Bronchogenic Cysts
Borislav A. Alexiev, M.D.
Fabio R. Tavora, M.D., Ph.D.
Allen P. Burke, M.D.
Definition
Bronchogenic cysts are uncommon congenital anomalies of foregut origin resulting from abnormal ventral budding or branching of the tracheobronchial tree during embryologic development.1,2,3,4,5 The location of the cyst depends on the embryologic stage of development at which the anomaly occurs. Cysts forming in earliest development occur detached from the airways within the mediastinum. Those forming later are present along the tracheobronchial tree or within the lung parenchyma.
Incidence and Clinical
About one-third of bronchogenic cysts are diagnosed in children, as early as 1 day of age. The others are detected in adults, with a mean age of 41 years and a male-to-female ratio of 1:2.3
Bronchogenic cysts account for 50% to 60% of all mediastinal cysts.2 They may occur in any part of the mediastinum, but most are found in a subcarinal location, in the posterior mediastinum, or in the middle mediastinum in a paratracheal location. Less than 20% occur in the superior or anterior mediastinum6 (Table 115.1).
In the majority of patients (50% to 75%), there are no clinical symptoms, and the lesions are found incidentally by chest imaging.4,7 The chief complaint is chest pain. In children, symptoms are somewhat more common and include cough, dyspnea, infection, and hemoptysis.
Gross Pathology
Bronchogenic cysts are unilocular, typically measuring from 4 to 5 cm. The outer surface is tan, smooth, and glistening. The inner lining of the cyst is smooth, without papillary projections. The cyst contents vary in color and texture; they are white, yellow, pale yellow, or brown in color and liquid, sticky and creamy, or mucinous in texture.4 Occasional tumors become infected, resulted in purulent contents.
TABLE 115.1 Clinicopathologic Characteristics of Bronchogenic Cysts | |||||||||
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