Cutaneous bronchogenic cyst of the back: a case report and review of the literature

[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.

The first Korean case of cutaneous lung tissue heterotopia

Cutaneous lung tissue heterotopia is a very rare disorder where mature lung tissues develop in the skin. This is only the second known report of cutaneous lung tissue heterotopia, with the first by Singer et al. in 1998. A newborn infant had a hemangioma-like, freely movable mass connected to the anterior aspect of the sternal manubrium. Pathologic findings showed mature lung tissues with bronchi, bronchioles, and alveoli through the dermis and subcutis, and it was diagnosed as cutaneous lung tissue heterotopia. Cutaneous lung tissue heterotopia is hypervascular, so grossly it looks like a hemangioma. It can be differentiated from pulmonary sequestration, teratoma, bronchogenic cyst, and branchial cleft cyst by histology and the location of the mass. We describe the clinical, radiologic, and pathologic findings of a cutaneous lung tissue heterotopia, the first reported in Korea.

Congenital cervical bronchogenic cyst in a calf

The present report describes an extrathoracic bronchogenic cyst in a 30-day-old female calf. Histologically, the cyst wall was lined by a layer of ciliated pseudostratified columnar epithelium with peripheral arrangement of cartilage, glands, and smooth muscle fascicles. The mass was successfully removed by simple surgical excision.

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.

Sacral intraspinal bronchogenic cyst: a case report

Intraspinal bronchogenic cysts are rare congenital cystic lesions. In all the reported cases, the cysts have been located in the cervical, upper thoracic or thoracolumbar segments. We report the case of an intraspinal bronchogenic cyst in the sacral location. We present the case of a 5-month-old female with a skin dimple in the midline over the sacral vertebra. Magnetic resonance image of the lumbar and sacral vertebra revealed a dermal sinus tract and an epidural cystic mass at the S2 level. The patient underwent the removal of the dermal sinus tract and the cyst. The cystic mass was shown to be connected to the subarachnoid space through a slender pedicle from the dura. The cyst was diagnosed to be a bronchogenic cyst based on the results of the histopathological examination. We conclude that intraspinal bronchogenic cysts may appear in the sacral location.

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.

[Cutaneous bronchogenic cyst]

Bronchogenic cysts rarely affect the cutaneous surface, so they are difficult to diagnose clinically and are often confused with other types of cysts. We present the case of a young adult in whom a cystic lesion showing characteristics of a bronchogenic cyst was excised from the upper thorax area. We emphasize the fact that, in nearly all cases, the diagnosis of this pathology is made through a histopathological study, and we make special reference to the differential diagnoses.

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.

Gastric mucosa in a bronchogenic cutaneous cyst in a child: case report and review of literature

We report a case of cutaneous bronchogenic cyst, partially lined by gastric mucosa of antral type in a 9-year-old boy. This is, to the best of our knowledge, the first report of gastric mucosa in bronchogenic cutaneous cyst in the literature.

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.

Cutaneous ciliated cyst with interspersed apocrine features presenting as a pilonidal cyst in a child

We present a case of a cutaneous ciliated cyst that presented in a 13-year-old female. The lesion was felt to be a pilonidal cyst, based on its location and clinical appearance. This case is unusual because it is the youngest reported example of this very rare lesion. In addition, the admixture of apocrine and ciliated cells is extremely unusual. The histogenesis of cutaneous ciliated cysts is considered.

Congenital cervical bronchogenic cyst

A bronchogenic cyst is a rare developmental aberration that occurs in the paediatric age group. Over 50 cases of bronchogenic cysts have been reported in the literature. There is still a possibility of clinically misdiagnosing this condition as a more common congenital neck cyst like a branchial cyst. We report here the case of a 12-year-old female presenting with a neck swelling since birth who was diagnosed to have a bronchogenic cyst based on characteristic clinical and histopathological findings.

Presternal bronchogenic sinus with predunculated lymphoid aggregate

Congenital cranial, cervical, and upper thoracic sinuses are rare conditions that historically have been classified according to their location and/or pathology. However, published reports of bronchogenic or branchial anomalies are on the increase, and the traditional defining characteristics--location and histopathology--are proving to be less reliable. We describe the pathologic and clinical findings of a congenital presternal pedunculated lesion with a sinus, and review the literature to describe its proper classification.

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.

Bronchogenic cysts and esophageal duplications: common origins and treatment

BACKGROUND/PURPOSE

Bronchogenic cysts and esophageal duplications are usually considered as separate foregut malformations. Yet, both are thought to arise from the same embryological event, division of the embryonic foregut, and they share common histological characteristics, often making their clinical differentiation difficult.

METHODS

A retrospective review of the cases of 68 children treated at a single institution between 1937 and 1995 was performed. Thirty children were girls (44%) and 38 were boys (56%). Ages ranged from newborn to 24 years. Complete records were available in all children. Fourteen of these 68 children were asymptomatic.

RESULTS

Respiratory (54%) or gastrointestinal (13%) symptoms were the most frequent presenting problems. The majority of children were treated by resection of the cyst (52 of 68; 76%), while 9 of 68 (13%) required lobectomy for intraparenchymal lesions. Three children underwent marsupialization, with all of these children requiring additional surgery for recurrent disease. Five children (5 of 68; 7%) had multiple cysts. The mortality rate from this series was 10% (7 of 68). Two deaths were caused by perioperative exsanguination, one related to bleeding from a cyst lined with gastric mucosa with subsequent ulceration and hemorrhage into the esophagus. Two deaths occurred secondary to septic complications, one from an esophageal leak and the other from an intraparenchymal abscess. Two deaths were caused by respiratory failure; one was unrelated (SIDS). The majority of cysts found on histological review were lined by respiratory epithelium or bronchial glands (51 of 68; 75%). Gastrointestinal epithelium was present in cysts of nine children, only two of which were clinically diagnosed as esophageal duplications. Twenty-one cases (21 of 68; 31%) were classified as esophageal duplications based on the intramural location of the cyst, yet 15 of 21 (71%) contained respiratory epithelium, substantiating the hypothesis of the common origin of these lesions.

CONCLUSIONS

The histological similarity and anatomic proximity of the "bronchogenic cysts" and the intramural "esophageal duplications" supports their common origin. The possible complications of bleeding, ulceration, infection, and obstruction of the esophagus or airway, should generally lead to prompt resection.