The Laryngoscope V C 2011 The American Laryngological, Rhinological and Otological Society, Inc. Case Report Poorly Differentiated Adenocarcinoma Arising from a Cervical Bronchial Cyst Audrey P. Calzada, MD; Winnie Wu, MD; Amanda R. Salvado, MD; Chi K. Lai, MD; Gerald S. Berke, MD Bronchogenic cysts with malignant change are rarely reported. We describe a case of poorly differentiated ade- nocarcinoma arising from a cervical bronchial cyst in a patient presenting with a thyroid mass, cervical lymphade- nopathy, and initial biopsy suggestive of papillary thyroid carcinoma. The clinical presentation, intraoperative find- ings, radiographic images, and pathology slides are presented. To our knowledge, this is the first report of a poorly differentiated adenocarcinoma arising from a bronchial cyst in the cervical region. Key Words: Head, neck. Laryngoscope, 121:1446–1448, 2011 INTRODUCTION Bronchogenic cysts are a rare, benign congenital malformation derived from the embryonic foregut and occur most commonly in the mediastinum in close prox- imity to the thoracic trachea. Ectopic locations in the neck are rare and have been described mostly in the pe- diatric population. 1 In adults, cervical bronchial cysts have been reported in the paratracheal, cutaneous, lingual, and supraclavicular areas. 2 Malignant transfor- mation of a bronchial cyst arising in the neck has never been reported. We present the first case of a poorly differentiated adenocarcinoma arising from a cervical bronchial cyst. CASE REPORT A 32-year-old female presented with a 3-month his- tory of throat pain, an enlarging left neck mass, and left vocal cord paresis. CT imaging showed a 4.2 Â 3.5 cm mass arising from the left thyroid lobe with left cervical lymphadenopathy. Ultrasound-guided fine-needle aspira- tion of the left thyroid mass was suggestive of papillary thyroid carcinoma (Fig. 1a). Based on the presumed diagnosis of a well-differen- tiated thyroid carcinoma, the patient was taken to the operating room for a planned total thyroidectomy and left neck dissection. Intraoperatively, the patient was found to have a large left thyroid mass with gross tra- cheoesophageal invasion and extensive jugular chain lymphadenopathy densely adherent to the common carotid artery. Intraoperative frozen specimen analysis showed a poorly differentiated adenocarcinoma. Subtotal thyroidectomy with a limited neck dissection was performed. Postoperative PET/CT imaging 3 weeks later showed a hypermetabolic mass in the area of the left thyroid lobe, left neck (levels II and IV) and tracheo- esophageal invasion (Fig. 2a), consistent with diffuse aggressive disease encountered intraoperatively. Addi- tionally, the patient had diffuse substernal and pulmonary metastases (Fig. 2b). Microscopically, a poorly differentiated adenocarci- noma was seen extensively invading into the thyroid gland (Fig. 3a), skeletal muscle, and fibroadipose tissue. Furthermore, a cystic structure was present, lined by ciliated columnar epithelium with a single underlying smooth muscle layer with dysplastic changes (Fig. 3b); focally, the cyst lining was seen to transition into inva- sive adenocarcinoma and contained mucin. Extensive immunohistochemistry was performed; the tumor cells were strongly positive for CK7, CEA, and P53 and mod- erately positive for CA19.9 and vimentin. Tumor cells From the Division of Head and Neck Surgery, Department of Surgery (A.P .C., A.R.S., G.S.B.), Department of Pathology and Laboratory Medicine (WW. C.K.L.) at the University of California, Los Angeles David Geffen School of Medicine, Los Angeles, California, U.S.A. Editor’s Note: This Manuscript was accepted for publication April 4, 2011. This work presented as a poster presentation at the Combined Section of the Triological Society Annual Meeting, January 26–29, 2011, Scottsdale, Arizona. The authors have no financial interests to disclose. The authors have no conflicts of interest to disclose. Send correspondence to Dr. Gerald S. Berke, University of Califor- nia, Los Angeles Surgery, Division of Head and Neck Surgery, Box 951624, 62-132 CHS, Los Angeles, CA 90095-1624. E-mail: gberke@mednet.ucla.edu DOI: 10.1002/lary.21858 Laryngoscope 121: July 2011 Calzada et al.: Cervical Bronchial Cyst Adenocarcinoma 1446