysts and branchial anomalies develop from the branchial cleft apparatus that persists after fetal development. The most common anatomical site for the occurrence of branchial cleft cysts is in the cervical area, generally anterior to the sternomastoid muscle in the upper or middle portion of the neck. A mediastinal branchial cleft cyst is extremely rare and few cases have been reported. We report the case of branchial cleft cyst found in the anterior mediastinum with literature review.

A Cases of Primary Branchial Cleft Cyst Carcinoma / 대한이비인후과학회지

The hypothesis that primary branchiogenic carcinoma originates from a branchial cleft cyst is controversial since the entity was first described in 1882. In 1950, stringent criteria were established for the diagnosis of primary branchiogenic carcinoma, the most important criterion being histologic proof of carcinoma arising from a normal cyst epithelium. Only a limited number of cases have successfully fulfilled these criteria. In this article, we describe a case of squamous cell carcinoma arising in the second branchial cleft cyst and also discuss the diagnosis, histopathologic features, and therapeutic options.