Cervical thymic cysts

Cervical thymic cysts in children: A case report

INTRODUCTION AND IMPORTANCE

Cervical thymic cysts are rare benign lesions that rarely considered in the differential diagnosis of neck cysts in children. The correct diagnosis is often made after surgical excision and though determination of the specific histopathological findings of the thymic cyst.

CASE PRESENTATION

We report an observation of a cervical thymic cyst erroneously diagnosed preoperatively respectively as a cystic lymphangioma.

CLINICAL DISCUSSION

The diagnosis is generally rectified after surgery by identifying the specific histopathological findings of the thymic cyst. Treatment is surgical.

CONCLUSION

This diagnosis should be considered in front of any indolent lateral cervical mass.

Some uncommon cystic lesions in the anterior head and neck region: Pitfalls to be avoided on cytology

Cystic lesions of the anterior head and neck region are a challenging and frequent finding on cytological smears. The scant amount of cellular material in cystic slides poses the greatest difficulty to interpretation, so that frequently they are diagnosed as inadequate or with minimal cellular component. Despite the majority of cystic lesions being benign, a minor portion consist of malignant cystic entities. In these latter cases, the evidence of very scant malignant cells can be misdiagnosed and/or underestimated, leading to a false negative diagnosis. Many papers have already described and detailed the range of possible benign and malignant cystic lesions in head and neck. In the current review we have focused on the less common entities that often lead to serious misinterpretation.

Adult Cervical Thymic Cysts: A Narrative Review

OBJECTIVE

Thymic cysts are rare benign neck masses, accounting for less than 1% of all cervical masses. This study aims to discern different presentations, investigations, and treatment options of thymic cysts in adults by reviewing prior published studies from January 2010 to October 2021 to bridge the knowledge gap since the last review by Michalopoulos in 2011. Moreover, we present a case of a 28-year-old male with a left cervical thymic cyst.

DATA SOURCES

Data were obtained from a literature search using the ScienceDirect, PubMed, ResearchGate, and Google Scholar databases.

METHODS AND RESULTS

This study retrospectively analyzes reported cases of adult cervical thymic cysts by collecting demographic data, patient presentation, duration, location, size, type of imaging, fine-needle aspiration, and surgical approach. Eighteen patients were included. Cysts were seen on the left (n = 9), right (n = 5), and midline (n = 4). The age of the patients ranged from 19 to 64 years. Most patients present with painless left-sided neck swelling. Computed tomography (CT) was the preferred imaging modality in most cases. Moreover, surgical excision was essential for therapeutic and diagnostic purposes. This study did not require institutional review board approval.

CONCLUSION

Adult cervical thymic cyst is a rare etiology. Nevertheless, a painless left-sided neck mass with no clear lower border should uphold thymic cyst as a differential diagnosis. MRI and CT scans are the preferred imaging modalities for preoperative planning. Surgical excision is mandatory for treatment and histological confirmation. As of October 2021, around 54 cases of adult thymus cysts had been reported to the best of our knowledge and review.

Excision of rare adult cervical thymic cyst

Cervical thymic cysts (CTCs) represent 1% of all cervical cystic masses. A review of the literature found that CTCs are typically asymptomatic, with a propensity to be left sided. CTCs often require histological evaluation for diagnosis. A 27-year-old male patient presented to an outpatient otolaryngology clinic with worsening bilateral jaw and neck pain and an incidental right-sided neck mass found on cervical MRI. Preoperative differential diagnosis included venolymphatic malformation versus branchial cleft cyst. Histological examination of the excised specimen provided diagnosis of a CTC. Postoperatively, the patient reported improvement in cervical pain. CTCs are a rare cause of lateral neck mass in young adults. Typical presentation included neck enlargement with no symptoms or in some cases compressive symptoms. It is important to consider CTCs when formulating a differential for a lateral neck mass.

The paediatric thymus: recognising normal and ectopic thymic tissue

The appearance of the paediatric thymus changes as the normal process of thymic involution occurs. Thymic tissue may be orthotopic within the anterior mediastinum or ectopically located along the course of its embryological development. The variable appearance of orthotopic and ectopic thymic tissue in children on imaging studies may lead to misinterpretation of the normal thymus as pathology. Recognition of normal thymic tissue can mitigate unnecessary further diagnostic testing and patient anxiety. In this review, we discuss the embryological development and anatomical variants of normal thymus, and demonstrate the multimodality imaging features of the normal thymus in children, including positron-emission tomography, and diffusion-weighted imaging and in- and opposed-phase imaging on magnetic resonance imaging. We demonstrate the normal thymus mimicking pathological processes and discuss features that distinguish normal thymus, including thymic rebound hyperplasia, from pathology.