Soft Tissue Cysts of the Neck Flashcards
Dermoid Cyst
Charcterstics
- Benign developmental cystic lesion
- Considered a form of teratoma
Remember: Teratomas have
all four embryologic layers and so you can see these cysts that have teeth, bone, hair, muscle, and nerves.
Dermoid cyst is sort of a lesser version of a teratoma in that it just has dermis, rather than all the other layers
Dermoid Cyst
Clinically
- Depending on whether the cyst is above or below the mylohyoid muscle►the lesion will cause swelling into the oral cavity elevating the tongue or under the chin in the submandibular area, respectively
- Usually found on the midline
- Painless and slow growing, if not infected
- Upon palpation, cyst feels doughy or rubbery
- Usually roundish to oval-ish swelling
Dermoid Cyst
demographic and locations
- Most common in the 1st and 2nd decade ( young pts)
- Can be found anywhere, but in the oral cavity they are ususally located in the anterior floor of the mouth (FOM) - usually on the midline
Dermoid Cyst
Histologically
■ the cystic space is filled with keratinaceous debris and sebum ~ Often there’s sebaceous
glands and sweat glands within the wall of the cyst
■ The cyst lining appears similar to skin: SSE with orthokeratinized surface, prominent granular cell layer, and
skin appendages (adnexal structures) in the FCT wall (ex. sebaceous glands, hair follicles and sweat
glands)
Dermoid Cyst
Treatment
- surgical excision
- recurrence is rare
Dermoid Cyst
a dome shaped
swellingin the floor of the
mouth.
If these were left long
enough, they could cause issues
with swallowing
Dermoid Cyst
✎This is a larger lesion on the floor of the mouth, causing
elevation of the tongue
✎If you let this go/grow, it would be similar to Ludwig’s angina where you would basically eventually obstruct the airway
✎The difference is this is very slow growing while Ludwig’s happens rather quickly. with fever and other symptoms.
Dermoid Cyst
- This is showing you when they occur below the mylohyoid muscle.
- You get an elevation under the chin.
- This is a fairly small one but they can get much larger
Dermoid Cyst
Histology
✎Histologically, you’ll see skin and the things that you see in the dermis. looking at the epithelium,
we have stratified squamous epithelium with ortho-keratin, which means there’s no nuclei within the keratin itself
✎Within the wall of that cyst you can see there’s this sebaceous gland.
There’s a hair follicle and you can also
see sweat glands.
✎You can see all the things that you would normally see in skin
Epidermoid Cyst
also known as
infundibular cyst
epidermal inclusion cyst
“sebaceous” cyst (laymen’s term, not really sebaceous) ~
Epidermoid Cyst
Charcterstics
- A very common skin cyst
The epidermoid cyst is similar to which cyst?
similar to the dermoid cyst, except we don’t see those adnexal structures
Epidermoid Cyst
Etiology
- Often occur after _inflammation of a hair follicl_e
Epidermoid Cyst
Demographics and Location
■ Males > Females
■ Young adults more likely to have cysts of the face
■ Older adults have cysts of the back
Epidermoid Cyst
Associated with which
syndrome?
Associated with Gardner’s syndrome
Gardner syndrome is associated with polyps
in the intestine.
Gardner syndrome is associated with epidermoid cysts.
Epidermoid Cyst
Clinically
■ Subcutaneous nodular, firm to fluctuant, papule
~ It tends to be a subcutaneous, dome-shaped nodule that
can be either firm to fluctuant, depending on how much stuff is within the lumen
Epidermoid Cyst
Histologically
- Cavity lined by SSE with a granular layer and abundant keratin on epithelial surface and in lumen, no adnexal structures in cyst wall
- Histologically we’re going to see a stratified squamous epithelium with no granular cell layer because we don’t have orthokeratin.
- The center of the lesion tends to have a lot of keratin.
- There are adnexal structures in a dermoid cyst. The adnexal structures are: sebaceous glands, sweat glands, hair follicles, etc
What is the key difference between a dermoid and epidermoid cyst?
- The key difference between a dermoid and
- epidermoid cyst, is that there’s no adnexal structures in an epidermoid cyst. There are adnexal structures in a dermoid cyst.
- The adnexal structures are: sebaceous glands, sweat glands, hair follicles, etc.
Epidermoid Cyst
Treatment
■ Treatment is excision
■ Recurrence is rare
Epidermoid Cyst
A dome-shaped swelling.
There’s no change in the
overlying skin color, no redness, no pain
Epidermoid cyst
Histology
This (red star) is the connective tissue wall
(green star) this is the squamous epithelial lining, and
then this (blue star) is all the keratin that the cyst is
making.
They usually are filled with a lot of keratin,
similar to the way that OKC (odontogenic
keratocysts) are filled with a lot of keratin
Thyroglossal Duct Cyst
Etiology/Origin
- A developmental cyst that develops from epithelial remnants of a tract which forms when the thyroid anlage descends into the neck from an area that later forms the foramen caecum
- Follows a path that goes anterior to the hyoid bone and ends below the thyroid cartilage
What is the most common
developmental cyst of the neck?
Thyroglossal Duct Cyst
Thyroglossal Duct Cyst
Clinically
■ Cysts are typically painless fluctuant swellings, unless infected
■ If the cyst remains attached to the hyoid bone or the tongue ► i_t will move up and down when swallowing or protruding the tongue_
■ ~ 1/3 will present with a fistulous tract ~ so they’ll be draining.
Thyroglossal Duct Cyst
Treatment
■ surgical excision
■ recurrence are not uncommon
■ Rare cases of thyroid carcinoma developing in these cysts have been reported
Thyroglossal Duct Cyst
Demographics and locations
■ 60-80% of cysts are below the hyoid bone
■ Most commonly present in the first 2 decades (~ 50% prior to 20 years of age)
■ Cyst classically forms at the midline
■ The most common developmental cyst of the neck
Thyroglossal Duct Cyst
Histology
■ C_yst lining can be var_y from SSE to pseudostratified columnar with cilia
■ FCT wall often contains thyroid tissue ~that’s an
unusual finding with the thyroglossal duct cyst
Thyroglossal Duct Cyst
This is NOT a goiter.
It looks like an enlargement of the thyroid, but this ended up being just
a cyst, so they had a thyroglossal duct cyst
Thyroglossal Duct Cyst
Histology
This is the cyst lumen (red star) and the cyst lining
around it and then within the wall of a cyst, the
follicles of the thyroid (green star). You can see that
there’s thyroid tissue in the walls of this particular
lesion
Branchial Cleft Cyst
Also known as
cervical lymphoepithelial cysts
Branchial Cleft Cyst
Demographic and location
■ Most commonly presents in the 3rd to 5th decades
■Located on the lateral aspect of the neck, usually anterior to the sternocleidomastoid muscle
■2/3 of the reported lesions have been on the left side
■Although cyst are uncommon in the parotid gland, can see multiple lymphoepithelial cysts bilaterally in HIV positive patients
■These cases present as painless uni- or bilateral swellings of the parotid glands
Branchial Cleft Cyst
Clinically
- presents as a soft fluctuant swelling ranging from 1 to 10 cm in diameter
Branchial Cleft Cyst
Etiology
Etiology is disputed
- Some think it is from remnants of the branchial cleft
- Others think it is cystic change of parotid gland epithelium which became entrapped in a cervical lymph node during development
Branchial Cleft Cyst
Histology
Wall of the cyst contains lymphoid tissue often with germinal center formation
Branchial Cleft Cyst
&
HPV patients
We can see multiple Branchial Ceft cysts bilaterally on the parotid gland
Painless swelling bilaterally or unilaterally on the parotid gland
Branchial Cleft Cyst
Treatment
surgical excision, recurrence is rare
Branchial Cleft Cyst
a small one in a child.
You can see that
there’s a small cystic lesion here on the neck
Branchial Cleft Cyst
Then you can see it in an older person; this is getting
to be maybe 4-5 centimeters at least in size. He left
his for a little bit longer
Branchial Cleft Cyst
Histologically, there’s this stratified squamous lining (red), a cystic space (green), and then within the wall of
the cyst, you have this dense lymphocytic infiltrate (yellow). You get so much lymphocytic infiltrate that you start
to generate these germinal centers or follicles (orange)
From low power, it kind of looks like a lymph node because there’s so many germinal centers in it but then as
you get closer you can actually see that there’s a cyst epithelium and so that’s how you know that it’s a
lymphoepithelial cyst
Oral Lymphoepithelial Cyst
Demographics and Location
■ Uncommon lesion
■ The Most frequent location is the floor of the mouth (FOM) (> 50%)
Oral Lymphoepithelial Cyst
Clinically
■ Usually less than 1 cm in diameter
■ May feel firm or soft on palpation
■ Typically creamy to yellow in color
■ Painless unless infected
Oral Lymphoepithelial Cyst
Histology
Oral Lymphoepithelial Cyst
Treatment
- Surgical Excision
- Reccurance is Rare
Oral Lymphoepithelial Cyst
A pale dome-shape swelling in the floor of the mouth. because the lesion is so close to the surface; you’re seeing little capillaries of the mucosa lining the lesion
Oral Lymphoepithelial Cyst
histology
On biopsy, you can see that there is a pathologic space (red) filled with debris from this surface epithelium
sloughing into it.
This (green) is the epithelial lining running along, which is stratified squamous epithelium.
You can see the dense lymphocytic infiltrate (yellow) in the connective tissue wall of the cyst.
There are a couple
areas where it looks like it’s trying to form germinal centers
