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cervical bronchogenic cyst

Tuesday 17 July 2018

Bronchogenic cysts of the neck

Definition: Bronchogenic cysts are rare congenital malformations of ventral foregut development. They are usually located in the mediastinum and intrapulmonary regions, localization in the cervical area is unusual.

The majority of bronchogenic cysts are diagnosed in the paediatric population, the location being either intra- or extra-thoracic.

Intra-thoracic cysts are usually found in the anterior mediastinum or around the ilum and may remain connected to the tracheobronchial airway by either a fibrous cord or a patent bronchus-like connection.

In the absence of an attachment, bronchogenic cysts can migrate and occasionally become displaced anteriorly by fusion of the mesenchymal bars forming the sternum.

A superficial presternal or suprasternal location is most common, while deep neck or laterally located bronchogenic cysts are comparatively rare.

Bronchogenic cysts of the cervical area are usually asymptomatic, but if the cyst is large, symptoms may occur, including dyspnoea, respiratory distress, cough and dysphagia.

Very occasionally, secondary infection may occur which results in sinus tract formation and external drainage of purulent material if the cyst is superficial, or with abscess formation if the cyst is deep.

In adults, the two most common locations of bronchogenic cyst are the mediastinum and lung parenchyma.

Most bronchogenic cysts are unilocular, filled with fluid and are not in communication with the airways. However, when a patent connection exists, symptoms are likely to occur and the risk of developing infectious complications increases.

A review of the literature revealed 14 cases of bronchogenic cysts of the neck in adults: the thyroid and paratracheal region were more frequently affected than the supraclavicular and suprasternal notch. In that review, 10 cases of cervical bronchogenic cysts were reported in the midline region, while 4 cases were located in the lateral neck. The male to female ratio was 4:1.

A FNAB can be performed. Cytology show clear serous material and the presence of non-atypical ciliated columnar cells and degenerative fragments of cytoplasm some of which containing pyknotic nuclear debry and tufts of cilia (ciliocytoforia) and mucoid and ciliated cells.

The histological examination shows respiratory epithelium lining the cervical bronchial cyst and mucoid cells.

See also

- cervical cysts
- bronchogenic cyst

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