Cutaneous 'bronchogenic' cyst

[Main Types of Cysts in Dermatopathology: Part 1]

Cystic structures represent one of the most common findings in dermatopathology. These encompass both cystic tumors and pseudocysts resulting from the accumulation of certain substances, such as mucin. In a two-part series (of which this is the first part), we have reviewed the principal types of cysts and pseudocysts that may be observed in cutaneous biopsies, examining their histopathological features and primary differential diagnoses. This first part encompasses infundibular cysts, eruptive dermoid cysts, pigmented follicular cysts, pilonidal cysts, tricholemmal cysts, milium cysts, hybrid cysts, bronchogenic cysts, as well as steatocystoma, hydrocystoma, and comedones.

Scapular Bronchogenic Cyst in a Girl Presenting as Recurrent Cellulitis: A Case Report and Review of the Literature

Bronchogenic cysts are rare, congenital cysts originating from respiratory epithelium and typically found within the chest. Cutaneous bronchogenic cysts are exceedingly uncommon, with only 19 reported cases in the scapular region and almost exclusively occurring in male patients. Herein, we present the case of a female patient with recurrent cellulitis secondary to a bronchogenic cyst, which was diagnosed after surgical excision. We also provide a review of the literature to consolidate the current understanding of cutaneous scapular bronchogenic cysts. To our knowledge, this is the first such case reported from Canada.

Cutaneous bronchogenic cyst in the left scapular region of a boy

BACKGROUND

Scapular bronchogenic cyst (SBC) is rare.

METHODS

A sinus on a boy's left scapula was excised.

RESULTS

Histopathological analysis showed the epithelium with scattered PAS-positive goblet cells was positive for CEA and CK7.

CONCLUSION

SBC should be suspected of a superficial scapular skin lesion in children.

Scapular bronchogenic cyst: a case report and literature review

Bronchogenic cysts originate from abnormal budding of the tracheal diverticula during the embryological period. Inaccuracy in the process of growing of the ventral foregut will give rise to bronchogenic cyst. Scapular bronchogenic cyst is an extremely rare form of this anomaly. A three years old boy suffered for 2 years with left sided suprascapular cystic lesion which was gradually increasing in size. The swelling was 4 × 3 cm in size and non tender. The cyst was evaluated by CT scan that showed complex cystic lesion over the left scapular spine. Total excision of the cyst was done and histopathology showed cutaneous bronchogenic cyst. The proposed mechanism for such cutaneous lesion is that the accessory buds from the tracheobronchial tree/primitive foregut migrated from the thorax in an aberrant manner to lie in periscapular positions. The definitive treatment of scapular lesions is total surgical excision. The final diagnosis is based on the histopathological findings in the majority of cases.

A case of cutaneous bronchogenic cyst presenting with lymphoid follicles

Cutaneous bronchogenic cysts are rare, and stem from developmental abnormalities of the tracheobronchial tree. The condition is often misdiagnosed clinically, with the correct diagnosis usually established by histopathologic examination. Published reports of bronchogenic or branchial anomalies are increasing, and the traditional defining characteristics of location and histopathology are proving to be less reliable for the identification of cutaneous bronchogenic cysts. In this report, we describe a case of a cutaneous bronchogenic cyst that presented with unusual histologic features, and was associated with several lymphoid follicles.

Cutaneous heterotopic bronchogenic tissue in the scapular area

Cutaneous bronchogenic anomalies are very rare lesions, and most of them present as cysts and/or sinus tracts in the subcutaneous layer. We report a 15-year-old boy who presented with a crusted and papillomatous plaque over the right scapular region. Histopathological examination of this plaque revealed pseudostratified ciliated columnar epithelium with papillary invaginations that included mucinous material. The lesion had no cyst or sinus formation and was bordered with smooth muscle bundles in stroma.

Bronchogenic cyst of the shoulder

An 8-month-old girl presented with a painless mass on her left shoulder that was noticed by her mother. Ultrasonography and magnetic resonance imaging (MRI) showed a well-defined subcutaneous cystic mass. The excised cyst was lined with ciliated pseudostratified columnar epithelium with occasional goblet cells and diagnosed as a bronchogenic cyst. She made a good recovery.

A congenial cutaneous bronchogenic sinus of the abdominal wall in an infant

Cutaneous bronchogenic anomalies are very rare, and we report a child who presented with mucoid discharge from a small opening on her epigastrium that was present since birth. Diagnosis and treatment of congenital bronchogenic anomalies are important because surgical excision is needed to prevent the potential risk of infection and malignant degeneration. To the best to our knowledge, this is the first report of a congenital bronchogenic sinus of the abdominal wall.

Scapular bronchogenic cyst

We report a rare case of a 3-year-old male child with scapular bronchogenic cyst. The cyst was excised because of associated pain and discharge from the swelling. Till date, 64 cases of cutaneous bronchogenic cyst have been reported in the literature. Only 12 of these patients had lesion located in periscapular area. The treatment is surgical as it can undergo malignant transformation.

A bronchogenic cyst under the scapula with a fistula on the back

A 20-year-old patient with a chronic fistula located at the left scapular region caused by a deep located subscapular bronchogenic cyst is described.

Scapular bronchogenic cysts in children: case report and review of the literature

Cutaneous bronchogenic cysts (CBC) are rare solitary lesions which originate from primitive tracheobronchial tree. The periscapular location of these lesions is even a rare condition. The aim of this study is to evaluate this pathology after our case with literature review. An one-year-old girl was brought to our clinics with the complaint of a drainage at the back of her shoulder. In her physical examination, a hyperemic enduration with a sinus and purulent drainage was noted at the left scapular region. Ultrasonography revealed a lesion of 15x11 mm2 in size with a thick wall and a hypoechoic center. The lumen of the cyst was demonstrated with fistulography. Surgical excision of the lesion was performed and pathological examination revealed a cutaneous bronchogenic cyst. CBC have been reported in 64 cases in the literature. They are often found in the lower neck, sternum and shoulders. They arise due to abnormal bronchial budding during the embryological period. Only in 12 of these patients, including our case, the lesion was located in the periscapular area. Its treatment is surgical because of malignant transformation and infection. The recognition of this entity may help the surgeon for early diagnosis.

Periscapular bronchogenic cyst

Periscapular location of bronchogenic cysts is extremely rare with four cases reported in literature. We report a relatively late presentation in a ten-year-old boy that was clinically mistaken for a typical sebaceous cyst. The definitive treatment is total excision after preoperative imaging to detect the occasional intrathoracic extension. Histologically they are lined by pseudostratified ciliated columnar epithelium, which can rarely undergo malignant transformation.

Malignant melanoma arising from cutaneous bronchogenic cyst of the scapular area

Bronchogenic cyst, an uncommon developmental anomaly that originates from the primitive tracheobronchial tree, is rare in the skin. The shoulder region is a particularly rare location. We report a 46-year-old Japanese man with recurrent malignant melanoma that arose from such a cutaneous bronchogenic cyst in the left scapular area. Despite wide local excision and subsequent chemotherapy, he died 18 months after surgery of the melanoma because of its lung metastasis. This is the first case of bronchogenic cyst in which malignant melanoma occurred.

Cutaneous bronchogenic cyst of the abdominal wall

We report a case of the unusual location of a cutaneous bronchogenic cyst on the abdominal wall. The patient was a 9-month-old boy who had presented with a 1.5 cm-sized polypoid mass, present since birth. Pathological examination of the excised mass revealed multiple small cystic structures surrounded by the fibroadipose tissue. The lining epithelium consisted of either pseudostratified ciliated columnar epithelium with goblet cells or a single layer of ciliated or non-ciliated cuboidal to columnar cells. The cystic walls contained a well-developed smooth muscle bundle, mucous glands and hyaline cartilage plate. This lesion was adherent to the peritoneum, but there was no direct communication with the abdominal cavity. Cutaneous bronchogenic cyst located in the abdominal wall has not been described in the English literature. The present case suggests a possible origin from a downward migration, from the sequestered bud of a tracheobronchial tree primordium along the midline of the body surface, during embryonic development.

A case of cutaneous bronchogenic cyst over the left scapula

Bronchogenic cyst is noted shortly after birth or in early childhood and usually presents as a swelling or draining sinus in the presternal area. Its origin and pathogenesis can be explained as a developmental anomaly of the tracheobronchial buds from the primitive foregut. The patient was a 4-year-old boy with a child-fist-sized soft mass over his left scapula, which had been detected at birth and had been gradually growing. Grossly, it appeared to be a simple cyst with clear mucoid fluid. Histopathological study demonstrated a unilocular cyst composed of ciliated pseudostratified columnar epithelia, interspersed goblet cells, smooth muscles, and mucous glands on the cyst wall, which are features compatible with cutaneous bronchogenic cyst.

Bronchogenic cyst presenting as a nodular lesion

We report a subcutaneous bronchogenic cyst in a 7-year-old girl with unusual presentation as a nodular lesion. The cyst was excised and no connection with deeper structures was found. Histologic examination showed the typical features of a bronchogenic cyst. The characteristic clinical and histologic features of bronchogenic cysts are reviewed. The problems of differential diagnosis are also discussed.

Cutaneous lung tissue heterotopia

AIMS

We describe the clinical and pathological findings of a previously unreported cutaneous lung tissue heterotopia in a child.

CASE DETAILS

The 3-year-old female patient developed a 8-mm secreting papule over her left scapula. Pathological examination revealed a lesion composed of bronchioles and alveoli within the subcutis and the dermis, with bronchiolar connection to the epidermis. Alveolar type II cells indicating full pulmonary differentiation were detected with a monoclonal antibody (AMH 152).

CONCLUSIONS

The described features suggest that this lesion is a unique variant of rarely observed bronchus-like entities of the skin, designated as cutaneous bronchogenic cysts or cutaneous branchial cleft cysts.

Ciliated cyst of the perineal skin

Cutaneous cysts lined by ciliated epithelium are very rare, benign tumors predominantly occurring on the lower extremities of young women. We describe a ciliated cyst found in the perineum of a 60-year-old man. The location and histological features led us to attribute a primitive tailgut origin to this cyst, probably from the embryonic remnants of cloacal membrane. Only two previous examples of similar cysts were found in the literature.

Branchial cleft heterotopia of the lower neck

A cutaneous ciliated structure from the lower neck of a 61-year-old man having seromucous, sebaceous and respiratory-type differentiation is reported. The finding of continuity between endodermal and ectodermal structures in the reported lesion suggests an origin from the branchial apparatus. Many lesions with similar appearance have been labeled bronchogenic though these, in fact, may have branchial origins. The term cutaneous bronchogenic cyst, implying an origin from the tracheobronchial tree, maybe misleading and should be reconsidered for those lesions with respiratory-type differentiation in the lower neck.