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A ciliated cyst with müllerian differentiation arising in the posterior mediastinum.

Lee SJ, Hwang CS, Park do Y, Huh GY, Lee CH - Korean J Pathol (2014)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Pusan National University School of Medicine, Yangsan, Korea.

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We found a posterior mediastinal cyst with Müllerian differentiation that was consistent with previous description of Hattori’s cyst... To our knowledge, this is the first report of Hattori’s cyst arising in the posterior mediastinum in Korea... An abnormal mass lesion in the posterior mediastinum of a 42-year-old woman was found incidentally during a routine medical check-up... The cystic wall was lined by a simple ciliated cuboidal to columnar epithelium supported by thin connective tissue... Some H-caldesmon positive bundles of smooth muscle cells were found (Fig. 2B)... The epithelium of the papillary structure was composed of ciliated pseudostratified columnar and intercalated clear cells (Fig. 2C)... We did not identify any atypia in the epithelial cells... The pathologic diagnosis was benign ciliated cyst of the posterior mediastinum showing Müllerian differentiation, suggestive of the so-called mediastinal Hattori’s cyst... Thus, because the histogenesis of these structures is still not understood, the descriptive term ‘ciliated cyst with Müllerian differentiation’ may be more appropriate for the designation of these cysts... Before Hattori suggested Hattori’s cyst as a new disease entity, mediastinal cysts with Müllerian differentiation were misdiagnosed as bronchogenic cysts due to their ciliated epithelium... Compared with bronchogenic cysts, the lining epithelium of cystic structures with Müllerian differentiation do not have cartilage structure and are ER and PR positive... ER, PR, and PAX-8, which show positivity to epithelial cells in the present case, are known to be the best markers of Müllerian cysts... Additionally, the lining epithelial cells of the present case were positive for CK7, and negative for CK5/6 and calretinin, which are specific for mesothelial differentiation.

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Microscopic appearance of the posterior mediastinal cyst with Müllerian differentiation. (A) The cystic wall is supported by thin connective tissue stroma and shows a focal papillary structure. (B) The supportive wall shows some bundles of smooth muscle cells. (C) The lining epithelium of the cyst, including its papillary structure, is composed of tubal-type Müllerian epithelium with ciliated columnar, secretory, and intercalated cells. (D) Immunohistochemistry for estrogen receptor shows diffuse nuclear positivity in the cyst epithelium. Immunohistochemical stains for Wilms tumor-1 (E) and PAX-8 (F) also demonstrate diffuse nuclear positivity in the lining epithelium. (G) The negativity for calretinin suggests the epithelial cells are not of mesothelial origin.
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f2-kjpathol-48-5-401: Microscopic appearance of the posterior mediastinal cyst with Müllerian differentiation. (A) The cystic wall is supported by thin connective tissue stroma and shows a focal papillary structure. (B) The supportive wall shows some bundles of smooth muscle cells. (C) The lining epithelium of the cyst, including its papillary structure, is composed of tubal-type Müllerian epithelium with ciliated columnar, secretory, and intercalated cells. (D) Immunohistochemistry for estrogen receptor shows diffuse nuclear positivity in the cyst epithelium. Immunohistochemical stains for Wilms tumor-1 (E) and PAX-8 (F) also demonstrate diffuse nuclear positivity in the lining epithelium. (G) The negativity for calretinin suggests the epithelial cells are not of mesothelial origin.

Mentions: Microscopically, the cystic tumor had a papillary structure, reminiscent of a fallopian tube (Fig. 2A). The cystic wall was lined by a simple ciliated cuboidal to columnar epithelium supported by thin connective tissue. Some H-caldesmon positive bundles of smooth muscle cells were found (Fig. 2B). The epithelium of the papillary structure was composed of ciliated pseudostratified columnar and intercalated clear cells (Fig. 2C). We did not identify any atypia in the epithelial cells. We used immunohistochemical assay for estrogen receptor (ER), progesterone receptor (PR), Wilms’ tumor 1 (WT1), PAX-8, cytokeratin 7 (CK7), cytokeratin 5/6 (CK5/6), calretinin, and thyroid transcription factor-1 (TTF-1) to identify the character of the epithelium. The epithelial cells were positive for ER, PR, WT1, and CK7, but negative for TTF-1, CK5/6, and calretinin (Fig. 2D-G). This epithelium was histologically reminiscent of the fallopian tube with characteristic expression of ER and PR as well as PAX-8. These results suggest that the cyst might have originated from a Müllerian duct structure. The pathologic diagnosis was benign ciliated cyst of the posterior mediastinum showing Müllerian differentiation, suggestive of the so-called mediastinal Hattori’s cyst. Four days after complete surgical removal of the mediastinal cystic mass, the patient was discharged from our hospital. At her 4-month follow up visit she was healthy with no evidence of recurrence.


A ciliated cyst with müllerian differentiation arising in the posterior mediastinum.

Lee SJ, Hwang CS, Park do Y, Huh GY, Lee CH - Korean J Pathol (2014)

Microscopic appearance of the posterior mediastinal cyst with Müllerian differentiation. (A) The cystic wall is supported by thin connective tissue stroma and shows a focal papillary structure. (B) The supportive wall shows some bundles of smooth muscle cells. (C) The lining epithelium of the cyst, including its papillary structure, is composed of tubal-type Müllerian epithelium with ciliated columnar, secretory, and intercalated cells. (D) Immunohistochemistry for estrogen receptor shows diffuse nuclear positivity in the cyst epithelium. Immunohistochemical stains for Wilms tumor-1 (E) and PAX-8 (F) also demonstrate diffuse nuclear positivity in the lining epithelium. (G) The negativity for calretinin suggests the epithelial cells are not of mesothelial origin.
© Copyright Policy
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4215971&req=5

f2-kjpathol-48-5-401: Microscopic appearance of the posterior mediastinal cyst with Müllerian differentiation. (A) The cystic wall is supported by thin connective tissue stroma and shows a focal papillary structure. (B) The supportive wall shows some bundles of smooth muscle cells. (C) The lining epithelium of the cyst, including its papillary structure, is composed of tubal-type Müllerian epithelium with ciliated columnar, secretory, and intercalated cells. (D) Immunohistochemistry for estrogen receptor shows diffuse nuclear positivity in the cyst epithelium. Immunohistochemical stains for Wilms tumor-1 (E) and PAX-8 (F) also demonstrate diffuse nuclear positivity in the lining epithelium. (G) The negativity for calretinin suggests the epithelial cells are not of mesothelial origin.
Mentions: Microscopically, the cystic tumor had a papillary structure, reminiscent of a fallopian tube (Fig. 2A). The cystic wall was lined by a simple ciliated cuboidal to columnar epithelium supported by thin connective tissue. Some H-caldesmon positive bundles of smooth muscle cells were found (Fig. 2B). The epithelium of the papillary structure was composed of ciliated pseudostratified columnar and intercalated clear cells (Fig. 2C). We did not identify any atypia in the epithelial cells. We used immunohistochemical assay for estrogen receptor (ER), progesterone receptor (PR), Wilms’ tumor 1 (WT1), PAX-8, cytokeratin 7 (CK7), cytokeratin 5/6 (CK5/6), calretinin, and thyroid transcription factor-1 (TTF-1) to identify the character of the epithelium. The epithelial cells were positive for ER, PR, WT1, and CK7, but negative for TTF-1, CK5/6, and calretinin (Fig. 2D-G). This epithelium was histologically reminiscent of the fallopian tube with characteristic expression of ER and PR as well as PAX-8. These results suggest that the cyst might have originated from a Müllerian duct structure. The pathologic diagnosis was benign ciliated cyst of the posterior mediastinum showing Müllerian differentiation, suggestive of the so-called mediastinal Hattori’s cyst. Four days after complete surgical removal of the mediastinal cystic mass, the patient was discharged from our hospital. At her 4-month follow up visit she was healthy with no evidence of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Pusan National University School of Medicine, Yangsan, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

We found a posterior mediastinal cyst with Müllerian differentiation that was consistent with previous description of Hattori’s cyst... To our knowledge, this is the first report of Hattori’s cyst arising in the posterior mediastinum in Korea... An abnormal mass lesion in the posterior mediastinum of a 42-year-old woman was found incidentally during a routine medical check-up... The cystic wall was lined by a simple ciliated cuboidal to columnar epithelium supported by thin connective tissue... Some H-caldesmon positive bundles of smooth muscle cells were found (Fig. 2B)... The epithelium of the papillary structure was composed of ciliated pseudostratified columnar and intercalated clear cells (Fig. 2C)... We did not identify any atypia in the epithelial cells... The pathologic diagnosis was benign ciliated cyst of the posterior mediastinum showing Müllerian differentiation, suggestive of the so-called mediastinal Hattori’s cyst... Thus, because the histogenesis of these structures is still not understood, the descriptive term ‘ciliated cyst with Müllerian differentiation’ may be more appropriate for the designation of these cysts... Before Hattori suggested Hattori’s cyst as a new disease entity, mediastinal cysts with Müllerian differentiation were misdiagnosed as bronchogenic cysts due to their ciliated epithelium... Compared with bronchogenic cysts, the lining epithelium of cystic structures with Müllerian differentiation do not have cartilage structure and are ER and PR positive... ER, PR, and PAX-8, which show positivity to epithelial cells in the present case, are known to be the best markers of Müllerian cysts... Additionally, the lining epithelial cells of the present case were positive for CK7, and negative for CK5/6 and calretinin, which are specific for mesothelial differentiation.

No MeSH data available.


Related in: MedlinePlus