Bronchogenic cysts: a narrative review

Abstract

Background and Objective Bronchogenic cysts represent a rare form of cystic malformation of the respiratory tract. Primarily located in the mediastinum if occurring early in gestation as opposed to the thoracic cavity if arising later in development. However, they can arise from any site along the foregut. They exhibit a variety of clinical and radiologic presentations, representing a diagnostic challenge, especially in areas with endemic hydatid disease. Endoscopic drainage has emerged as a diagnostic and potentially therapeutic option but has been complicated by reports of infection. Surgical excision remains the standard of care allowing for symptomatic resolution and definitive diagnosis via pathologic examination; minimally invasive approaches such as robotic and thoracoscopic approaches aiding treatment. Following complete resection, prognosis is excellent with essentially no recurrence. Methods A review of the available electronic literature was performed from 1975 through 2022, using PubMed and Google Scholar, with an emphasis on more recent series. We included all retrospective series and case reports. A single author identified the studies, and all authors reviewed the selection until there was a consensus on which studies to include. Key Content and Findings The literature consisted of relatively small series, mixed between adult and pediatric patients, and the consensus remains that all symptomatic lesions should be excised via minimally invasive approach where feasible. Conclusions Surgical excision of symptomatic bronchogenic cysts remains the gold standard, with endoscopic drainage being reserved for diagnosis or as a temporizing measure in clinically unstable patients.

Young patient with a giant gastric bronchogenic cyst: A case report and review of literature

“…The lesions can be divided into mediastinal, intrapulmonary, and ectopic types according to their location[ 2 ]. The tumor is primarily located in the mediastinum if it occurs early in gestation, as opposed to the thoracic cavity if it arises later in development[ 3 ]. Abdominal BCs, especially those situated within the gastric wall, are exceptionally uncommon occurrences[ 4 ].…”

Comparative outcomes of video-assisted thoracoscopic surgery versus open surgery for bronchogenic cysts in adults: a retrospective cohort study

“…While the precise incidence is unknown, BCs may be more prevalent than currently estimated. These cysts occur more frequently in children than adults and are typically localized within the mediastinum or lung parenchyma ( 3 ), with rare occurrences in the pericardium or esophageal wall ( 4 , 5 ). Ectopic BCs can also be found intra-abdominally or, in exceedingly rare instances, in the head and neck region ( 6 - 8 ).…”

Bronchogenic cysts in rare sites (retroperitoneum, skin, spinal cord and pericardial cavity): A case series and characterization of epithelial phenotypes

“…Bronchogenic cysts are rare congenital malformations of the bronchial tree (a type of bronchopulmonary foregut malformation) with an incidence of ~1 in 42,000 admissions at St. Joseph Hospital between May 1975 and August 1986 (Houston, TX, USA) ( 1 ) and are detected as a cystic and/or mass lesion in the thoracic cavity, particularly in the mediastinum or pulmonary parenchyma ( 2 , 3 ). Bronchogenic cysts account for 6-15% of primary mediastinal masses ( 4 ), while pulmonary parenchymal bronchogenic cysts are ~20% of all bronchogenic cysts in the thoracic cavity ( 5 , 6 ).…”

“…Conversely, in adult cases, although some symptoms are seen in 20-40% of patients, bronchogenic cysts often result in incidental radiological findings with computed tomography (CT) and/or magnetic resonance imaging ( 4 , 5 ). Surgical therapy should be considered for symptomatic patients with bronchogenic cysts as a primary treatment to prevent complications and histopathologically determine a final diagnosis ( 3 ).…”

“…The key histopathological characteristic of bronchogenic cysts is the pseudostratified ciliated columnar epithelium ( 3 ). Govaerts et al ( 8 ) defined the criteria for bronchogenic cysts as the presence of pseudostratified, ciliated, columnar epithelium in addition to the presence of at least one of cartilage, smooth muscle or seromucous glands.…”