Malignant Ameloblastoma Metastatic to the Lungs

sequences. One possible explanation for the high signal intensity is the presence of proteinaceous material within the cyst. Cyst fluid that has a low specific gravity and is mainly serous (a “spring water” cyst), will show very low signal intensity on T1-weighted images and have very high signal intensity on T2-weighted images. Most bronchogenic cysts contain large amounts of proteinaceous material and characteristically have high signal intensity on T1-weighted images.5,6 Enucleation is the procedure of choice, usually through a medial laparotomy for subdiaphragmatic cysts. When the patient has a history of laparotomy, adhesions may make resection hazardous. Bronchogenic cysts located in the retroperitoneum can be excised using either a laparotomy incision or a flank incision.1 Resection of previously infected cysts is more difficult, giving further impetus to early removal of asymptomatic cysts. The treatment of asymptomatic bronchogenic cysts remains a controversial topic. Most bronchogenic cysts are benign and remain asymptomatic. Therefore, the argument has been made that intervention is not warranted as long as the cyst is not causing problems. However, this philosophy is shortsighted because asymptomatic cysts do not always remain so.6 Infection is a well-known complication in these lesions, and the morbidity and mortality of surgery to remove an infected cyst is higher than that for a purely elective procedure. Furthermore, carcinomas and fibrosarcomas have been reported arising from benignappearing bronchogenic cysts.2 Since it usually is not possible to establish an unequivocal diagnosis of bronchogenic cyst preoperatively, and it is impossible to anticipate infection, early surgical resection of bronchogenic cysts is warranted in all good surgical candidates.