Thyroglossal Duct Cyts:

Thyroglossal

duct cysts are the result of a cystic

dilatation of the thyroglossal duct.

The

normal location of a thyroglossal duct cyst is the

midline of the anterior neck , in the region of
the hyoid bone.

The

cysts are lined by columnar or squamous

epithelium and may contain thyroid tissue in
their walls.

 On

very rare occasions, a papillary thyroid

carcinoma may arise within a thyroglossal duct
cyst.

Fine

needle aspiration of a benign thyroglossal

duct cyst usually yields colloid material,
sometimes containing a few mature squamous
or columnar epithelial cells.

DD:

In order to correctly interpret the material

present in the smear, one has to know the precise
location of the mass because, by cytology alone, it
may be difficult to differentiate thyroglossal duct
cyst from a colloid goiter.

Branchial cleft cysts

Branchial

cleft cysts are congenital cysts that are

located in the lateral aspect of the neck.

They

are the result of developmental anomalies of

the branchial clefts.

The

cysts may remain occult until middle or older

age and may appear suddenly.

The

branchial cysts may become inflamed and

clinically painful.

 The

cysts are usually lined by mature squamous

epithelium supported by a stroma rich in
lymphoid tissue, sometimes forming mature
lymph follicles.

Occasionally,

the squamous epithelium is less mature

and is composed of smaller squamous cells of
parabasal type with large nuclei.

On

rare occasions, part of the cyst lining will be

composed of mucus-producing columnar cells.

Cytology:
Aspiration

usually yields thick, very turbid, white or yellow

fluid.
The

cysts may disappear after complete aspiration of the

contents, resulting in cure. may recur and the fluid can
reaccumulate.

Microscopically,

the fluid contains a variable number of

mature squamous cells and acellular squames,
proteinaceous material, cellular debris, and lymphocytes.

Less

often, and particularly in the presence of inflammation,

the squamous cells may be smaller, of a parabasal or even
basal type, and may show nuclear enlargement, some

 The

smear back ground may show evidence of

acute or subacute inflammation and sometimes
may contain granulation tissue, characterized by
numerous capillaries, fibroblasts, and monoand multinucleated macrophages.

Branchial

cleft cysts must be differentiated from

metastatic squamous cell carcinoma, especially
the well-differentiated, keratin-forming type that
may become cystic.

The

degree of cellular atypia in a branchial

cleft cyst may mimic carcinoma, and
conversely, the cells of squamous carcinoma
may be so well-differentiated that they may
mimic a branchial cleft cyst.

Branchiogenic carcinoma or
primary cervical neoplastic cysts:
1. The cervical tumour occurs along the line extending
from a point just anterior to the tragus, along the
anterior border of the sternocleidomastoid muscle, to
the clavicle;
2. The histologic appearance must be consistent with
an origin from tissue known to be present in the
branchial vestigial;
3. No primary source of the carcinoma should be
discovered during follow-up for at least 5 years;
4. Cancer arising in the wall of an epithelium-lined
cyst situated in the lateral aspect of the neck can be
demonstrated histologically

Cervical Thymic Cyst

Faulty

development of the third and fourth

pharyngeal pouches results in abnormalities of the
thymus and parathyroid glands.

They

are found in the anterior triangle of the neck

along the normal path of descent of the thymus,
with or without parathyroid glands, and they have a
fibrous band or a solid thymic cord connection to
the pharynx or mediastinum

 Less

common overall. Males >> females.

They

can be found anywhere from the angle of the

mandible to the sternum, paralleling the
sternocleidomastoid muscle and normal descent of
the thymus. 67% in less than 10 yrs.

unilocular

or multilocular.

The

epithelial lining may be cuboidal, columnar, or

stratified squamous.

epithelium

may be replaced by fibrous or granulation

tissue containing cholesterol clefts and
multinucleated giant cells.

To

qualify a cyst as a CTC, thymic tissue must be

found within the cyst wall

 The

differential diagnosis includes the other

developmental cysts of the neck, as well as rare
cystic presentations of Hodgkins disease, thymoma,
and germinoma.

Cervical Bronchogenic Cyst

Uncommon

congenital lesions found in the skin or

subcutaneous tissue in the suprasternal notch or
manubrium sterni, rarely in the anterior neck or
shoulder.

Derived

from small buds of diverticula that separate

from the foregut during formation of the
tracheobronchial tree.

When

they occur outside the thoracic cavity, the cyst

presumably arises from erratic migration of
sequestered primordial cells.

Discovered

at or soon after birth and appear as

asymptomatic nodules that slowly increase in size or
as draining sinuses exuding a mucoid material.

They are more common in male

The cysts range from 0.3 to 6 cm in size.

They are lined by ciliated, pseudostratified columnar

epithelium

If the cyst is infected squamous epithelium is found. The

cyst wall contains smooth muscle, elastic fibres and
seromucous glands.

A bronchogenic cyst can be distinguished from a teratoma

by a complete absence of tissues other than those that
can be explained on the basis of a malformation.

The lack of ciliated epithelium distinguishes a lateral

cervical cyst containing gastric mucosa from a cervical
bronchogenic cyst.

TDC can be differentiated from a bronchogenic cyst by

finding thyroid follicles

Dermoid Cyst

The term dermoid cyst should be reserved for a cystic

neoplasm that originates from the ectoderm and mesoderm;
endoderm is never found in these cysts.

The head and neck area is a common site - located in the

skin and subcutaneous tissues.

The position of these dermoid cysts at the midline and along

the lines of embryonic fusion of the facial processes is
consistent with their origin by inclusions of ectodermal tissue
along lines of closure at junctions of bone, soft tissue, and
embryonic membranes.

Dermoid cysts in the neck account for 22% of midline or

near-midline neck lesions. May occur in upper neck, near the
thyroid cartilage, and as low as the suprasternal notch.

 They

may occur in people of almost any age.

More

than 50% are detected by the time a person is 6

years old, and approximately onethird are present at
birth.

The

distribution between the sexes is approximately

equal.

Dermoid

cysts range in size from a few millimetresto 12

cm in diameter.

On

microscopic examination they are lined by stratified

squamous epithelium supported by a fibrous
connective tissue wall.

Ectodermal

derivatives may be seen, including dermal

adnexa such as hair follicles, sebaceous glands, and
sweat glands