Abstract
Pediatric cervical masses can present a diagnostic dilemma given their broad differential diagnosis. We present a 3-year-old girl with a midline anterior neck mass found to have histopathologic findings consistent with a bronchogenic cyst. Although rare, bronchogenic cysts should be considered in the differential diagnosis in both lateral and anterior pediatric cervical masses as their pathophysiology and embryogenesis differ considerably from more common cervical masses. Imaging is an important aspect in the pre-operative work-up, although diagnosis is only made after histopathologic analysis. Complete surgical excision is the definitive treatment.
1
Introduction
Foregut duplication cysts are benign congenital malformations of the embryonic foregut occurring at any point along the alimentary tract . Three diagnostic criteria of these cysts include a smooth muscle layer, epithelium derived from the foregut, and attachment to a portion of the foregut . The various cyst sub-types are defined by their epithelial lining and include bronchogenic cysts, esophageal duplication cysts, and enteric duplication cysts.
Although previous case reports describe bronchogenic cysts in the neck, their diagnosis pre-operatively continues to be difficult. Their location can be quite variable, and given the rarity to which they occur are often mistaken for more common congenital neck masses. The purpose of this report, therefore, is to discuss a case at our institution as well as review the literature regarding diagnosis and management.
2
Case presentation
A 3-year-old girl presented for evaluation of an anterior midline neck mass present since birth with little change over time. She was otherwise healthy without significant past medical history. Parents denied any symptoms including airway compromise, dysphagia, or infection.
Physical exam revealed a non-tender, non-erythematous 1.25 cm anterior midline neck mass directly superior to the sternal notch with a non-palpable inferior margin and no cutaneous sinus tract. No other head and neck abnormalities were noted. Pre-operative ultrasonography revealed a complex mixed solid and cystic mass superior to the sternal notch measuring approximately 1.6 × 1.8 × 1.1 cm without identifiable blood flow ( Fig. 1 ).
Intraoperatively, the mass was well circumscribed with a capsule separate from the surrounding fascia and infra-hyoid muscles. The cyst was bluntly and sharply dissected from the surrounding tissues and excised without complications.
Histopathologic evaluation revealed a pink-tan, smooth, cystic structure with a pale white to yellow, mucoid, semi-solid material within a smooth luminal surface. The cyst was lined by respiratory-type epithelium with associated mucinous glands and cartilage consistent with a bronchogenic cyst ( Fig. 2 ).
2
Case presentation
A 3-year-old girl presented for evaluation of an anterior midline neck mass present since birth with little change over time. She was otherwise healthy without significant past medical history. Parents denied any symptoms including airway compromise, dysphagia, or infection.
Physical exam revealed a non-tender, non-erythematous 1.25 cm anterior midline neck mass directly superior to the sternal notch with a non-palpable inferior margin and no cutaneous sinus tract. No other head and neck abnormalities were noted. Pre-operative ultrasonography revealed a complex mixed solid and cystic mass superior to the sternal notch measuring approximately 1.6 × 1.8 × 1.1 cm without identifiable blood flow ( Fig. 1 ).
Intraoperatively, the mass was well circumscribed with a capsule separate from the surrounding fascia and infra-hyoid muscles. The cyst was bluntly and sharply dissected from the surrounding tissues and excised without complications.
Histopathologic evaluation revealed a pink-tan, smooth, cystic structure with a pale white to yellow, mucoid, semi-solid material within a smooth luminal surface. The cyst was lined by respiratory-type epithelium with associated mucinous glands and cartilage consistent with a bronchogenic cyst ( Fig. 2 ).
