Bronchogenic Cyst

 Less commonly: Lateral, thyroid, or subcutaneous



• M:F = 4:1

• Presents with airway compression, dysphagia, or infection, or may be asymptomatic

• Complete surgical excision is treatment of choice

• Excellent long-term clinical prognosis




Imaging




• Best study: Contrast-enhanced MR T1WI or T2WI to show well-defined, solitary, smooth-bordered mass


Macroscopic




• Grossly tubular, altered by infection

• Cut sections show clear serous to mucoid material


Microscopic




• Cyst lined by respiratory-type epithelium

• Cyst wall with mucoserous glands, hyaline cartilage, and smooth muscle


Top Differential Diagnoses




• Teratoma

• Dermoid cyst

• Branchial cleft cyst

• Thyroglossal duct cyst

• Cystic hygroma (lymphangioma)

image
Cyst Wall With Cartilage and Glands
This hematoxylin and eosin shows all the major features of a bronchogenic cyst: A cyst space image lined by respiratory-type epithelium image with a fibrous connective tissue wall that contains mucoserous glands image, hyaline cartilage image and smooth muscle image. Multiple step sections may be needed to identify the different components.


image
Ciliated Respiratory Epithelium
High-power image shows ciliated respiratory-type epithelium image overlying a band of smooth muscle image closely associated with cartilage image.

image
Wall Contents
Hematoxylin and eosin shows the fibrous wall of a bronchogenic cyst. Seromucinous glands image are found throughout the wall and may contribute to the mucoid material found within the cyst.

image
Highlighting of Smooth Muscle
Smooth muscle, highlighted with smooth muscle actin, is characteristic within the wall of a bronchogenic cyst. Other cysts in the differential diagnosis, such as branchial cleft cysts and thyroglossal duct cysts, lack smooth muscle.


TERMINOLOGY


Synonyms




• Bronchial cyst


Definitions




• Rare congenital malformation of ventral foregut
image Enteric cyst, neurenteric cysts are part of same family


ETIOLOGY/PATHOGENESIS


Embryogenesis




• Derived from small buds of diverticula that separate from foregut during formation of tracheobronchial tree

• Usually between 26th-40th day of gestation

Apr 24, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Bronchogenic Cyst
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