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Clinical Problem Solving: Radiology
March 2004

Radiology Quiz Case 2—Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2004;130(3):374-375. doi:10.1001/archotol.130.3.374-b

The MRI scan revealed a multilobulated 3.5 × 2.7 × 3.0-cm cystic structure in the floor of the mouth. There was no evidence of invasion into adjacent structures. The tongue was displaced superiorly and posteriorly, causing a slight narrowing of the oropharynx. A normal-appearing thyroid gland was seen.

The differential diagnosis included ranula (mucocele), dermoid and epidermoid cysts, thyroglossal duct cyst, retention cyst of the salivary gland, lymphoepithelial cyst, cystic hygroma (lymphangioma), cyst with heterotopic gastrointestinal mucosa, and sialolithiasis of the sublingual or submandibular glands. The initial biopsy specimen revealed gastric foveolar, squamous, and ciliated columnar epithelium, findings that were highly suggestive of a congenital heterotopic gastrointestinal cyst. Excision of the lesion revealed a red fibromembranous piece of tissue measuring 5.0 × 2.0 × 0.3 cm in thickness and containing soft, white, amorphous cyst material and fluid. Pathologic evaluation revealed ciliated columnar epithelium with focal keratinization, findings that were consistent with a foregut duplication cyst.