Bronchogenic cysts with infection in the chest wall skin of a 64-year-old asymptomatic patient: A case report

Abstract

Background: Skin bronchogenic cysts are extremely rare congenital bronchocystic changes caused by the abnormal development of the trachea, bronchial trees or lung buds during the embryonic period. The first case of skin bronchogenic cysts was reported in 1945. Since then, this disease has attracted increasing attention, but due to the low incidence, its pathogenesis is still not clear.

Case summary: Here, we report another case of skin bronchogenic cysts with infection in a 64-year-old female patient. The patient had no symptoms for more than 60 years until her chest wall was recently found to be swollen, and she felt pain and discomfort. At the same time, secretions were found on the surface of the swelling. Color Doppler ultrasound examination showed abnormal echoes in the soft tissue under the frontal chest wall, suggesting the presence of cysts. Cytological puncture resulted in about 2 mL of pus and showed the presence of more acute inflammatory cells. The final clinical diagnosis was skin cyst with infection, and surgery was carried out. The pathological results obtained after surgery showed that the cystic wall was covered with column-like cilia epithelial cells, and the interstitial structure was partially inundated with inflammatory cells. After a variety of examinations and clinical diagnoses, we finally confirmed that the patient was suffering from bronchogenic cyst.

Conclusion: This article not only describes the case of an elderly patient with rare skin bronchogenic cysts with infection but also provides a detailed and correct diagnosis and a successful treatment process, which is of great value for the diagnosis and treatment of the disease.

Keywords: Benign chest wall lesion; Bronchogenic cyst; Case report; Chest wall infection; Dermal cyst.

Figure 1

Imaging of the puncture test prior to surgery. A: On September 24, 2020, cytological puncture resulted in about 2 mL of pus, and a large number of acute inflammatory cells were found (× 200); B: On July 20, 2021, cytological puncture resulted in about 2 mL of pus, and an increased number of acute inflammatory cells were found (× 200); C and D: Represent other microscope fields of view of A and B, respectively.

Figure 2

Imaging prior to surgery. A: A low-to-no-echo area of about 8 mm × 19 mm × 26 mm in the patient’s subcutaneous soft tissue. The boundaries of the area were clear, and the morphology was clear. Furthermore, this area showed no obvious blood flow signal (September 24, 2020); B: A low-echo nodule of about 9 mm × 21 mm × 26 mm in the patient’s subcutaneous soft tissue. The boundaries of the nodule were clear, and the morphology was clear. At the same time, no intact envelope was found. A dense dot weak echo was found inside. The internal blood flow signal was not intense (July 20, 2021); C: Most of the cyst borders did not resemble the smooth walls of typical cysts, and the cyst appeared as a frizzy capsule instead. Echoes of the smooth wall can be seen in a few areas (white arrow; July 20, 2021); D: The inside of the cyst showed a relatively homogeneous low echo, and a small amount of oxalate calcification (white arrow) was found in some areas. The inflammation was mainly manifested in the cyst wall (July 20, 2021).

Figure 3

Postoperative histopathology. A: Combined with immunohistochemical staining for CK7 (+), CK20 (-), TTF1 (-) and S-100 (-), the histopathological examinations showed that the specimen was consistent with a bronchogenic cyst with obvious hyperplasia of histiocytes (× 100); B: The white arrows represent column-like cilia epithelial cells; C: Smooth muscle bundles; D: Bronchial glands.

Figure 4

Imaging of the postoperative area. A: Imaging of the postoperative area after 3 d of debridement and suture surgery; B: Imaging of the postoperative area after 20 d of debridement and suture surgery.