Cyst

Retention cyst in chronic otitis media

March 24, 2013     Min-Tsan Shu, MD; Kang-Chao Wu, MD; Yu-Chun Chen, MD
article

The retention cyst originates from the obstruction of a glandular structure and contains fluid, while the cholesteatoma contains keratinizing squamous epithelium.

Cervical thoracic duct cyst: Importance of preoperative suspicion for appropriate management of left-sided neck mass

December 31, 2012     Matthew T. Gill, MD; Timothy S. Lian, MD; Joel D. Thibodeaux, MD; Cherie-Ann O. Nathan, MD, FACS
article

Abstract

Cervical thoracic duct cysts occur infrequently but are an important consideration when evaluating cystic supraclavicular masses. Only 22 cases have been reported to date. We review the clinical presentation, evaluation, and treatment of 2 cases of large thoracic duct cysts treated with surgical resection. A high suspicion of thoracic duct cyst based on location, radiographic findings, and fine-needle aspiration results is sufficient evidence for recommendation of surgical excision. However, enlarged cysts, as noted in our cases, can obliterate or attenuate the thoracic duct, making it difficult to identify intraoperatively. A high suspicion of thoracic duct cyst is important for identifying and ligating the duct to prevent complications such as chyle leak or chylothorax.

Unusual presentation of Sjogren syndrome: Multiple parotid cysts

October 31, 2012     Ankur Gadodia, MD, DNB; Ashu Seith, MD; Raju Sharma, MD
article

Abstract

Sjögren syndrome is a chronic autoimmune exocrinopathy that destroys salivary and lacrimal gland tissue. We report an unusual case of this disease in a 40-year-old woman who presented with bilateral parotid cystic masses. As this case illustrates, Sjögren syndrome should be included in the differential diagnosis of bilateral cystic parotid lesions.

Hearing loss secondary to a nasopharyngeal retention cyst

October 31, 2012     Enrique Palacios, MD, FACR; Michael Ellis, MD; Harold Neitzschman, MD, FACR
article

Resection is generally not indicated for small, asymptomatic pharyngeal cysts. Symptomatic cysts, on the other hand, can be treated with aspiration or a complete transoral resection, particularly if the lesion is large.

Tongue base cyst in a 6-week-old boy

October 8, 2012     Joel Y. Sun, BA; Ron B. Mitchell, MD; Seckin O. Ulualp, MD
article

After excision, a histologic finding of an epithelial lining without ectopic thyroid tissue confirms the diagnosis of a lingual thyroglossal duct cyst.

Endoscopic view of bilateral maxillary sinus cysts removed with a powered instrument

September 7, 2012     Dewey A. Christmas, MD; Joseph P. Mirante, MD, FACS; Eiji Yanagisawa, MD, FACS
article

Powered instrumentation is a good choice for the removal of maxillary sinus lesions. It is efficient and safe and preserves normal sinus mucosa.

Subglottic thyroglossal duct cyst: A rare intralaryngeal presentation

July 5, 2012     Regi Kurien, MS; Rajiv Michael, MS, DLO
article

Abstract

Thyroglossal duct cysts are common midline neck swellings that can present at any site along their migratory pathway. They are frequently situated just below the hyoid bone. Extension to the subglottic area is very rare; such an unusual presentation can complicate the diagnosis of a thyroglossal duct cyst. We report the case of a 30-year-old man who presented with a subglottic thyroglossal duct cyst and associated laryngeal symptoms. To the best of our knowledge, only 2 similar cases have been previously reported in the literature, both of which occurred in 2-year-old boys. We believe, therefore, that ours is the first reported case of a subglottic thyroglossal duct cyst in an adult. We discuss the clinical presentation, diagnosis, and treatment of our patient, and we summarize the literature on intralaryngeal thyroglossal duct cysts.

Fourth branchial cleft cyst with no identifiable tract: Case report and treatment approach

July 5, 2012     Peter Dziegielewski, MD; Jason Chau, MD, FRCSC; Sarfaraz Banglawala, MD; Hadi Seikaly, MD, FRCSC
article

Abstract

We describe a rare case of a fourth branchial cleft cyst that had no identifiable tract. The patient was a 23-year-old man who presented with recurring neck abscesses. After six similar episodes, computed tomography finally demonstrated that the most recent abscess had extended into the thyroid gland, a finding that led to the correct diagnosis. Extensive surgical extirpation of the cyst with an adjacent neck dissection was performed, and the patient remained symptom-free at 25 months of follow-up. The occurrence of a fourth branchial cleft cyst with no clear tract presents a surgical dilemma, as complete dissection cannot be guaranteed. Consequently, such patients are predisposed to recurrence. We propose that definitive management of a fourth branchial cleft cyst with no identifiable tract focus on eliminating the likely embryologically based path of bacterial seeding. This includes a hemithyroidectomy in conjunction with a selective neck dissection to cover all areas where a fourth branchial tract may lie within the neck.

Aneurysmal bone cyst at the base of the skull

April 30, 2012     Arun Goyal, MS; Shalabh Rastogi, MS; P.P. Singh, MS; Sonal Sharma, MD
article

Abstract

Aneurysmal bone cysts have been described as pseudocysts in view of their lack of an epithelial lining. These cysts are uncommon, but when they do occur they typically involve the long bones of the extremities, the membranous bones of the thorax and pelvis, and the vertebrae. Skull involvement is uncommon. We present the case of a 14-year-old girl who presented with nasal obstruction and a swelling of the right cheek. Contrast-enhanced computed tomography detected a heterogeneous cystic mass involving the sphenoid and ethmoid bones. The mass was excised via a lateral rhinotomy approach, and it was identified as an aneurysmal bone cyst on histologic examination. The patient experienced a recurrence in the right sphenoid sinus within 3 months, and the lesion was removed via transnasal endoscopy.

Ventricular cyst of the larynx

March 1, 2012     Johnathan B. Sataloff, Rima A. DeFatta, MD, Mary J. Hawkshaw, BSN, RN, CORLN, and Robert T. Sataloff, MD, DMA FACS
article

Surgery for supraglottic cysts may not be necessary in patients in whom the cysts do not grow or interfere with phonation, if these patients will comply with follow-up for close observation. If the mass enlarges or causes severe enough symptoms to warrant the risks of surgery, excision is usually safe and effective.

Endoscopic view of maxillary ostia mimicking a maxillary sinus wall

March 1, 2012     Joseph P. Mirante, MD, FACS, Dewey A. Christmas, MD, and Eiji Yanagisawa, MD, FACS
article

A patient presented with what appeared to be a defect in the left medial wall of the maxillary sinus but that was actually two large maxillary ostia with the absence of a left uncinate process. He was successfully treated with functional endoscopic sinus surgery.

Cervical thymic cyst presenting as a possible cystic nodal metastasis of papillary carcinoma in a 53-year-old man

September 20, 2011     Woong Na, MD, Si-Hyong Jang, MD, Kyueng-Whan Min, MD, Seok Hyun Cho, MD, PhD, and Seung Sam Paik, MD, PhD
article

Abstract

Cervical thymic cysts are rare embryonic remnants that develop along the course of thymic migration in the neck. They usually occur during infancy and childhood, and they are extremely rare in adults. We report a case of cervical thymic cyst in a 53-year-old man. The patient presented with a small mass of the thyroid gland and a cystic mass at the left level II area of the neck. On histopathology, the thyroid mass was identified as a papillary carcinoma and the left-sided neck mass was diagnosed as a cervical thymic cyst lined with nonkeratinizing, flattened squamous epithelium. The cyst wall contained atrophic thymic tissue composed of lymphoid cells, epithelial cords, and Hassall corpuscles. Although it is rare, cervical thymic cyst should be considered in the differential diagnosis of a lateral cystic neck mass in an adult.

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