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Thymic cyst in the differential diagnosis of paediatric cervical
masses.B-ENT.
2006;2(1):35-7
Thymic cyst in
the differential diagnosis of paediatric cervical masses. Cervical
ectopic thymic tissue is rarely reported. However, it should be
included in the differential diagnosis of neck masses, especially in
children. We present a case of a 7-year-old male with a soft,
asymptomatic right-sided cervical mass. The patient underwent complete
excision of a 3 x 4 cm cyst, which was derived from a mass of soft
tissue and was in close relation with the carotid sheath. Histological
examination of the specimen showed a thymic cyst. The child's
post-operative course was unremarkable and follow-up appointment six
months later showed complete recovery. The embryological development,
clinical presentation and management of ectopic thymic lesions are
discussed together with a brief review of the literature.
Thymic cyst in
the neck.Acta
Otolaryngol. 2005 Jan;125(1):108-12.
A rare case of
a thymic cyst in the neck containing both thymus and parathyroid
tissue in a 7-year-old boy is presented. The clinical presentation,
diagnostic evaluation, surgical management and histopathological
features are described. The embryology of cervical thymic cysts and
the differential diagnosis of cystic neck masses in children are
briefly reviewed. The diagnosis is seldom made preoperatively.
Surgical resection is the treatment of choice for definitive
diagnosis, resolution of symptoms and cure.
Cervical
presentations of thymic anomalies in children.Int
J Pediatr Otorhinolaryngol. 2004
Jul;68(7):909-14.
OBJECTIVE: To
better define the clinical manifestations, radiologic imaging and the
surgical management of cervical thymic lesions in children. STUDY
DESIGN: Multi-center retrospective case review. METHODS: The charts of
all children with pathologically confirmed thymic lesions at six
children's hospitals (1990-2002) were reviewed for demographics,
physical findings, X-ray findings, operative outcomes and pathology.
RESULTS: There were a total of 15 children, 2 of whom had ectopic
cervical thymus and 13 who had thymic cysts. They ranged in age from 1
month to 18 years. Thymic lesions were more common in males. Ectopic
cervical thymus was best defined by MRI whereas thymic cyst had a more
consistent appearance on CT. All children had successful surgical
resection with no recorded complications or recurrences. CONCLUSIONS:
Cervical thymic lesions are rare. Ectopic cervical thymus tends to be
found primarily in infants whereas thymic cysts occur in a wider age
range. Radiologic imaging is important but is not histologically
specific. Definitive diagnosis and cure requires complete surgical
excision.
Familial
thymic cyst.Int
J Pediatr Otorhinolaryngol. 2004
May;68(5):573-9.
Thymic cysts
are rare lesions of the anterior mediastinum or neck. The majority are
asymptomatic, and the remainder are associated mainly with symptoms of
dysphagia or dyspnea. Diagnosis is difficult before surgery. Cervical
thymic cysts are relatively rare; age at presentation ranges from the
neonatal period to adulthood, and the most frequent presenting sign is
a lateral neck mass. Mediastinal thymic cysts are more common and
account for 1% of all mediastinal masses. They tend to occur in the
older age group and are usually detected incidentally on chest X-ray
film or computed tomography scans. Dysphagia and dyspnea are the main
symptoms. We describe two brothers, aged 5 and 8 years, with
mediastinal thymic cysts that presented as low cervical masses and
review the embryology, diagnosis and management of thymic cysts.
Management of
thymic cysts.Ann
Chir. 2004 Feb;129(1):14-9.
OBJECTIVE: The
thymic cysts are rare tumors of the neck and anterior mediastinum. The
management of these patients in our institution is reported. Minimally
invasive procedures are discussed. PATIENTS AND METHODS: Six patients
operated in our institution within ten years, with a follow-up of 7.1
+/-3.7 years are studied retrospectively. RESULTS: There were four
women and two men with an average of 39.8 +/-16.5 years. The tumor was
found on chest radiograph in four asymptomatic patients, one took
medical advice for laryngeal discomfort and another for dysphagia and
dyspnea. The tumor was localized in the anterior mediastinum in three
cases, in the cervicomediastinal site in two cases and in the cervical
site in one case. CT scan was practiced in three patients with a
mediastinal tumor and MR imaging in one of them. In patients with
cervical or cervicomediastinal tumor, a cervical echography was
practiced. All patients were operated on: three by cervicotomy, one by
sternotomy, one by partial upper mini-sternotomy and one by right
lateral video-assisted mini-thoracotomy. Histology confirmed benign
epithelial thymic cyst. CONCLUSION: There is no specific marker of
thymic cysts. Only the surgical management, leads to precise the
diagnosis and to treat these tumors. No mortality, no complications or
recurrences are reported. The minimally invasive surgery takes an
interesting place for thoracic location, to explore and treat these
benign mediastinal lesions.
Congenital
thymic cysts in children--mostly misdiagnosed.J
Pediatr Surg. 1998 Jun;33(6):821-5.
BACKGROUND/PURPOSE: Thymic cysts are rare lesions of the neck and
mediastinum that are difficult to diagnose. Often considered
inconsequential, these lesions can frequently be symptomatic. In this
report the authors contrast their experience with that of the
literature. METHODS: From 1984 through 1997, the authors encountered
14 patients with this lesion. All cysts were completely excised.
Patients that had an acquired cyst of the thymus were excluded from
this series. RESULTS: Of the 14 patients ranging in age from 2 weeks
to 16 years, seven patients had cervical masses, five had mediastinal
masses, and two children had both sites involved. Seven children were
symptomatic with wheezing and upper respiratory infection, with cough
and fever being the most common clinical features. Investigations
included chest radiograph, contrast esophagram, sonography (US) and
computerized tomography (CT). Displacement of vital mediastinal or
neck structures was observed in eight patients. Only two patients
received correct diagnosis before surgery. Successful and complete
excision of all cysts was achieved. The cysts were benign and ranged
in size from 2 to 22 cm in diameter. CONCLUSION: Often forgotten,
thymic cysts are rare benign lesions that should be considered in the
differential diagnosis of cervical and mediastinal masses in children.
Cervical
thymic cyst: case reports and review of the literature.
Laryngoscope. 1996 Mar;106(3 Pt
1):247-52.
Due to its
rarity, cervical thymic cyst is seldom included in the differential
diagnosis of a neck mass. Approximately 80 cases have been reported
thus far, and most of these cases have occurred asymptomatically in
children and adults. Only 5 cases have involved patients younger than
1 year of age. The authors report four new patients with thymic cyst
in the neck. Two of the patients were newborns in whom the cyst caused
airway obstruction and dysphagia. All four patients underwent
successful resection of the lesions, with complete resolution of
symptoms. The embryology, histopathology, and differential diagnosis
of cervical thymic cysts are also reviewed. The authors recommend that
despite its infrequent occurrence cervical thymic cyst should be
considered in the evaluation of neck masses in children.
Cervical
thymic cysts. A clinical case report.Minerva
Chir. 1992 Oct 15;47(19):1581-3.
The presence
of thymic residues in a laterocervical site is very rare, as is cystic
degeneration. The paper reports the case of a six-year-old boy who
presented a swelling in a left laterocervical site; preoperative tests
(especially echography and fine needle aspiration) identified the
cystic nature of the swelling which was then confirmed
intraoperatively; histological test diagnosed a thymic cyst. The paper
analyses the embryological, anatomopathological and clinical aspects
of these formations and underlines the difficulty of making a
differential diagnosis from other neck pathologies, especially
branchial cysts. In conclusion, preoperative tests can only determine
the cystic component but not the thymic origin of these formations
which can only be confirmed by final histological tests.
Differential
diagnosis of children's enlarged necks--cervical thymic cysts.HNO.
1992 Feb;40(2):59-63.
We present a
cervical thymic cyst in an otherwise healthy 11 year old boy.
Ultrasonography revealed a smooth, medium echogenic cystic mass of 62
x 28 x 12 mm with weak acoustic enhancement lying between the carotid
artery and the internal jugular vein. The mass extended from the hyoid
bone to the inferior pole of the thyroid gland. CT scans also revealed
the displacement of the carotid artery and the internal jugular vein
by an atypically dense cystic mass. At operation the vagus nerve had
to be dissected from the posterior wall of the cyst. A solid band of
fibrous tissue extended to the inferior pole of the thyroid gland;
there was no connection to the pharyngeal wall. On histological
examination Hassal's bodies, cholesterol crystals and a mild
round-cell infiltration were observed. The postoperative course was
normal. There were no immune defects or signs of lymphogranulomatous
disease. Cervical thymic cysts may be recognised before operation and
differentiated from second arch cysts by their atypically low
infrahyoid position, their intimate relation to the vessels of the
neck and their extension into the upper mediastinum. Surgery can be
difficult due to the intimate relation to the vessels of the neck and
the vagus nerve, and to extension into the upper mediastinum.
Cervical
thymic cyst as a cause of acute suppurative thyroiditis.Jpn
J Surg. 1990 Sep;20(5):593-6.
A case of
acute suppurative thyroiditis following a perithyroidal abscess, which
was thought to have resulted from infection of a cervical thymic cyst,
is reported herein. The patient was an 8 year old asthmatic Japanese
boy who originally presented with tender swelling of the left anterior
neck in July, 1986. Although pharyngography could not clearly
demonstrate the pyriform sinus fistula, a hypoechoic area around the
left lobe of the thyroid gland was noted on ultrasonography.
Incisional drainage revealed Streptococcus milleri. A diagnosis of
acute suppurative thyroiditis was established, and a cystic tubular
mass was surgically resected from the left perithyroidal space some
time later. Histopathological examination of the specimen revealed
partly cystic thymic tissue along with parathyroid tissue. These
observations suggested that acute suppurative thyroiditis in this case
was caused by a perithyroidal abscess and that a perithyroidal abscess
may also result from infection of a cervical thymic cyst.
Respiratory
complications in cervical thymic cysts.J
Pediatr Surg. 1988 Jul;23(7):657-60.
Thymic cysts
are considered uncommon lesions in the differential diagnosis of
pediatric neck masses. They have been described as asymptomatic and of
little clinical consequence. Recent reports have stressed the
possibility of respiratory compromise associated with these lesions.
We reviewed our experience with cervical thymic cysts with emphasis on
respiratory problems. Ten pediatric patients underwent surgery and
were found to have cervical thymic cysts. Ages ranged from newborn to
14 years. There were four boys and six girls. Two were found to have
the thymic cysts at time of neck exploration for Grave's disease and
hyperparathyroidism. Of the remaining eight patients, all had mobile
cystic masses, located anterior to but extending beneath the lower
third of the sternocleidomastoid muscle. The size of the mass ranged
from 3.0 to 8.5 cm. Preoperative diagnosis included cystic hygroma/branchial
cleft cyst (five), lymphoma (one), teratoma (one), and thymic cyst
(one). All had a history of rapidly developing neck mass. Seven of the
eight gave a history of upper respiratory tract infection (URI) prior
to the development of the mass. Five had imaging studies that showed
tracheal compression. Three of these required airway management in the
early postoperative period. All were excised through a neck incision,
with two requiring sternal extension. Histology showed cholesterol
crystals, Hassall's corpuscles, and giant cell reaction diagnosis of
thymic cysts. There has been no recurrence and no permanent
respiratory sequela in the ten patients. Cervical thymic cysts are
benign lesions that may be more common than literature suggests.
Congenital
thymic cysts in the neck.Int
J Pediatr Otorhinolaryngol. 1983
Sep;6(1):95-100.
Cervical
thymic cysts are rare. Sixty-seven cases are reported in the
literature up until 1982. Remnants of thymic tissue in the course of
descent may lead to cystic development. The majority of the cases is
found in males under 10 years of age, typically on the left side of
the neck. The characteristic histological features are thymic tissue
with Hassall's corpuscles and cholesterol clefts found in the cyst
wall. A preoperative correct diagnosis has never been made. Typically,
the templative diagnosis has been a common branchial cyst. An
additional case of a thymic cyst is reported, here. Surgical removal
was complicated by lesion of the vagal nerve, which has never been
described, although the cysts are often adherent to the carotid sheath
and vagal nerve.
Cervical
thymic cyst.J
Laryngol Otol. 1982 Feb;96(2):181-9.
Thymic
derivatives should be included in the differential diagnosis of cystic
masses in the neck. A classification of thymic cysts is proposed:
namely, true mixed or false. A thymic cyst may contain cholesterol
crystals in the luminal fluid, cholesterol clefts, granulomas and
lymphocytic follicles as well as Hassall corpuscles in the wall.
Treatment consists of simple excision of the cyst and its tract. The
thirty-fifth case of cervical thymic cyst in the English Literature is
reported.
Cervical
thymic cyst.
Arch Dermatol. 1982
Feb;118(2):122-4.
Various types
of cysts that originate in embryonal remnants may be observed in the
neck. Among these, branchial cleft and thyroglossal duct cysts are
more commonly observed, whereas thymic cysts are rare. Most patients
with a cervical thymic cyst complain of a painless, enlarging mass in
the neck. The histopathologic features of thymic cysts are diagnostic.
Cystic thymomas, which seem to have a more aggressive clinical
behavior in children, should be differentiated from the benign
cervical thymic cyst. Thymic cysts most probably arise from embryonic
remnants of the thymopharyngeal duct. Our patient had a cervical
thymic cyst with neurofibromatosis.
Progressive
neonatal airway obstruction secondary to cervical thymic cyst.Otolaryngol
Head Neck Surg. 1981 Sep-Oct;89(5):723-5.
Cervical
thymic cysts are extremely unusual neoplasms that only rarely produce
signs and symptoms of upper airway tract compromise. Less than 7% of
patients initially have dyspnea or hoarseness. We report the first
known case of progressive neonatal airway obstruction secondary to a
rapidly enlarging cervical thymic cyst. Because one half of these
benign tumors may demonstrate mediastinal extension, computed axial
tomography or B-mode ultrasonography or both is recommended prior to
surgical excision. Review of the literature confirms that the majority
are successfully removed via a transcervical approach without
recurrence.
Symptomatic
cervical thymic cyst in a neonate.Otolaryngol
Head Neck Surg. 1981
Sep-Oct;89(5):738-41.
Thymic cysts
are unusual neck masses in adults and children and are rarely
differentiated from other neck masses by physical examination. This is
a case report of a thymic cyst producing airway obstruction in a
neonate. The embryogenesis and differential diagnosis of thymic cysts
are reviewed.
Cervical thymic cyst: report of an unusual
presentation of a rare lesion.Aust
N Z J Surg. 1980 Jun;50(3):309-10.
A case of
cervical thymic cyst presenting as a thyroid swelling is reported, and
the embryology of the thymus gland is discussed in order to explain
this unusual presentation.
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