Intrathyroidal lymphoepithelial cysts of probable branchial origin

Apel, Robyn L.; Sylvia, L.; Chalvardjian, Ara; LiVolsi, Virginia A.

doi:10.1016/0046-8177(94)90042-6

Cited by 54 publications

(59 citation statements)

References 19 publications

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“…An intrathyroidal presentation was observed in eleven patients in the present study. The histologic appearance of intrathyroidal TGDC overlaps with that of lesions previously described as lymphoepithelial cysts or branchial cleft like cysts of the thyroid gland [39][40][41]. Unlike TGDC, intrathyroidal lymphoepithelial cysts are lined predominantly by squamous epithelium.…”

Section: Discussionmentioning

confidence: 72%

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

Thompson¹,

Herrera²,

Lau³

2016

Head and Neck Pathol

104

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The clinical features of thyroglossal duct remnant cysts (TGDC) have been well described, however the histopathologic aspects of these lesions have not been addressed in a detailed manner. In particular, there has been no large community practice based series evaluating TGDC histologically compared with management outcomes. A retrospective review of all TGDC diagnosed between 2005 and 2015 was performed. Six hundred eighty-five patients were identified (344 males; 341 females). Age at presentation was bimodal (first and fifth decades) and ranged from 0.8 to 87 years (mean 31.3 years). Males predominate in children (150:111); females in adults (230:194). Patients presented most frequently with a mobile midline neck mass in an infrahyoid location. An associated skin fistula (n = 67) was twice as common in pediatric as adult patients. The average cyst size was 2.4 cm (range 0.4-9.9 cm) by imaging studies and 2.6 cm (range 0.2-8.5 cm) by pathologic examination; pediatric patients had smaller cysts (mean 2.1 cm) than adults (mean 2.8 cm). Histologically, 257 (38 %) TGDC were lined by respiratory epithelium alone, 68 (10 %) squamous epithelium alone, 347 (51 %) exhibited both respiratory and squamous epithelium, and 13 (1 %) had no identifiable epithelial lining. Four hundred eighty-four (71 %) TGDC had associated thyroid gland tissue present within the cyst wall (n = 282), skeletal muscle (n = 71), adipose tissue (n = 34), or a combination of these sites (n = 97). The hyoid bone was identified in 647 (grossly and/or histologically), and absent in 38. Surgical management consisted of Sistrunk procedure (n = 647), cystectomy (n = 31), or thyroidectomy/thyroid lobectomy (n = 7). Treatment related complications were observed in 6 patients, which included vocal cord damage, seroma, and hematoma. Recurrences developed in 20 (3 %) patients, 14 of whom were managed initially by cystectomy. Papillary thyroid carcinoma was identified in 22 (3.2 %) TGDC. In summary, TGDC show a bimodal peak in the 1st and 5th decades, commonly presenting as a midline cervical lesion below the hyoid bone, associated with a skin fistula in 10 %. Histologically TGDC are most commonly lined by a combination of respiratory and squamous epithelium. Thyroid gland tissue is identified in 71 % of cases (0.45 cm mean size), although not limited to the cyst wall, but present in the surrounding soft tissues. Rare TGDC may harbor malignancy (3.2 %). TGDC are most effectively managed by Sistrunk procedure rather than excision, which carries low rates of complications (1 %) and recurrence (3 %).

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Section: Discussionmentioning

confidence: 72%

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

Thompson¹,

Herrera²,

Lau³

2016

Head and Neck Pathol

104

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“…Since both the thymus and the thyroid develop embryologically in large part from the third pharyngeal pouch, it is tempting to assume this is related to the aberrant thymus tissue being in the thyroid. It has also been suggested that the histogenesis of intrathyroidal thymomas might be related to the fact that the origin of some accessory thymic tissue has been associated with the IV and V pharyngeal pouches (14,33).…”

Section: Discussionmentioning

confidence: 98%

A Six-Year-Old Boy with a Suspicious Thyroid Nodule: Intrathyroidal Thymic Tissue

Hernández-Cassis

Poniecka

Vogel

et al. 2008

Thyroid

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“…branchial cleft-like cysts (intrathyroidal lymphoepithelial cysts) with histopathological features resembling those of branchial cleft cysts have been reported in the thyroid gland [1][2][3]. The cysts have a squamous but sometimes columnar epithelial lining with abundant underlying lymphoid tissues, including lymphoid aggregates with large reactive germinal centers.…”

Section: Multiplementioning

confidence: 99%

“…In addition, the role of thyroid autoimmunity, which is frequently seen in multiple branchial cleft-like cysts [1,2], has not been clarified in branchial cleft-like cysts. Further investigation is necessary to determine the origin and the mechanism of formation of multiple branchial cleft-like cysts.…”

Section: Microscopic Findingsmentioning

confidence: 99%

“…The histogenesis of branchial cleft cysts is unclear, but is generally assumed to be a developmental abnormality originating from branchial cleft remnants. On the other hand, solid cell nests (SCNs), which were disclosed to be of ultimobranchial body origin [9][10][11][12], were considered alternatively to be the origin of multiple branchial cleft-like cysts [2] . In SCNs, small microscopic cystic structures containing mutinous materials were commonly present [9,10]; this suggests that they could be the origin of multiple branchial cleft-like cysts.…”

Section: Multiplementioning

confidence: 99%

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Multiple Branchial Cleft-Like Cysts in a Female Patient with Hashimoto's Thyroiditis.

et al. 2000

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Abstract.We report a case of branchial cleft-like cysts (intrathyroidal lymphoepithelial cysts) associated with Hashimoto's thyroiditis.Palpation did not detect any nodules. Multiple cystic lesions were detected in the lateral side of the thyroid bilateral lobes by imagings of an I-123 scintigram, T1-201 scintigram, sonography, and computerized tomography.Sonography displayed multiple cysts with strong echogenic spots in the cystic fluid. Repeated fine needle aspiration biopsies of the cysts consistently revealed only normal lymphocytes.Although these lesions could not be given diagnosis, subtotal thyroidectomy leaving the intact isthmus was performed.Microscopic findings revealed multiple branchial cleft-like cysts lined by flattened epithelial cells. Surrounding the epithelial lining were dense lymphoid follicles with large, reactive germinal centers. The remaining thyroid parenchyma showed Hashimoto's thyroiditis.Multiple branchial cleft-like cysts should be considered when sonographic examination reveals multiple cysts in the lateral side of the bilateral lobes, and fine needle aspiration biopsy displays only normal lymphocytes.To our knowledge, this is the first case of branchial cleft-like cysts associated with Hashimoto's thyroiditis reported in Japan.

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Intrathyroidal lymphoepithelial cysts of probable branchial origin

Cited by 54 publications

References 19 publications

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts

A Six-Year-Old Boy with a Suspicious Thyroid Nodule: Intrathyroidal Thymic Tissue

Multiple Branchial Cleft-Like Cysts in a Female Patient with Hashimoto's Thyroiditis.

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