Intrathyroidal Lymphoepithelial (Branchial) Cyst: Diagnostic and Management Challenge of a Rare Entity

Abstract

Intrathyroidal lymphoepithelial (branchial) cysts are very rare, and only few cases have been previously reported worldwide.Here, we report on a case of a male patient with such a rare histological finding after a routine left hemithyroidectomy performed for a nearly 4 cm cystic left thyroid lobe lesion. The patient was an 80-year-old man, fact that makes, to our knowledge, our patient the oldest in the current literature. Through a review of the existing literature, we concluded that although some entities are extremely rare, they should also be taken under consideration in everyday clinical differential diagnosis of otherwise common medical cases, such as our presented case. Such cases pose a differential dilemma for the clinical doctor in order to make a correct diagnosis, if that is possible, and then proceed with the efficient treatment.

An Uncustomary Branchial Cleft Cyst Presentation With Associated Autoimmune Thyroiditis

“…Similar to the present case, authors have noted that branchial cysts were discovered to affect the left lobe of the thyroid more frequently (13 cases) than the right lobe [3,[7][8][9][10]. A small number of cases involving both lobes were also reported [7][8][9][10]. Age, gender, and the laterality of the lesion have all been specifically implicated, but their significance has not yet been determined [8].…”

“…The age range spanned from the first to the eighth decade (average age = 45.6 years), with a female preponderance (21 cases) like the current case [3,[7][8][9][10]. Similar to the present case, authors have noted that branchial cysts were discovered to affect the left lobe of the thyroid more frequently (13 cases) than the right lobe [3,[7][8][9][10]. A small number of cases involving both lobes were also reported [7][8][9][10].…”

“…So far, only around 33 cases of intrathyroidal branchial cleft cyst have been documented in the literature, and only very seldom from India [3,[7][8][9][10]. The age range spanned from the first to the eighth decade (average age = 45.6 years), with a female preponderance (21 cases) like the current case [3,[7][8][9][10].…”

“…So far, only around 33 cases of intrathyroidal branchial cleft cyst have been documented in the literature, and only very seldom from India [3,[7][8][9][10]. The age range spanned from the first to the eighth decade (average age = 45.6 years), with a female preponderance (21 cases) like the current case [3,[7][8][9][10]. Similar to the present case, authors have noted that branchial cysts were discovered to affect the left lobe of the thyroid more frequently (13 cases) than the right lobe [3,[7][8][9][10].…”

“…A small number of cases involving both lobes were also reported [7][8][9][10]. Age, gender, and the laterality of the lesion have all been specifically implicated, but their significance has not yet been determined [8].…”