Miyazaki Masaya, Kiuchi Shizuka, Fujioka Yasunori
Department of Pathology, Nikko Memorial Hospital, Muroran, Hokkaido, Japan.
Department of Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.
Pathol Int. 2016 May;66(5):297-301. doi: 10.1111/pin.12411.
We report an extremely rare case of branchial cleft-like cysts in Hashimoto's thyroiditis. The patient was a 77-year-old man with a growing mass in the anterior neck. Ultrasonography and computed tomography revealed a cystic lesion with septum in the left thyroid and multiple small cystic lesions in the right thyroid. Lymph node swelling of the cervical region, supraclavicular fossa and submandibular region was also observed. Left thyroidectomy and lymph node dissection were performed. Histologically, cysts were lined by stratified squamous epithelium and dense lymphoid tissue having conspicuous follicle formation surrounded the epithelial lining. Solid cell nest (SCN)-like aggregations were seen in the thyroid parenchyma adjacent to the cyst walls and a small number of thyroid follicles were observed in the fibrous wall. Immunohistochemically, it is suggested that both the cyst lining and SCN-like aggregations are originally from thyroid follicles. Although, the exact histogenesis of branchial cleft-like cysts remains unclear, there are probably two different processes for its development, one is of branchial cleft origin and the other is mere squamous metaplasia, while in our case the latter is suggested. Herein, we report our new case and update information about branchial cleft-like cysts that appears in the literature.
我们报告了1例桥本甲状腺炎中极为罕见的鳃裂样囊肿病例。患者为一名77岁男性，颈部前方肿物逐渐增大。超声和计算机断层扫描显示左侧甲状腺有一个带隔膜的囊性病变，右侧甲状腺有多个小囊性病变。还观察到颈部区域、锁骨上窝和下颌下区域的淋巴结肿大。实施了左侧甲状腺切除术和淋巴结清扫术。组织学上，囊肿内衬复层鳞状上皮，致密的淋巴组织形成明显的滤泡围绕上皮内衬。在囊肿壁附近的甲状腺实质中可见实性细胞巢（SCN）样聚集，纤维壁中可见少量甲状腺滤泡。免疫组化显示，囊肿内衬和SCN样聚集物可能均起源于甲状腺滤泡。尽管鳃裂样囊肿的确切组织发生仍不清楚，但其发生可能有两种不同过程，一种起源于鳃裂，另一种仅是鳞状化生，而在我们的病例中提示为后者。在此，我们报告这一新病例并更新文献中出现的关于鳃裂样囊肿的信息。
