Congenital Cystic Masses

of Neck: Radiologic-
Pathologic Correlation

Pembimbing: Franky Oscar Sp.BM

Presentan: Fibrianti Seputri 0995039
 Predilection: no gender
has been reported.
Hereditary thyroglossal
duct cyst: rase case.
Typically
Autosomal dominant
pattern transmission
and occur in
prepubertal girls.

1. Thyroglossal Duct Cyst

 Located : midline (75% of cases) or slightly off-
midline (25%) in anterior neck.
80% of the cyst located at or below the level of
hyoid bone.
Manifests: enlarging, painless mass in pediatric or
young adult patient.
Size cyst: 0.5 6 cm in diameter (mostly: 1.5 and 3
cm).

Clinical Characteristics:
 Initial improvement with antibiotic therapy,
cyst recurs after the antibiotic course is
completed.
Simple incision and drainage or partial
resection leads to recurrence (up to 38%)
Complete excision with sistrunk procedure
recommended (reccurence 2.6%).
 Colorless, viscous secretion.
Histologic: stratified squamous epithelium or
ciliated pseudostratified columnar epithelium
lining the cyst wall is usually seen. Mucous
glands may also be present.

Pathologic Characteristics:
 Pathogenesis: arise from incomplete
obliteration of the cervical sinus og His or from
buried epothelial cell rests.
Manifest: any combination of sinus, fistula, or
cyst.
Most of the anomalies: Cyst (75%), Fistulas
(25%), Skin tags and catilages (1%).
Cleft: Usually older children or young adults.

2. Branchial Cleft
Anomalies
 Fisulas: infants or young children.
Bilateral branchial cleft anomalies: occur in 2-
3% of cases and are often familial.
 Clinical Characteritics:
Manifest: reccurent abscesses or other
inflamation (sinus tract) either around ear or at
the angle of the mandible.
Often mimic the clinical characteristic of parotid
neoplasms and associated with facial nerve
palsy.
Children and adults.
Complete surgical excision is the only curative
therapy for these lesions.

First Branchial Cleft Cyst

 Radiologic Features:
First branchial cleft cyst: as a cystic mass.
CT or MR Imaging: enough to allow
differentiating a first branchial cleft cyst from any
other cystic mass of the parotid gland.
 95% of branchial cleft anomalies arise from
the second cleft.
Typically occur between 10 and 40 years of age.
No gender predilection.

Second Branchial Celft

Cyst
 Clinical Characteristic:
Most located in submandibular space. Can occur
anywhere along a line from the oropharyngeal
tonsillar fossa to the supreclavicular region of the
neck.
Painless, fluctuant masses in the lateral portion
of the neck adecent to the anteromedial border of
the sternocleidomastoid muscle at the
mandibular angle.
 The mass enlarges slowly over time and become
painful and tender if secondary infected.
Surgical excision is the recommended therapy.
 Cyst size range from 1 to 10 cm.
Filled with turbid, yellowish, fluid that may
contain cholesterol crystals.
Walls: thin and lined with stratified squamous
epithelium overlying lymphoid tissue.

Pathologic Characteristics
 US: sharply marginated round to ovoid,
centrally anechoic mass with a thin peripheral
wall that displaces the surrounding soft tissues.
CT: typically well-circumscibed,
homogeneously hypoattenuated masses
surrounded by a uniformly thin wall.
Location (CT&MR imaging): at anteromedial
border of the sternocleidomastoid muscle,
lateral to the carotid space, and at the posterior
margin of the submandibular gland.

Radiologic Features
 Extremely rare.
Described in children and young adults.
Anomalies of the fourth branchial cleft usually
manifest as a sinus tract.
Vast majority: occur on the left side.

3. Third and Fourth Branchial Cleft Cyst

 Clinical Characteristic:
Painless, fluctuant mass in the posterior triangle
area of the neck.
Recommended therapy: surgical excision.
Radiologic Characteristic:
Third branchial cleft cyst: unilocular cystic mass
centered in the posterior cervical space (CT &
MR images).
Fourth branchial cleft cyst: connected with the
pyriform sinus.
 The most common form of lymphangioma.
5% of all benign tumors of infancy and
childhood.
80%-90% detected by the time the patient is 2
yold.
Rare in adults.
No gender predilection.

4. Cystic Hygroma
 75-80% involve the neck and the lower portion
of the face.
Location in children: posterior cervical space,
oral cavity.
Location in adults: sublingual, submandibular,
and parotid space, axilla (20%), mediastinum
(5%), abdominal cavity, retroperitoneum,
scrotum, skeleton.

Clinical Characteristics
 Majority of cystic hygromas: asymptomatic,
painless, soft or semifirm masses in the neck.
Size: very large compromise the airway by
extrinsic pressure resulting in death.
Other clinical manifestation: facial nerve
paralysis, dysphagia, feeding problems.
 Size: from a few mm to more than 10cm.
Lesions extend adjacent soft tissue, invade into
muscle, and surround vascular structures.

Pathologic Characteristic
 US Scans: manifest as a multiocular
predominantly cystic mass with septa of
variable thicness.
Fluid levels: characteristic echogenic,
hemorrhagic component latering in the
dependent portion of the lesion.

Radiologic Features
 Manifest during 2nd and 3rd decades of life.
No gender predilection.
Location: lateral eyebrow, floor of the mouth.

5. Dermoid and
Epidermoid Cysts
 Most common clinical appearance: midline,
suprahyoid, slowly growing mass.
Rapid growth: occur secondary to a sudden
increase in the amount of desquamation,
pregnancy, of association with a sinus tract.
Mass: soft, mobile, unattached to overlying
skin.
Size cyst: few mm 12 cm.

Clinical Characteristics
 Circumscribed, encapsulated lesions. Lined
with ectodermally derived squamous
epithelum that contains a variable number of
skin appendages (sebaceous glands, hair
follicles, and sweat glands).

Pathologic Characteristics
 Thin walled, uniocular masses, located in the
submandibular or sublingual space.
CT scans: central cavity filled with a
homogeneous, hypoattenuating (0-18 HU) fluid
material. Marbles (coalescence of fat into small
nodules within the fluid matrix).

Radiologic Features
 MR imaging: topographic realationship of
these cyst to mylohyoid muscle in the floor of
the mouth and helps determine the surgical
approach.
 Congenital persistence of the thymopharyngeal
duct remnants as the cause of these lesions.
Result from acquired, progressive cystic
degeneration degeneration of thymic
corpuscles and the epithelium reticulum of the
thymus.

6. Thymic Cyst
 Very uncommon 2/3 of lesions detected in
1st of life, 1/3 2nd and 3rd decades.
Male > females.
Vast majority : asymptomatic.
Found anywhere : alon the path of the
thymopharyngeal duct, adjecent to the carotid
sheath from the angle of the mandible to the
thoracic inlet.

Clinical Characteristics
 Characteristically: slowly enlarging, painless
mass in the lateral portion of the neck near the
thoracic inlet, either anterior or deep to the
sternocleidomastoid muscle.
 Most: unilocular and thin walled, containing
light amber to dark brown fluid.

Pathologic Characteristics
 CT: uniloculated or multioculated,
hypoattenuated cystic mass adjecent to the
carotid space.

Radiologic Features
 Rare.
From anomalous foregut development.
Male 3 times as often as in females.

7. Cervical Bronchogenic
Cysts
 Manifest: swelling or draining sinus, located
usually suprastenal notch or supraclavicular
area.
Size: 1 cm more than 6 cm.

Clinical Characteristics
 Columnar, ciliated, pseudostratified epithelial
lining.
In the cyst wall: blood vessels, hyaline cartilage,
smooth muscles, seromucinous glands, elastic
fibers.

Pathologic Characteristics
 CT: tubular configuration anterior to the
trachea.

Radiologic Features
 Saccule that extended beyond the superior
border of the thyroid cartilage to qualify as a
laryngocele.
Large saccule the symptomatic and palpable.
Dilated laryngeal saccule, there types:
Internal 40%
External 26%
Mixed 44%

8. Laryngocele
 Rare.
Likely reflect the presence of an enlarged
saccule during infancy and early childhood.
Prevalence: one case per 2.5 million people in
England.
Aquired laryngoceles usually manifest
clinically in middle-aged men.
Bilateral lesions: 23% of cases
Infection: 8%-10% called laryngopyocele.
 Internal laryngoceles: hoarseness, dysphagia,
and stridor may occur.
External type: compressible soft-tissue mass

Symptoms: air way obstruction, feeding

difficulties, and a weak cry.
Recommended therapy: surgical resection

Clinical Characteristic
 Lined: pseudostratified, columnar, ciliated,
epithelium with occasional foci of stratified
squamous epthelium and a mixture of
submucosal serous and mucus glands.

Pathologic Features
 CT: well-defined, smooth mass in the lateral
aspect of the superior paralaryngeal space.

Radiologic Features
 Uncommon.
Diagnosed: infancy or childhood detection
adulthood.
CT and MR imaging: essential information on
the cyst location that allows optimal
preoperative planning.

Summary