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  • br Discussion Bronchogenic cysts are rare congenital

    2018-11-06


    Discussion Bronchogenic cysts are rare congenital malformations arising from abnormal Ro 3306 of the primitive tracheobronchial tube during the development of ventral foregut. Corresponding to the rostral to caudal development of the tracheobronchial tree, the earlier abnormal buddings are located at higher levels, whereas the later ones are located peripherally. Neck bronchogenic cysts are less common, and are mostly detected in childhood. Ustundag et al reported 45 cervical bronchogenic cysts, and only six of the patients were older than 25; furthermore, the cysts remained asymptomatic in most cases, which correlated with the location in the mediastinum or lung parenchyma. Although previous reports emphasized that bronchogenic cysts are usually asymptomatic, more recent series have revealed that the majority of bronchogenic cysts in adults ultimately become symptomatic. A fistulous opening that drains mucoid material may be observed, or the cysts may fluctuate in size and become infected, presenting as neck abscesses. However, only two adult cases have been reported previously. Differential diagnoses for bronchogenic cyst are branchial cleft cyst, thymic cyst, thyroid cystic papillary carcinoma, thyroglossal duct cyst, cystic hygroma, and tracheal diverticulum. These conditions mostly present with cystic components with an air–fluid level on CT images, and a distinction among these lesions is primarily based on location and histology. Therefore, a histopathological examination is still needed for definitive diagnosis. Aspiration cytology is an alternative diagnostic tool for a neck mass, and diagnostic components in the bronchogenic cyst are ciliated columnar epithelial cells. In our case, these were found retrospectively after surgical resection and pathological confirmation. Therefore, sensitivity of aspiration cytology may be low because relatively few epithelial cells may be scattered in the cystic components. Previous studies also revealed a low yield of fine-needle aspiration (FNA), which may produce a false-negative result in preoperative differential diagnosis. Therapeutic aspiration may temporarily relieve the symptoms, but the recurrence rate is high. Surgical resection may be difficult in symptomatic cases because of severe pericystic adhesion, as in our case, making prevention of intraoperative recurrent laryngeal nerve injury difficult, as was observed in all the three documented cases (Table 1). Despite the observed high complication rate, complete resection should be attempted to avoid recurrence following incomplete resection, and the patient should be informed about surgery-related vocal cord palsy preoperatively. In previous cases, postoperative vocal cord palsy was treated using Teflon injection into the true vocal cord, and the patient underwent conservative speech rehabilitation. However, Teflon is no longer used in laryngoplasty, because of poor tissue compatibility, and permanent substances including hydroxyapatite, silicone, and hyaluronic acid are favored for vocal cord injection. Intraoperative nerve monitoring, which is widely used in thyroid surgery for recurrent laryngeal nerve detection, is also valuable for preventing such complications. A malignancy arising from bronchogenic cysts is rare and mostly seen in intrathoracic cysts. Reported malignancies have included adenocarcinoma, squamous cell carcinoma, anaplastic carcinoma, and various types of sarcomas. Only one documented malignancy has been reported arising from a cervical bronchogenic cyst; however, this was a poorly differentiated adenocarcinoma with thyroid invasion, which was initially misdiagnosed as thyroid papillary carcinoma by ultrasound-guided FNA.
    Introduction Gallbladder duplication is a rare anatomical malformation occurring in about 1/4000 births. Anatomical variations in the biliary system are associated with higher chances of common bile duct injury, especially during laparoscopic cholecystectomy. Preoperative imaging is helpful for diagnosis. Surgical removal of both gallbladders with intraoperative cholangiography seems to be the appropriate treatment.