Ann Surg Treat Res.  2014 May;86(5):227-231. 10.4174/astr.2014.86.5.227.

Cervical bronchogenic cysts mimic metastatic lymph nodes during thyroid cancer surgery

• Jun HH
• Kim SM
• Lee YS
• Hong SW
• Chang HS
• Park CS

• KMID: 1889658
• DOI: http://doi.org/10.4174/astr.2014.86.5.227

Abstract

PURPOSE
Although congenital bronchogenic cysts in the cervical region, especially in the thyroid or perithyroidal area, are rare, distinguishing them from other cervical cystic lesions (e.g., thyroglossal duct and branchial cleft cysts) and metastatic cervical lymph nodes is difficult preoperatively. Additionally, cystic degeneration of metastatic lymph nodes is common in patients with thyroid cancer. We investigated the clinical characteristics and proper treatment for individuals with cervical bronchogenic cysts.
METHODS
Of the 18,900 patients treated for thyroid cancer, 18 patients with pathologically confirmed bronchogenic cysts were retrospectively reviewed. Bilateral total thyroidectomy or less than total thyroidectomy with central compartment node dissection, including cystic mass excision was done and cystic mass was confirmed by postoperative pathologic examination.
RESULTS
All cervical bronchogenic cysts were asymptomatic. Their mean size was 1.2 cm (range, 0.3 to 3 cm). Of these 18 patients, 15 did not have any abnormal radiological findings, except for lymphadenopathy during preoperative evaluations. Most bronchogenic cysts were detected around the thyroid and paratracheal areas. On preoperative imaging and intraoperatively, most were indistinguishable from metastatic cervical lymph nodes or other cystic lesions.
CONCLUSION
Although cervical bronchogenic cysts are rare and benign, they should be distinguished from other cystic cervical masses, especially metastatic cervical lymph nodes associated with thyroid cancer. Possible cervical bronchogenic cysts found during thyroid cancer evaluation or surgery should be surgically excised.

Keyword

Bronchogenic cyst; Thyroid neoplasms

MeSH Terms

Branchial Region
Bronchogenic Cyst*
Humans
Lymph Nodes*
Lymphatic Diseases
Retrospective Studies
Thyroid Gland
Thyroid Neoplasms*
Thyroidectomy

Figure

• 

  Fig. 1 (A) Axial CT view showing a cystic mass (arrow) with a homogeneous low-density mass around the thyroid cartilage, (B) 1.5-cm-sized cystic mass (arrow) at the right level III region in the neck.

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  Fig. 2 The pathologic findings of bronchogenic cyst. (A) The lesion comprises variable sized cysts and fibrotic tissue with inflammation (H&E, ×40). (B) The cysts are lined by respiratory type epithelium, which is characterized by pseudostratified columnar cells and cilia (H&E, ×400).

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