Soft Tissue Cysts of the Neck Dr. T

Question 1

Dermoid Cyst

Charcterstics

Answer 1

• 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

Question 2

Dermoid Cyst

Clinically

Answer 2

• 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

Question 3

Dermoid Cyst

demographic and locations

Answer 3

• 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

Question 4

Dermoid Cyst

Treatment

Answer 4

• surgical excision
• recurrence is rare

Question 5

Answer 5

Dermoid Cyst

a dome shaped
swellingin the floor of the
mouth.

If these were left long
enough, they could cause issues
with swallowing

Question 6

What is this clinical finding?

Answer 6

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.

Question 7

What is this clinical finding?

Answer 7

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

Question 8

Epidermoid Cyst

also known as

Answer 8

infundibular cyst

epidermal inclusion cyst

“sebaceous” cyst (laymen’s term, not really sebaceous) ~

Question 9

Epidermoid Cyst

Charcterstics

Answer 9

• A very common skin cyst

Question 10

The epidermoid cyst is similar to which cyst?

Answer 10

similar to the dermoid cyst, except we don’t see those adnexal structures

Question 11

Epidermoid Cyst

Etiology

Answer 11

• Often occur after _inflammation of a hair follicl_e

Question 12

Epidermoid Cyst

Demographics and Location

Answer 12

■ Males > Females

■ Young adults more likely to have cysts of the face

■ Older adults have cysts of the back

Question 13

Epidermoid Cyst

Associated with which

syndrome?

Answer 13

Associated with Gardner’s syndrome

Gardner syndrome is associated with polyps
in the intestine.

Gardner syndrome is associated with epidermoid cysts.

Question 14

Epidermoid Cyst

Clinically

Answer 14

■ 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

Question 15

What is the key difference between a dermoid and epidermoid cyst?

Answer 15

• 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.

Question 16

Epidermoid Cyst

Treatment

Answer 16

■ Treatment is excision

■ Recurrence is rare

Question 17

What is this clinical finding?

Answer 17

Epidermoid Cyst

A dome-shaped swelling.

There’s no change in the
overlying skin color, no redness, no pain

Question 18

Thyroglossal Duct Cyst

Etiology/Origin

Answer 18

• 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

Question 19

What is the most common

developmental cyst of the neck?

Answer 19

Thyroglossal Duct Cyst

Question 20

Thyroglossal Duct Cyst

Clinically

Answer 20

■ 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.

Question 21

Thyroglossal Duct Cyst

Treatment

Answer 21

■ surgical excision

■ recurrence are not uncommon

■ Rare cases of thyroid carcinoma developing in these cysts have been reported

Question 22

Thyroglossal Duct Cyst

Demographics and locations

Answer 22

■ 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

Question 23

What is this clinical finding?

Answer 23

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

Question 24

Branchial Cleft Cyst

Also known as

Answer 24

cervical lymphoepithelial cysts

Question 25

**Branchial Cleft Cyst** _Demographic and location_

Answer 25

■ 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

Question 26

Branchial Cleft Cyst _Clinically_

Answer 26

* presents as a **soft fluctuant swelling** ranging from **1 to 10 cm** _in diameter_

Question 27

Branchial Cleft Cyst _Etiology_

Answer 27

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**

Question 28

Branchial Cleft Cyst & HPV patients

Answer 28

We can see _multiple Branchial Ceft cysts_ bilaterally on the parotid gland Painless swelling bilaterally or unilaterally on the parotid gland

Question 29

**Branchial Cleft Cyst** _Treatment_

Answer 29

surgical excision, recurrence is rare

Question 30

What is this clinical finding?

Answer 30

Branchial Cleft Cyst **a small one in a child.** You can see that there's a small cystic lesion here on the neck

Question 31

What is this clinical finding?

Answer 31

**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

Question 32

Oral Lymphoepithelial Cyst _Demographics and Location_

Answer 32

■ **Uncommon lesion** ■ **The Most frequent location is _the floor of the mouth (FOM)_** (\> 50%)

Question 33

**Oral Lymphoepithelial Cyst** _Clinically_

Answer 33

■ Usually **less than 1 cm** _in diameter_ ■ May feel **firm or soft** _on palpation_ ■ Typically **creamy to yellow** _in color_ ■ **Painless** _unless infected_

Question 34

**Oral Lymphoepithelial Cyst** _Treatment_

Answer 34

* **Surgical Excision** * _Reccurance_ is ***Rare***

Question 35

What is this clinical finding?

Answer 35

**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_