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Intrathyroidal branchial cleft-like cyst in chronic thyroiditis
1First Department of Pathology, Kagawa Medical School, Kagawa, Japan. ichibyou@kms.ac.jp
Insights
A rare intrathyroidal branchial cleft-like cyst was found in a 71-year-old man. This unusual neck mass was successfully removed, with no signs of recurrence after 43 months.
Area of Science:
- Endocrinology
- Head and Neck Surgery
- Pathology
Background:
- Branchial cleft cysts are congenital anomalies typically found in the lateral neck.
- Intrathyroidal presentation of these cysts is exceptionally rare, posing diagnostic challenges.
Observation:
- A 71-year-old male presented with a progressively enlarging mass in the right lateral neck.
- Ultrasonography and computed tomography revealed a cystic mass within the upper lobe of the right thyroid gland.
Findings:
- Surgical excision yielded a cystic mass (22 x 20 x 10 mm) with a fibrous capsule.
- Microscopic examination showed squamous epithelium lining the cyst, surrounded by thyroid tissue with significant lymphoid infiltration and lymphoid follicles.
- Immunohistochemistry confirmed squamous epithelium markers (keratin, cytokeratin 19, CEA, EMA) and ruled out neuroendocrine differentiation (calcitonin, chromogranin A negative).
Implications:
- This case highlights the importance of considering rare differential diagnoses for thyroid masses.
- Accurate histopathological and immunohistochemical analysis is crucial for correct diagnosis and management of intrathyroidal cystic lesions.
- Complete surgical resection appears to be an effective treatment for intrathyroidal branchial cleft-like cysts, with favorable long-term outcomes.
Abstract:
An extremely rare case of intrathyroidal branchial cleft-like cyst is reported. A 71-year-old man complained of a growing mass in the right lateral neck. A cystic mass in the upper lobe of the right thyroid was demonstrated by ultrasonography and computed tomography. The surgical specimen revealed a cystic mass with dense fibrous capsule, 22 x 20 x 10 mm in size. Microscopically, the cyst walls and the surrounding thyroid tissue contained severe lymphoid cell infiltration with lymphoid follicle. Squamous epithelium lined the cyst wall. Immunohistochemically, squamous epithelium was positive for keratin, cytokeratin 19, carcinoembryonic antigen, and epithelial membrane antigen, but negative for calcitonin and chromogranin A. The patient is currently well with no evidence or recurrence for 43 months.