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Interactive Case Study - June 2025

Chronically Draining Cyst In A Young Man
Kathleen E. Kramer, LCDR MC(FS) USN 
Willis H. Lyford, LCDR USN MC 
Nicholas F. Logemann, CDR USN MC 
 
 
A 36-year-old man presents for evaluation of a draining punctum on the lower neck. It first appeared as a small raised papule, subsequently ruptured and has remained open since that time. Physical exam reveals a 3x3 mm hyperpigmented papule with a small patulous opening which drains clear fluid and serous fluid upon expression.
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Clinical Image
Clinical Image
Dermoscopic Image
Dermoscopic Image
H&E - 4X
H&E - 4X
H&E - 10X
H&E - 10X
H&E - 20X
H&E - 20X
H&E - 40X
H&E - 40X
H&E - 60X
H&E - 60X
What is the diagnosis?
Branchial cleft cyst
Bronchogenic cyst
Cutaneous ciliated cyst
Dermoid cyst
Thyroglossal duct cyst
What immunohistochemical stain is typically positive?
Cytokeratin 7
Cytokeratin 20
BCL-2
P63
TTF-1
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  2. Khaled A, Sfia M, Fazaa B, Zermani R, Jilani S ben, Kamoun MR. Multiple cutaneous bronchogenic cysts located on the neck and the scalp. A case report. Acta Dermatoven APA. 2008;17(2).

  3. Annamalai A, Shemen L, Ruiz D. An Unexpected Finding of a Bronchogenic Cyst Presenting as a Thyroid Mass. Head and Neck Pathology. 2011;5(4):416. doi:10.1007/S12105-011-0272-0

  4. Güzel M, Küçükaydın M, Kontaş O, Yıkılmaz A. A Very Rare Case of a Bronchogenic Cyst Localized on the Scapular Region. Erciyes Med J. 2014;36(1):40-42. doi:10.5152/etd.2014.6679

  5. Tanita M, Kikuchi-Numagami K, Ogoshi K, et al. Malignant melanoma arising from cutaneous bronchogenic cyst of the scapular area. J Am Acad Dermatol. 2002;46(2):S19-S21. doi:10.1067/MJD.2002.105476

  6. Panchbhai AS, Choudhary MS. Branchial cleft cyst at an unusual location: a rare case with a brief review. Dentomaxillofacial Radiology. 2012;41(8):696. doi:10.1259/DMFR/59515421

  7. Bocchialini G, Bozzola A, Daleffe F, Ferrari L, Castellani A. Unusually rapid development of a lateral neck mass: Diagnosis and treatment of a branchial cleft cyst. A case report. International Journal of Surgery Case Reports. 2017;41:383. doi:10.1016/J.IJSCR.2017.10.06

  8. Kim YH, Lee J. Cutaneous ciliated cyst on the anterior neck in young women: A case report. World Journal of Clinical Cases. 2020;8(19):4481. doi:10.12998/WJCC.V8.I19.4481

  9. Bivin WW, Heath JE, Drachenberg CB, Strauch ED, Papadimitriou JC. Cutaneous ciliated cyst: A case report with focus on mullerian heterotopia and comparison with eccrine sweat glands. American Journal of Dermatopathology. 2010;32(7):731-734. doi:10.1097/DAD.0B013E3181D43F01   

  10. Choi JS, Bae YC, Lee JW, Kang G bin. Dermoid cysts: Epidemiology and diagnostic approach based on clinical experiences. Archives of Plastic Surgery. 2018;45(6):512. doi:10.5999/APS.2018.00017

  11. Wei S, LiVolsi VA, Baloch ZW. Pathology of thyroglossal duct: an institutional experience. Endocr Pathol. 2015;26(1):75-79. doi:10.1007/S12022-015-9354-Y

  12. Roma A, Varsegi M, Magi-Galluzzi C, Ulbright T, Zhou M. The distinction of bronchogenic cyst from metastatic testicular teratoma: a light microscopic and immunohistochemical study. Am J Clin Pathol. 2008;130(2):265-273. doi:10.1309/JKJU9VE1P4WXVCPG

  13. Bobos M, Hytiroglou P, Kostopoulos I, Karkavelas G, Papadimitriou CS. Immunohistochemical distinction between merkel cell carcinoma and small cell carcinoma of the lung. Am J Dermatopathol. 2006;28(2):99-104. doi:10.1097/01.DAD.0000183701.67366.C7

  14. Elston, D. and Ferringer, T. and Ko, C.J. and Peckham, S. and High, W.A. and DiCaudo DJ. Dermatopathology E-Book. 3, ed. Published online 2018:552. Accessed August 9, 2022. https://books.google.co.id/books?id=4%5C_ReDwAAQBAJ

  15. Maruya SI, Kies MS, Williams M, et al. Differential expression of p63 isotypes (DeltaN and TA) in salivary gland neoplasms: biological and diagnostic implications. Hum Pathol. 2005;36(7):821-827. doi:10.1016/J.HUMPATH.2005.05.014

  16. Nishida N, Hata Y, Nomoto K. Intramyocardial bronchogenic cyst: histological appearance and a review of the literature. Cardiovasc Pathol. 2017;28:64-67. doi:10.1016/j.carpath.2017.03.005

 

Acknowledgements

 

Author Profiles

Kathleen E. Kramer, LCDR MC(FS) USN

Dr. Kathleen Kramer is a Chief Resident in Dermatology at the Naval Medical Center San Diego. Prior to dermatology residency she served as a Naval Flight Surgeon. She attended Uniformed Services University for medical school and has a strong interest in dermatopathology.

 

Willis H. Lyford, LCDR USN MC

Dr. Willis Hughes Lyford is a board certified Dermatologist at Naval Medical Center San Diego (NMCSD). He completed his residency training at NMCSD.

 

Nicholas F. Logemann, CDR USN MC

Dr. Nicholas F. Logemann is a board certified Dermatologist and fellowship-trained Dermatopathologist. He is director of the Dermatopathology Fellowship at Walter Reed National Military Medical Center.

 

 

 

 

 

 

 

Question:

 

 

 

 
 

Chronically Draining Cyst In A Young Man

Category

Cysts, Sinuses and Pits

Description

HOME CASE STUDY OF THE MONTH

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