flashpath - lung - bronchogenic cysts
TRANSCRIPT
FLASHPATHH A Z E M A L I
BRONCHOGENIC CYSTS
H A Z E M A L I
CLINICAL• Congenital anomalous budding of the primitive foregut during lung
development– But not connected to tracheobronchial tree
• Although relatively rare, represent the most common cystic lesion of the mediastinum
– Most commonly at middle mediastinum “at level of carina”
• Seen in children or young adults; more common in males
• Present as Space occupying lesion:– Recurrent infection– Compression to surrounding “bronchi”– Or asymptomatic
GROSS
Cyst:• Round to oval• Uni- or multi-locular• Range from 1 to 10cm• Smooth wall• Contain clear fluid or mucus• No communication with tracheobronchial tree
MICROSCOPY• Similar to Bronchial wall:
– Lining:• Respiratory epithelium
– “Pseudostratified columnar ciliated”– Wall:
• Smooth muscle• Cartilage• Submucosal glands
• If infected may show:– Squamous metaplasia– Chronic inflammation– Fibrosis
DIFFERENTIAL DIAGNOSIS“ O t h e r m e d i a s t i n a l c y s t s ”
• Esophageal cyst:– Lined by squamous epithelium– Wall has more developed, double- layer muscular layer– No cartilage
• Gastro-enteric cyst:– Lined by gastric or intestinal mucosa– No cartilage
• Thymic cyst:– Lined by flat, cuboidal, columnar, or squamous epithelium– Wall may show chronic inflammation, cholesterol clefts, or thymic tissue remnants– No cartilage or smooth muscle
DIFFERENTIAL DIAGNOSIS“ O t h e r m e d i a s t i n a l c y s t s ”
• Cystic Teratoma:– Heterogeneous tissue components from ectoderm, endoderm, and
mesoderm
• Pericardial cyst:– Lined by single layer of mesothelial cells overlying loose connective tissue
DIFFERENTIAL DIAGNOSISI f o c c u r r e d n e a r l u n g“ O t h e r c y s t i c l u n g d i s e a s e s ”
• Congenital:– Pulmonary sequestration– Congenital pulmonary cysts– Congenital pulmonary airway malformation– Congenital lobar emphysema
• Acquired:– Emphysema– Healed abscess– Honeycombing
• Mixed:– Cystic fibrosis
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