Sonographic appearance of branchial cysts

Benign lymphoepithelial cyst of parotid gland without human immunodeficiency virus infection: A case report

BACKGROUND

Benign lymphoepithelial cyst (BLEC) of the parotid gland is a rare benign embryonic-dysplastic cystic tumor in the anterolateral neck that occurs most commonly in human immunodeficiency virus (HIV)-positive adults and rarely in non-acquired immune deficiency syndrome patients. The main presentation is a slow-growing, painless mass, and secondary infection may cause acute inflammatory symptoms.

CASE SUMMARY

A 44-year-old Chinese male patient presented with a 1-year history of a mass in the left side of the neck. On physical examination, a mass similar in size and shape to a quail egg was found in the left parotid gland. The mass was tough, without tenderness, and easily moveable. The results of HIV tests, including antibody and nucleic acid tests and CD4+ T cell examination, were negative. Imaging examination revealed a left parotid gland mass. The patient underwent surgical treatment, and BLEC was diagnosed based on postoperative pathology. After 2 years of follow-up, the patient survived well without related discomfort.

CONCLUSION

The detailed characteristics of a BLEC in a patient without HIV infection contribute to an improved understanding of this rare disease.

Branchial cleft cyst at an unusual location: a rare case with a brief review

A branchial cleft cyst (BCC) commonly presents as a solitary, painless mass in the neck of a child or young adult. They are most commonly located along the anterior border and the upper third of the sternocleidomastoid muscle in the anterior triangle of the neck. It is very rare for a BCC to manifest in other locations, especially in the posterior triangle of the neck. BCCs are believed to be derived from the branchial apparatus, mostly from the second branchial arch, although many theories have been proposed to explain the aetiology of BCCs. It is possible for BCCs to be easily misdiagnosed as other swellings of oral or paraoral origin owing to their location. Intraoral lymphoepithelial cysts have also been reported in the literature. It is imperative that clinicians make an accurate diagnosis so that appropriate treatment can be performed. If the cysts are excised properly, recurrence is rare. A rare case report of BCC arising in the neck from an unusual location with components in the posterior triangle is presented here.

MRI of acute abdominal and pelvic pain in pregnant patients

OBJECTIVE

The purpose of this study was to show the usefulness of MRI in the evaluation of pregnant women with acute abdominal or pelvic pain.

SUBJECTS AND METHODS

All MRI studies of pregnant patients who were referred for examination because of acute abdominal or pelvic pain between June 2002 and May 2004 were included in this study (n=29). The use of MRI was at the discretion of the clinician. Fetal sonography was performed in all patients before any other imaging. A complete abdominal sonographic examination was performed in six patients before MRI. In the remaining 23 patients, MRI was the choice for primary imaging. Multiplanar multisequence MR images of the abdomen and pelvis were obtained in each patient. Unenhanced images were reviewed by an experienced radiologist to determine whether a diagnosis could be made without the administration of gadolinium. In 22 of 29 studies, gadolinium was not administered. The prospective clinical MR interpretations were compared with follow-up medical, surgical, and obstetric records to determine the correctness of the interpretation. All patients were followed up until the date of article submission or until the date of final chart entry.

RESULTS

Correlation of prospective clinical MR interpretations with follow-up medical records showed correct identification of disease entities in all but one patient. In one patient, torsion of the ovary was neither described prospectively nor seen in retrospect. The following disease processes were correctly identified using MRI: appendiceal abscess (n=1), appendicitis (n=2), intraabdominal and rectus muscle abscess (n=1), intussusception (n=1), pancreatitis (n=1), ulcerative colitis (n=1), Crohn's disease with diffuse peritoneal inflammation (n=1), bilateral adrenal hemorrhage (n=1), pyelonephritis (n=2), hydronephrosis (n=1), uterine fibroid degeneration (n=2), degeneration and torsion of a submucosal uterine fibroid (n=1), simple ovarian cysts (n=1), and ovarian torsion (n=1). Twelve of the 29 patients had normal findings on MR examinations and unremarkable follow-up.

CONCLUSION

The intrinsic safety of MRI and its ability to accurately show abdominal and pelvic disease in pregnant patients make it highly useful in the evaluation of these patients.

Branchial cleft or cervical lymphoepithelial cysts: etiology and management

BACKGROUND

The cervical lymphoepithelial or branchial cleft cyst is a developmental cyst that has a disputed pathogenesis. The objective of this article is to provide a brief review of the literature and to define diagnostic terms related to this anomaly, as well as to describe its etiology, clinical presentation and treatment.

CASE DESCRIPTION

The cervical lymphoepithelial or branchial cleft cyst usually presents as a unilateral, soft-tissue fluctuant swelling that typically appears in the lateral aspect of the neck, anterior to the sternocleidomastoid muscle, and becomes clinically evident late in childhood or in early adulthood. Clinicians can diagnose the cyst with appropriate imaging to assess the extent of the lesion before definitive surgical treatment. The authors describe a patient who underwent excision of a well-encapsulated cystic structure that was diagnosed as a branchial cleft cyst.

CLINICAL IMPLICATIONS

The cervical lymphoepithelial or branchial cleft cyst can be easily misdiagnosed as a parotid swelling or odontogenic infection. It is imperative that clinicians make an accurate diagnosis so that appropriate treatment (that is, surgical excision) can be performed. If the cysts are treated properly, recurrences are rare.

Three cases of papillary carcinoma and three of adenoma in thyroglossal duct cysts: clinical-diagnostic comparison with benign thyroglossal duct cysts

The clinical and diagnostic findings of 3 cases of papillary thyroid carcinoma in thyroglossal duct cyst (TDC) were compared to those of 3 cases of adenoma in TDC and 2 cases of benign TDC. The neck masses of the subjects with benign TDC grew slowly, whereas those of 2 patients with papillary carcinoma and 1 of the patients with adenoma grew rapidly (especially those with carcinoma). On the other hand, one case of carcinoma, and two cases of adenoma in TDC were diagnosed incidentally. Benign TDC had an anechoic pattern at US, whereas the cysts containing carcinoma and adenoma showed the presence of a mural nodule at US. Microcalcifications in the mural mass were present in one patient with carcinoma. The 3 patients with carcinoma in TDC underwent total thyroidectomy. The histology was negative in all 3 patients for thyroid cancer and thyroid nodules. However, in 2 of them it revealed the carcinoma invading the cyst wall and adjacent tissues, 1 of which also exhibited 2 metastatic lymph nodes in the central neck area. The cases reported illustrate the utility of enhancing one's clinical suspicion of carcinoma in patients bearing TDC, even when incidentally discovered. In particular, rapid growth of the cystic mass, and the presence of a mural nodule on US, especially with calcifications, must raise the physician's suspicion for a cancer arising in TDC.

Sonographic evaluation of thyroglossal duct cysts in children

BACKGROUND AND AIMS

Thyroglossal duct cysts (TDC) in children have a variable sonographic appearance. Some reports have suggested that TDCs appear on ultrasound as well defined, cystic masses with thin walls and posterior enhancement, whereas others have documented a heterogeneous echopattern within these lesions. In our experience, although TDCs in children have a variable ultrasound appearance, the most common appearance is that of a pseudosolid mass closely related to the hyoid bone. In this study we report on 23 patients with thyroglossal duct cysts and document the ultrasonic patterns.

PATIENTS AND METHODS

All patients in whom the diagnosis of TDC was made clinically (by at least two head and neck surgeons) and in whom ultrasound detected a cystic mass related to the hyoid bone, were included in this study. Sonograms of 23 children with TDCs were reviewed. The features evaluated included their location, internal echogenicity, posterior enhancement, the presence of septa, a solid component and a fistulous tract. The echopattern was not correlated with the biopsy results.

RESULTS

Three patterns of TDCs were identified: anechoic (13%); pseudosolid (56.5%); and a heterogeneous pattern (30.5%). The majority were midline (82.6%), showed posterior enhancement (56.5%), and had thin walls (82.6%).

CONCLUSION

On ultrasound, TDCs in children are not simple cysts but have a complex pattern ranging from a typical anechoic cyst to a pseudosolid appearance (most common).Ahuja, A. T. (2000). Clinical Radiology55, 770-774.

Solitary cystic nodal metastasis from occult papillary carcinoma of the thyroid mimicking a branchial cyst: a potential pitfall

Thyroid carcinoma presenting as cervical lymph node metastasis with a clinically normal neck indicates an aggressive tumour of the thyroid. When the nodal metastasis is solitary and cystic, with no obvious suspicious thyroid mass on ultrasound (US) it may be mistaken for a branchial cyst. As the management of these two conditions is different, it is important to make a correct pre-operative diagnosis. We present the US features that help in distinguishing the two.