[Pathology] Atlas of Reactive, Developmental, Inflammatory, and Tumorlike Conditions (part 2)

[Pathology] Atlas of Reactive, Developmental, Inflammatory, and Tumorlike Conditions (part 2)

Continued of part 1:  [Pathology] Atlas of Reactive, Developmental, Inflammatory, and Tumorlike Conditions (part 1)

Fig. 1.11 Cut surface of an acquired multilocular thymic cyst in a

56-year-old woman, showing multiple distended cystic cavities filled

with hemorrhagic fl uid. The walls of the cyst are thickened and edematous and 

show pinpoint foci of hemorrhage and cholesterol granulomas.

These cysts can grow to very large proportions and become symptomatic. 

Extensive sampling is required to rule out the possibility of cystic

degeneration of an underlying malignant neoplasm

Fig. 1.12 Histologic appearance of multilocular thymic cyst, showing

dilated cystic cavity surrounded by dense lymphoid aggregates. The lining of 

the cyst is made up of simple cuboidal epithelium to stratified

squamous epithelium. Focal areas of hemorrhage and inflammation are

commonly present in the wall of the cysts

Fig. 1.13 Acquired multilocular thymic cyst at higher magnification,

showing the lining of the cyst in continuity with residual thymic epithelium inside

the walls of the cyst (arrows). The residual thymic epithelium is accompanied 

by a small lymphocytic component and can be

seen to be in continuity with dilated Hassall’s corpuscles

Fig. 1.14 Detail of the lining in an acquired multilocular thymic cyst,

showing the cyst cavity lined by simple cuboidal epithelium originating

from a remnant of thymic tissue in the wall of the cyst. Notice the

admixture of the epithelium with small T lymphocytes  

Fig. 1.15 More advanced stage in a multilocular thymic cyst, showing

dense fi brosis of the walls of the cyst secondary to chronic inflammation and netlike branching of hyperplastic thymic epithelium surrounded by the fibrous tissue  

Fig. 1.16 Higher detail from an area of fibrosis in a multilocular thymic cyst, showing complex branching of thymic epithelium displaying a sieve-like architecture, with thin, elongated strands of thymic epithelial cells circumscribing dense areas of collagen in a fibroepitheliomatous fashion. This appearance is very distinctive in long-standing multilocular thymic cysts with prominent fibrotic changes in the walls

Fig. 1.17 Acquired multilocular thymic cyst showing severe inflammation of the walls with pseudoepitheliomatous hyperplasia. Notice the

tongues and strands of squamous epithelium arising from the luminal

surface of the cyst and infiltrating into the wall of the cyst (arrows).

These reactive changes can sometimes be quite prominent and display

mild cytologic atypia and even mitotic fi gures, simulating an invasive

squamous cell carcinoma arising from the wall of the cyst

Fig. 1.18 Cholesterol cleft granuloma in the wall of an acquired multilocular 

thymic cyst. In addition to hemorrhage, fibrosis, and acute and

chronic inflammation, cholesterol cleft granulomas are a prominent feature 

often encountered in thymic cysts. Notice the admixture of foamy

macrophages and multinucleated giant cells with the cholesterol clefts

Fig. 1.19 Acquired multilocular thymic cyst of lymphoepithelial type

shows thickened, fleshy, and edematous walls with a fish-flesh appearance due to 

dense lymphoid infiltrates. Such cysts are very similar to

lymphoepithelial cysts of the pancreas or salivary glands and are a common feature 

in children with AIDS, but they can also be seen in adult

patients who are not immunosuppressed

Continue of part 3: https://www.tuyenlab.net/2018/01/pathology-atlas-of-reactive_93.html

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