Cervical Bronchogenic Cyst

Cervical bronchogenic cysts are uncommon congenital lesions found almost invariably in the skin or subcutaneous tissue in the vicinity of the suprasternal notch or manubrium sterni, rarely in the anterior neck or shoulder.

Bronchial cysts are derived from small buds of diverticula that separate from the foregut during formation of the tracheobronchial tree. When they occur outside the thoracic cavity, the cyst presumably arises from erratic migration of sequestered primordial cells.

They are usually discovered at or soon after birth and appear as asymptomatic nodules that slowly increase in size or as draining sinuses exuding a mucoid material. They are more common in males, in some series by a margin of 3:1 [31]. The cysts range from 0.3 to 6 cm in size. They are lined by ciliated, pseudostrati-fied columnar epithelium (Fig. 9.9). If the cyst is infect ed squamous epithelium is found. The cyst wall contains smooth muscle, elastic fibres and seromucous glands. In the 30 cases studied by Fraga et al., smooth muscle was identified in 24 and seromucous glands in 16. In contrast to their intrathoracic counterparts, only 2 contained cartilage [39].

A bronchogenic cyst can be distinguished from a ter-atoma by a complete absence of tissues other than those that can be explained on the basis of a malformation. The lack of ciliated epithelium distinguishes a lateral cervical cyst containing gastric mucosa from a cervical bronchogenic cyst. TDC can be differentiated from a bronchogenic cyst by finding thyroid follicles; furthermore, TDC do not contain smooth muscle or cartilage.

Complete surgical excision of a bronchogenic cyst along with its sinus tract is curative. Malignancies have not been described in cervical bronchogenic cysts.

ICD-O:9084/0

The term dermoid cyst should be reserved for a cystic neoplasm that originates from the ectoderm and meso-derm; endoderm is never found in these cysts [101]. The head and neck area is a common site of occurrence for dermoid cysts, accounting for 34% of cases. These cysts are located in the skin and subcutaneous tissues [113].

The position of these dermoid cysts at the midline and along the lines of embryonic fusion of the facial processes is consistent with their origin by inclusions of ectodermal tissue along lines of closure at junctions of bone, soft tissue, and embryonic membranes [87].

Dermoid cysts in the neck account for 22% of mid-line or near-midline neck lesions [101]. They have been described in the upper neck, near the thyroid cartilage, and as low as the suprasternal notch. They may occur in people of almost any age. More than 50% are detected by the time a person is 6 years old, and approximately one-third are present at birth [87, 101, 113]. The distribution between the sexes is approximately equal.

Dermoid cysts range in size from a few millimetres to 12 cm in diameter. On microscopic examination they are lined by stratified squamous epithelium supported by a fibrous connective tissue wall. Ectodermal derivatives may be seen, including dermal adnexa such as hair follicles, sebaceous glands, and sweat glands.

Some cysts may be difficult to classify because of an apparent discrepancy between the anatomic site of presentation and the histologic features, indeterminate microscopic findings, loss of an intact epithelial lining, or mixed histologic appearance. When a final determination regarding the type of cyst is not possible, the term "congenital or developmental cyst, indeterminate type" should be used [121].

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