Search

Bronchogenic cysts are classified as a type of congenital foregut cyst. They are usually extrapulmonary and occur mostly along the tracheobronchial tree. Intracardiac bronchogenic cysts are very rare. As far as we know, only 3 cases have been reported previously. This paper presents a unique case of a 70-year-old male who was diagnosed with a bronchogenic cyst in the interatrial septum with a concomitant persistent left superior vena cava. He underwent successful complete excision of the cyst under cardiopulmonary bypass and enjoyed an uneventful life with normal sinus rhythm during the 1-year follow-up. The relevant literature is reviewed and an explanation for the embryogenesis of the bronchogenic cyst in such a peculiar location is proposed.

The retroperitoneal bronchogenic cyst is an extremely rare anomaly. During the examination of an 18-year-old female patient due to her extreme thinness, the abdominal ultrasound and later the CT indicated as an accidental finding--a left side adrenal/suprarenal adenoma, which turned out to be hormonally inactive. But while we were doing a laparoscopic surgical intervention we found a 6-8-cm cyst in the retroperitoneum, between the greater curvature and the spleen. It contained light grey, mucinous liquid. The left suprarenal gland had normal size and appearance. During the microscopic examination the removed terime showed cystic structures, which were covered inside with multilayer ciliated columnar epithelium, mucous excretory glands, a whole layer of connective/interstitial and smooth muscle tissue. Neither cartilage, nor gastrointestinal epithelium was found. Only a few publications have reported about retroperitoneal bronchogenic cyst so far. These lesions occur very rarely at the greater curvature. Although this alteration is really unusual, bronchogenic cysts have to be expected in the differential diagnostics of the retroperitoneal tumors.

Mediastinal tumors and cysts are relatively uncommon lesions requiring histologic confirmation. This retrospective study reports the experience of our department in the diagnosis and treatment of mediastinal lesions. Mediastinal lesions that were surgically treated in 200 patients aged 6-84 years, during a period of 28 years, were included in this series. Sixty patients had an apparently non-resectable lesion or lymphadenopathy of the anterior superior mediastinum. They had an anterior mediastinotomy and biopsy of the mediastinal lesion. No perioperative deaths were recorded in those patients. There were recorded 5 (8.3%) complications. Histological diagnosis was established in all patients: lymphoma (n = 21), metastatic carcinoma (n = 16), thymic lesions (n = 10), germ cell tumor (n = 3), other lesions (n = 10). The remainder 140 patients underwent a resection of the mediastinal lesion. One (0.7%) perioperative death and 21 (15%) complications were recorded. The histological diagnosis of the excised lesions was: thymic lesions (n = 60), neural tumors (n = 21), thyroid lesions (n = 14), bronchial cysts (n = 12), pericardial cysts (n = 10), germ cell tumors (n = 6), other lesions (n = 17). Our results are compared favorably with those reported in international literature. Surgery is the management of choice for patients with mediastinal lesions. It allows for establishing certain histological diagnosis and curative excision of the lesion, when it is necessary, with low operative risk.

We experienced a case of bronchogenic cyst located on the left lower pleural space extending into the retroperitoneum in a 33-year-old man with left chest pain. Preoperative imaging studies and operative findings showed a broad-based cystic mass on the left lower posterior pleura and diaphragmatic pleura extending into the retroperitoneal region across the diaphragm. Histologic studies proved this mass to be a bronchogenic cyst.

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.

Background and Study Aims: The aims of this study were: firstly, to determine the usefulness of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in obtaining tissue diagnosis of intramural and extraintestinal lesions; secondly, to assess the immediate, acute, and 30-day complications in these patients; and thirdly, to assess the impact of the tissue diagnoses on patient management., Patients and Methods: All EUS-FNAs of extraintestinal mass lesions and intramural gastrointestinal tumors over a 26-month period were evaluated prospectively. The reference standards for the final diagnosis were surgery (n = 20), repeat imaging (n = 12), clinical follow-up (n = 4), or death from disease (n = 2). Four patients were lost to follow-up., Results: Forty-two consecutive patients (24 men, 18 women; mean age 59.7 years) underwent EUS-FNA of extraintestinal mass lesions and intramural gastrointestinal tumors. Previous attempts at tissue diagnosis had failed in 52.4 % of the patients. The EUS-FNA cytological diagnoses included: 17 gastrointestinal stromal tumors, five esophageal cancers, five rectal cancers, one bronchogenic cyst, one foregut duplication cyst, and 13 other miscellaneous diagnoses. The mean number of passes needed to reach a diagnosis was 3.9 (+/- 2.2). The mean follow-up period was 13.1 months. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EUS-FNA of extraintestinal and intramural tumors were 97 %, 100 %, 100 %, 90 %, and 98 %, respectively. No major complications were encountered., Conclusions: EUS-FNA is a safe and accurate method that can provide a tissue diagnosis in intramural and extraintestinal mass lesions, especially when other modalities have failed. EUS-FNA significantly affects the management of patients by allowing them to be allocated to appropriate treatment and by avoiding the need for more invasive procedures to obtain tissue diagnosis.

We present the case of a 52-year-old male who underwent thoracotomy for resection of a suspected bronchogenic cyst in the right posterior mediastinum. The size of the tumor had increased over years, according to repeated X-rays, and the cyst became symptomatic with obstruction of the right subclavian and jugular veins. To our surprise, histopathology revealed a hydatid cyst.

Bronchogenic cysts are lesions that are an anomaly of congenital development. Although most are found in the mediastinum, bronchogenic cysts can be found in many different anatomical positions in the body and can have multiple presentations. These lesions can be asymptomatic and found incidentally, or they can present with specific symptoms. Bronchogenic cysts can be diagnosed on multiple radiographic modalities including conventional radiography, computed tomography, and magnetic resonance imaging. Most are treated conservatively but the possibility of infection or malignant transformation has caused some clinicians to recommend invasive treatment for these lesions. This article presents a case report of the diagnosis and management of a paravertebral bronchogenic cyst in a 64-year-old female.

Purpose: The aim of the study was to determine the natural course and select appropriate therapy for pneumatocele (PC) in children with postpneumonic empyema., Materials and Methods: Records of 134 children treated for postpneumonic empyema between October 1997 and June 2003 were reviewed retrospectively, and 58 (43%) of them were found to have PC. Their chest x-rays and computed tomography scans as well as patient profiles were evaluated to assess the size, location, course, and complications. Clinical course, treatment indications, and results were also reviewed., Results: The patients were aged from 14 months to 15 years (mean 3.8 years). There were 36 boys and 22 girls. The PC was located on the right hemithorax in 34 patients and on the left in 24. Staphylococcus aureus was the most common isolated infective agent. Of the 58 children, 37 (63.7%) showed complete resolution with improvement of the infection within 2 months. Thirteen PCs had evidences of gradual decrease in size without any indication for invasive approaches, and they resolved completely, with a mean time of 6.1 (ranging from 1-13) months. One tension PC, 3 large PCs (>50% of hemithorax), 1 case with bad tolerance to follow-up, and 2 persistent PCs had no reduction in size on follow-up; a total of 7 patients underwent image-guided catheter drainage procedure, and 5 of them resolved completely. In the last 2 cases, surgical excision was required because of persistent cystic cavity caused by thickened PC wall. One patient whose PC had not been decreasing in size developed findings of severe lung abscess with thickened wall and directly underwent surgery. In none of these patients recurrences or complaints related to PC were noted on their control visits., Conclusion: Most of these PCs are simple PC and show spontaneous resolution with improvement of the infection within the first 2 months. However, some decrease gradually by time, and close follow-up should be continued in case of complicated PC. Persistent features of chest infection, more than 50% involvement of hemithorax and severe atelectasis, development of broncopleural fistulae (tension PC), and bad tolerance to follow-up remind complicated PC, and they are indications of image-guided catheter drainage procedure. Its failure occurs in PC with thickened wall that does not collapse, as was in our cases with persistent PC and severe infected PC, and thus, this is an indication for surgical excision.

Congenital cysts of the neck are not uncommon. Most of these are thyroglossal, branchial cleft and thymic cysts. Bronchogenic cysts are uncommon developmental anomalies of the tracheobronchial tree and rarely occur in the neck. More than 70 cases of bronchogenic cysts in the head and neck region have been reported in the literature. We report three cases presenting with neck swelling in the hyoid region that were diagnosed as bronchogenic cysts based on clinical and histopathological findings.

A bronchogenic cyst is a rare congenital anomaly that appears in the thorax, usually the lungs or the mediastinum, being much rarer in the retrosternal space, within the pericardium or the diaphragm, as well as in the neck, while localisation within the abdomen is extremely rare, with only about 30 reported cases. We present the case of a 68-year-old woman. During an investigation for an epigastric pain, a cystic lesion in the area of the body and tail of the pancreas was found. During open surgery, a cystic lesion, spanning 95 x 75 x 70 mm, above the body and tail of the pancreas was excised. The wall of the cyst was 8-12mm thick; it contained viscous fluid, the culture of which stayed sterile. Histology determined that it was a bronchogenic cyst. After an early uneventful recovery, the patient developed a left colonic fistula, which healed spontaneously within 3 weeks, probably because of the unnoticed operative damage to the splenic flexure of the colon during splenectomy, which was adherent to the cystic mass and impossible to save during excision. Six months after surgery, the patient continued to remain symptom free.

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.

A case of amyloid goiter in a 73-year-old man with systemic amyloidosis complicating long lasting rheumatoid arthritis is reported. The thyroid gland was massively infiltrated with amyloid and contained foci of fat tissue and epithelial solid cell nests. Incidentally, a cyst lined by squamous epithelium, with small amount of lymphocytes in the subepithelial stroma was found. This cyst fulfilled the criteria for the diagnosis of a lymphoepithelial cyst presumably of branchiogenic origin. The herein described case of simultaneous occurrence of branchiogenic cyst and amyloid goiter represents, to our best knowledge, a unique coexistence of these two entities. The possible relationship between these lesions and their differential diagnosis is discussed.

Gastrointestinal stromal tumors (GIST) of the stomach are being recognized with increasing frequency. The diagnosis is usually made on the basis of appearance on computed tomography (CT) and excision is recommended for GIST larger than 5 cm. We report a 39-year-old woman referred for resection of a presumed GIST of the gastric fundus diagnosed by CT scan and upper gastrointestinal (UGI) series. A laparoscopic resection was performed, but upon pathologic examination the mass proved to be a bronchogenic duplication cyst of the stomach. Bronchogenic and esophageal duplication cysts usually arise in the chest or mediastinum. On rare occasions bronchogenic cysts may lose their connection to the tracheobronchial tree and migrate to a subcutaneous position in the neck or descend into the retroperitoneum. The importance of this case is that it demonstrates a rare yet essential component to the differential diagnosis of lesions of the stomach.

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.

Intradural extramedullary bronchiogenic cysts are rare findings. All five reported cases were located cervically or upper thoracically. To our knowledge, we describe the first case of an intraspinal bronchiogenic cyst in a thoracolumbar location. We present the case of a 41-year-old patient with a known spina bifida occulta who suffered from a continuous, sharp, and therapy-refractory pain in the left leg. Magnetic resonance imaging of the thoracic and lumbar vertebra revealed an intradural extramedullar mass at T12 to L1 level. After laminectomy T-12 through L-1/L-2 and longitudinal opening of the dura mater, the cystic mass was shown to be attached to the conus medullaris and the cauda equina, and therefore could be removed only partially. Histopathological examination revealed the diagnosis of bronchiogenic cyst. We therefore conclude that intradural extramedullary bronchiogenic cysts may appear also at thoracolumbar levels. Surgical resection can be achieved with good outcome.

A case of congenital bronchogenic cyst in the gastric mucosa is presented. The cyst was lined by pseudostratified epithelium and covered with ciliated cells. Congenital bronchogenic cysts should be differentiated from acquired gastric cysts lined with ciliated metaplastic cells that evolve as a result of environmental factors.

In a 73-year-old male patient with a history of prostate cancer, a right ventricular endoluminal tumor was diagnosed by echocardiography. An endocardial papillary fibroelastoma or myxoma appeared possible; a malignant tumor could not be ruled out. The tumor was resected using extracorporeal circulation and cardioplegic arrest. Histopathology study revealed a bronchogenic cyst with ciliated epithelium.

Gastric bronchogenic cyst is an extremely rare lesion. A 62-year-old Korean woman presented with an incidentally found perigastric nodule. An abdominal ultrasonogram and computed tomography showed a 1.5 cm solid, homogeneous, low-density nodule in the hepatogastric ligament near the gastric lesser curvature. At the time of surgery, a soft 1.7 cm nodule was found in the lesser curvature side just below the gastroesophageal junction, and a gelatinous mass was protruded from the nodule during the resection. Microscopically, the gastric subserosa showed cystic structures lined by pseudostratified ciliated columnar epithelium, seromucinous gland, connective tissue and complete layers of smooth muscle bundles. Neither cartilage nor gastrointestinal epithelium was identified. A mucocele was found near the cyst and foamy cells and faintly bluish mucinous substances were found near the cystic structures. All the mucinous substances were stained by alcian blue at pH 2.5 with varying degrees of staining intensity. The present case is the smallest reported cyst among the gastric bronchogenic cysts, and these lesions are unusually located at the lesser curvature side of the stomach. Although these lesions are very rare, gastric bronchogenic cyst should be included in the differential diagnosis of gastric wall mass.

We describe the anesthetic management of a case in whom a previously undiagnosed pulmonary hydatid cyst manifested as a large amount of intrabronchial fragmented pieces of laminated membrane suddenly and unexpectedly during diagnostic rigid bronchoscopy., (Copyright 2004 Blackwell Publishing Ltd.)

Bronchogenic cysts are congenital sacs that result from maldevelopment of the primitive foregut. Although they occur predominantly in the chest, there are reports of lesions in extrathoracic locations. The majority of reported bronchogenic cysts located in the neck are found in the pediatric population; a review of the literature reveals few reports of bronchogenic cysts of the neck among adults. The diagnosis of a bronchogenic cyst relies on the histology and location of the lesion. Here, we review our experience in the diagnosis and management of 2 adult patients with pathologically proven bronchogenic cysts. Both patients presented with solitary neck masses that proved to be bronchogenic cysts on histologic examination. Our purpose is to define the histopathologic and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts. In conclusion, congenital bronchogenic cysts can occur in the neck of adults and should be considered in the differential diagnosis of cystic cervical masses in adults, as well as children.

Background: The management of foregut duplication cysts is controversial, especially in asymptomatic patients. The safety and accuracy of endoscopic ultrasound (EUS) and EUS-fine-needle aspiration EUS-FNA) in confirming the nature of cysts by using electron microscopy (EM) has not been reported. In this study, the authors describe the utility of demonstrating detached ciliary tufts (DCTs) in the diagnosis of foregut duplication cysts with EUS-FNA., Methods: Consecutive patients with suspected mediastinal masses or mediastinal cysts on imaging studies were evaluated prospectively by EUS and EUS-FNA. Cyst fluid was examined by routine cytologic techniques. In two patients, EM was performed to confirm the nature of DCTs., Results: Ten consecutive patients were evaluated with EUS and EUS-FNA. Seventy percent of the cysts were characterized by computed tomography (CT) scans as solid masses. The mean greatest cyst dimension measured 34 mm x 48 mm by EUS. Microscopic examination of the cyst content revealed mucinous material, cellular debris, and DCTs. The latter were seen in routine cytologic preparations and by EM. Patients were followed up to a median of 321 days. Due to EUS-FNA confirmatory diagnoses of foregut duplication cysts, none of the patients except 1 underwent surgical resection after developing pneumonia 6 months later. Histologic sections of the resected specimen confirmed the presence of (foregut cyst, bronchogenic type). All other patients were asymptomatic. Cysts size and nature did not change on repeated imaging studies., Conclusions: EUS was superior compared with CT scanning in characterizing foregut duplication cysts. EUS-FNA is safe and accurate in the diagnosis of foregut duplication cysts. The demonstration of DCTs in cyst fluid and the absence of malignant cells confirmed the benign nature of these lesions, allowing conservative and expectant management for these patients.

We present a case of an intraperitoneal bronchogenic cyst located at inferior surface of the liver, next to the gallbladder which clinically mimicked a gallbladder tumor. This is the first case reported in Korea, and we offer reviews of the related literatures. A 48-yr-old woman was admitted to our hospital because of intermittent abdominal pain in right upper quadrant. Computed tomography showed a large mass along-side the gallbladder. During laparotomy, the mass showed an ovoid cystic nature, which was attached to the normal gallbladder and liver bed. Cyst excision with cholecystectomy was performed, and histopathological examination revealed a broncho-genic cyst. Most bronchogenic cysts have a benign nature, but malignant changes have also been reported. Therefore, if a cystic tumor in the abdomen is suspected during preoperative diagnosis, a bronchogenic cyst should be considered in the differential diagnosis.

Objective: To discuss the clinical and histopathologic features of cervical bronchogenic cysts., Methods: Retrospective case series., Results: A 22-year pathology database search identified 24 patients 18 years of age and younger with bronchial/bronchogenic cysts, four of which presented in the cervical region., Conclusion: Cervical bronchogenic cysts are rare in the pediatric population but deserve inclusion in the differential diagnosis of cystic neck masses. Such cysts result from abnormal tracheobronchial tree development with characteristic pathology including respiratory-type epithelium, mural cartilage, smooth muscle, and seromucinous glands. Definitive treatment requires surgical excision.

We describe the history and lung pathology of a premature female infant, who presented with respiratory distress immediately after birth. A thoracic computerized tomography scan showed abnormalities suggestive of congenital cystic adenomatoid malformation of the left lung. In addition, echocardiography revealed a tetralogy of Fallot. A left thoracotomy was performed and the lower lobe of the left lung was removed. Despite intensive supportive therapy, pulmonary hypoperfusion resulted in severe hypoxemia and death. Gross and microscopic analysis of the resected lobe revealed a partly cystic and solid lesion with multiple bronchus-derived cysts and an exuberant multifocal proliferation of glandular tissue, resembling bronchial glands, mixed with heterotopic cartilage surrounding ducts. Immunohistochemical analysis showed the presence of chromogranin A-reactive islet-like structures amidst exocrine tissue showing trypsin and chymotrypsin immunoreactivity, establishing the diagnosis of pulmonary pancreatic heterotopy. In the remaining pulmonary parenchyma, there were secondary changes consistent with partial obstruction and lymphangiectasis which was attributed to the presence of the cardiac malformation. To our knowledge, this is only the fourth reported case of heterotopic pancreatic tissue in the lung, and the first case where this bronchopulmonary foregut anomaly is not associated with a enteric duplication.

Purpose: Bronchogenic cysts are rare congenital cystic malformations of the lung. We retrospectively analyzed ten cases of bronchogenic cyst (BC) to reinforce the importance of recognizing this malformation., Methods: Between 1985 and 2000, ten pediatric patients with BC were treated surgically in our department. Their clinical presentation, radiological, operative, and pathological findings were analyzed retrospectively., Results: There were five boys and five girls, ranging in age from 16 days to 6 years (mean 6.5 months). The clinical signs and symptoms included respiratory distress in seven patients (70%), cyanosis in four (40%), chronic cough and fever in five (50%), and dysphasia in two (20%). Routine chest X-ray revealed a pulmonary air-filled cyst in six patients (60%) and a pulmonary nodular opacity in four (40%). The diagnosis was supported by computed tomography in four patients and by ultrasonography in two. Eight of the patients were treated by cyst excision and two by lobectomy. The pathological diagnosis made from all specimens was bronchogenic cyst, with squamous metaplasia in two., Conclusion: In newborns, infants, and even children, the development of dyspnea, cyanosis, chronic cough, and fever should alert us to the suspicion of a cystic malformation in the lung, such as a bronchogenic cyst, especially if an air-filled cyst is seen on a plain chest X-ray.

A 29 year old woman was found to have a chest mass as part of routine screening with a chest x-ray for an unrelated neurosurgical procedure. Further investigation with a chest CT raised the suspicion of a paravertebral neurogenic tumor. The patient underwent bronchoscopy and resection of the lesion by Video Assisted Thoracic Surgery (VATS). The diagnosis of Bronchogenic Cyst was established after histopathologic examination of the resected tumor. Bronchogenic Cysts are relatively rare primary mediastinal tumors. The paravertebral site is an unusual presentation for these tumors.

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.

Objective: To study the clinical and pathological features of congenital bronchial cysts., Methods: The clinical, X-ray, CT and histopathologic manifestations were retrospectively reviewed in 30 patients with congenital bronchial cysts., Results: There were 23 patients with intrapulmonary bronchogenic cysts, 5 patients with mediastinal bronchogenic cysts, and 2 patients with ectopic bronchogenic cysts. Of the 30 patients, 18 were liquid cysts, 7 air cysts, and 5 multiple pulmonary cysts. Intrapulmonary congenital bronchial cysts were diagnosed always due to infection. Nineteen of 23 patients (83%) presented with cough, sputum production, 2 accompanied by fever, 11 with hemoptysis or blood-stained sputum, 11 with chest pain. The imaging features were "bag included mass", which was characterized by a big bag surrounded by a little soft-tissue, or thin walled cavity, or multiple honeycomb or cystoid circular translucency. Two of 4 patients with mediastinal bronchogenic cysts incidentally discovered on a radiograph obtained for other reasons were almost asymptomatic, 2 presented with dyspnea due to compression of trachea, 1 with dysphagia due to compression of oesophagus. The imaging features included isolated well-defined round shape or ovoid soft-tissue mass with isodensity, and mutual compression between the surrounding organs. Two patients with ectopic bronchogenic cysts were diagnosed due to cystic mass on chest wall. Pseudostratified ciliated columnar epithelium, gland, cartilage, elastic fiber and smooth muscle were all confirmed by light microscopy., Conclusions: The main type of congenital bronchial cysts is intrapulmonary bronchogenic cysts. The clinical manifestations are cough, sputum production and hemoptysis, and the imaging feature is "bag included mass" on CT scan. A lining of respiratory epithelium associated with a wall containing glands, cartilage and smooth-muscle is the histopathologic feature for diagnosing congenital bronchial cysts. The optimal treatment is surgical resection.

Anterior mediastinal neoplasms comprise a diverse group of tumors and occasionally manifest as a cystic lesion. We retrospectively reviewed computed tomography (CT) scans in 46 patients with pathologically proved cystic anterior mediastinal tumors. We categorize them into a pure cystic mass and a cystic tumor with a solid portion. In this pictorial essay, the radiologic appearances of cystic anterior mediastinal tumors are described with CT and illustrated with their gross and histopathological findings on resected specimen.

Bronchogenic cysts are congenital anomalies that result from abnormal budding of the tracheobronchial tree. They are usually found in the mediastinum around the tracheobronchial tree or in the lung parenchyma. Although they can occur in infants and children, they are frequently detected coincidentally in the third and fourth decades. Their radiological findings can change according to their locations. In this pictorial assay we reviewed the radiological appearance of bronchogenic cysts with different imaging modalities.

The Authors describe a very rare congenital case of bronchogenic subcutaneous cyst of the scapular region occurring in a 8-year-old girl. Only 8 other cases have been published so far. The cyst was asymptomatic and was surgically removed. It measured 2.3 cm. in diameter. Histologically, the cyst was lined by ciliated columnar pseudostratified epithelium devoid of goblet cells and mucus secreting cells. The epithelium lacked immunoreactivity for estrogen and progesterone receptors. The cyst wall contained smooth muscle bundles, but cartilage was absent. Differential diagnosis with emphasis on cutaneous ciliated cyst (Mullerian cyst) is discussed. It appears conceivable that cutaneous ciliated bronchogenic cysts may show partial or fully developed features indicating their bronchial origin.

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and minimally invasive diagnostic technique for the analysis of mediastinal lesions. This case report describes a patient who developed a life-threatening mediastinitis after EUS-FNA of a mediastinal lesion, which (based on computed tomography of the thorax) had been suspected to be a lymph-node metastasis, but proved to be a bronchogenic cyst.

We describe here a case with a large bronchogenic cyst treated by surgical resection, who presented with evidence of left atrial overload on electrocardiogram (ECG). The 50-year-old male patient presented with the chief complaint of heaviness in the chest on exertion. An ECG revealed evidence of left atrial overload, and echocardiography and imaging revealed a mass having a maximum diameter of 9 cm on the cranial aspect of the left atrium, caudal to the tracheal bifurcation. The patient was treated by surgical resection of the cystic mass via right anterolateral thoracotomy. His postoperative course was satisfactory and the patient was relieved of his main symptom.

Retroperitoneal bronchogenic cysts are rare and those located in the diaphragm are exceptional. We describe an additional case of bronchogenic cyst of the left crus of diaphragm. Diagnosis of a diaphragmatic lesion was confirmed during laparotomy and complete resection was successful. Final diagnosis was done on pathology.

Abnormal cilia were demonstrated in the lining epithelial cells of three cases of intraspinal endodermal (bronchogenic) cyst. The changes comprised a wide spectrum of ultrastructural abnormalities, including (a). cilia with abnormal axonemal microtubules, (b). swollen cilia, (c). compound cilia with or without excessive ciliary matrix, (d). naked cilia without limiting membrane, and (e). intracytoplasmic cilia and aggregates of microtubules. Of these, compound cilia and swollen cilia were most common. Cilia with dynein arm deficiency were not observed. Ciliary abnormalities found in the present study were very similar to those described in the bronchial epithelium of various diseases. The present findings suggest that the lining epithelium of intraspinal endodermal cyst shares similar ciliogenesis and susceptibility to abnormal ciliary formation as that of the bronchial epithelium.

An eight-year-old boy presented with a sudden onset of chest pain. He had been diagnosed to have a left spontaneous pneumothorax. Chest radiographs and computed tomography of the chest showed a thin-walled cyst in the left lower lobe. Thoracotomy and a segmentectomy of the apical segment of the lower lobe was performed, confirming the diagnosis of a ruptured bronchogenic cyst. Imaging findings of various pulmonary cystic lesions in children are discussed.

A retroperitoneal bronchopulmonary foregut malformation in a 62-year-old man is reported. The lesion was composed of mature lung tissue with randomly distributed bronchial structures and ciliated epithelium-lined cysts, some of which were lined with gastric mucosa. The histological features of this lesion were of both pulmonary sequestration and a bronchogenic, or foregut, cyst, and thus were a unique example of bronchopulmonary foregut malformation with pulmonary differentiation. This case is important in understanding the pathogenesis of foregut anomalies (i.e. bronchopulmonary foregut malformations), which range from pulmonary sequestrations to bronchogenic cysts and foregut duplication cysts.

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.

Background: Congenital cervical cysts are frequently encountered in pediatric populations, and constitute one of the most intriguing areas of pediatric pathology. This report analyzes cervical cysts in Taiwanese children diagnosed at Chang Gung Memorial Hospital (CGMH) over the past 20 years. The pathologic and clinical findings are reviewed., Methods: Files on 331 patients under the age of 18 years, with a diagnosis of congenital cervical cyst at CGMH from January 1, 1983 to June 30, 2002, were retrieved from the Department of Pathology. There were 204 boys and 127 girls. We reviewed the histology of all cases and correlated it with clinical information in the medical records., Results: Thyroglossal duct cysts, the most common congenital neck cyst, accounted for 54.68% of all cases, followed by cystic hygromas (25.08%), branchial cleft cysts (16.31%), bronchogenic cysts (0.91%), and thymic cysts (0.30%). Nine cases (2.72%) remained unclassified., Conclusions: This is the largest series regarding pediatric cervical cysts in the literature to date. Thyroglossal duct cysts were the most common congenital cervical cyst encountered. Our experience indicates that each type of cyst has its unique location in the neck and is highly associated with its embryonic origin. Complete and precise clinical information is a prerequisite in order for pathologists to make accurate diagnoses of congenital cervical cysts.

Focal developmental malformations of the lung are a heterogeneous group of lesions that display a variety of features. They often are thought to be quite distinct entities, but there is considerable overlap among these lesions. Both standard nomenclature and common usage do not identify clearly the components of these lesions in a distinctive fashion. A classification based on pathologic features is presented. A malformation sequence based on airway obstruction during development is proposed as a unifying pathogenetic mechanism for some seemingly unrelated lesions., (Copyright 2003, Elsevier Science (USA))

Bronchogenic cysts in the interatrial septum are very rare. We experienced a case in which a 39-year-old man, incidentally diagnosed through echocardiography as having a cardiac tumor, was surgically treated. Pathologic investigation of the tumor, which was located in the interatrial septum and resected, revealed that the tumor was a bronchogenic benign cyst. Tumor enucleation was performed and the resultant atrial septal defect was closed by an autopericardial patch.

Encountering a developmental lung anomaly in the adult can be a challenge, as the abnormality may be mistaken for something more sinister. The common anomalies encountered are classified into three broad categories: bronchopulmonary (lung bud) anomalies, vascular anomalies, and combined lung and vascular anomalies. The imaging features of these developmental anomalies at conventional radiography, ventilation-perfusion lung nuclear scanning, angiography, computed tomography, and magnetic resonance imaging are useful in differential diagnosis of thoracic lesions. Lung bud anomalies include agenesis, congenital bronchial atresia, congenital lobar emphysema, congenital cystic adenomatoid malformation, pulmonary bronchogenic cysts, tracheal or pig bronchus, and accessory cardiac bronchus. Vascular anomalies include interruption or absence of a main pulmonary artery, anomalous origin of the left pulmonary artery from the right, anomalous pulmonary venous drainage (partial or complete), and pulmonary arteriovenous malformation. Combined lung and vascular anomalies include the hypogenetic lung (scimitar) syndrome and bronchopulmonary sequestration, both intralobar and extralobar.

Context: Congenital cystic adenomatoid malformation, intralobar sequestration, extralobar sequestration, bronchopulmonary foregut malformation, bronchial atresia, and lobar emphysema generally are treated as separate entities, but there are commonalities among them., Objective: To clarify the identity of congenital cystic adenomatoid malformation in relation to other cystic diseases., Design: We studied 10 consecutive cases of surgically resected cystic lung disease in children. We studied the bronchial and vascular trees by mapping bronchi, pulmonary blood vessels, systemic blood vessels, the size and configuration of cysts, and associated scarring., Results: The cystic lesions proved to be the following: 1 case of congenital cystic adenomatoid malformation, 2 cases of bronchial atresia with congenital cystic adenomatoid malformation, 1 hybrid case of congenital cystic adenomatoid malformation and intralobar sequestration, 1 case of intralobar sequestration with an aberrant hilum, 3 cases of intralobar sequestration with bronchial obliteration, 1 case of lung abscess, and 1 case of lobar emphysema. Congenital cystic adenomatoid malformation was the sole pathologic diagnosis in 1 case, but 7 other specimens had cystic adenomatoid change to various degrees. There was no bronchial connection between the cystic lesions and the patient's airway in 8 cases. The bronchial tree was absent in the cystic lung in 2 cases. Bronchus tapered into scar near the cystic lesion in 4 cases. Only 1 case had no significant bronchial abnormality., Conclusion: The high incidence of cystic adenomatoid change in cystic lung disease associated with an abnormality of the bronchial tree suggests that cystic adenomatoid change may develop together with and be related to other congenital or acquired conditions in the lung.