Aberrant cervical thymus: a case report and review of literature

AB thymoma revealed by a huge intraparenchymal lung mass: a case report

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum. Unusually it can be found in other locations as well. Ectopic thymoma rarely presents as an intrathoracic tumor. We report a case of ectopic thymoma presenting as a giant right intrathoracic tumor, the patient was 51-year-old, and who was presented with heaviness in chest and breathlessness. Detailed investigation including chest computed tomography scan revealed a well-defined large solid tumor in the right thoracic cavity, in this case, immunohistochemical analysis demonstrated a thymome AB. The tumor was metastatic to the lung. Patient received a neoadjuvant chemotherapy, with favorable evolution.

[Ectopic thymus: A rare cause of neck mass in children]

INTRODUCTION

Ectopic cervical thymus (ECT) is a rare embryological abnormality in children. It can be revealed by a compressive neck mass mistaken for a malignant tumor. Through a new case of ECT, we review the embryopathogenesis, diagnostic difficulties and therapeutic features.

CLINICAL OBSERVATION

A 19-month-old girl presented a right cervical mass that quickly increased in size, causing intermittent dyspnea. The physical examination objectified a 6-cm, soft and compressible, painless right cervical tumefaction, extending from the mastoid area to the ipsilateral supraclavicular fossa. The diagnosis suggested based on CT was a cervicomediastinal cystic lymphangioma. The diagnoses discussed based on MRI were a collection of necrotic lymphadenopathy, rhabdomyosarcoma or neurofibroma debris. The mass was surgically excised through a laterocervical incision. A whitish multilobular tissular mass was found, adherent to the neurovascular axis of the neck. Pathological examination concluded in normal ectopic thymus tissue. The postoperative course was uneventful.

CONCLUSION

Although ECT is a rare benign anomaly, it should be considered as a possible cause of a neck mass in children. Surgery is the curative treatment. Before surgery, the presence of a mediastinal thymus must be confirmed to avoid the risk of a total thymectomy in children. MRI is helpful in delineating thymic ectopia compared to the mediastinal thymus.

Ectopic cervical thymus associated with infant death: 2 case reports and literature review

An ectopic cervical thymus is a rare congenital anomaly that can be located anywhere along the developmental pathway of thymic descent. Most lesions manifest as a cystic mass and have an indolent course. Two fatal cases associated with ectopic cervical thymus in the form of a solid mass are presented in conjunction with a review of the clinicopathological characteristics of the solid form. This report emphasizes the importance of considering a diagnosis of ectopic cervical thymus in infants with neck masses, with or without obstructive symptoms, to prevent possibly fatal outcomes.

Intrathyroidal thymic tissue mimicking a thyroid nodule in a 4-year-old child

A 4 year-old girl was referred for CT of her neck for suspected submental lymphadenopathy and was found to have an incidental low-attenuation thyroid mass. Subsequent thyroid ultrasound showed a heterogeneous thyroid mass with punctate areas of increased echogenicity. Cytologic examination was consistent with ectopic intrathyroidal thymic nodule. We review the presentation of ectopic thymic tissue, especially in the thyroid gland.

Ectopic Thymic Tissue Presenting as a Neck Mass in Children: A Report of 3 Cases

The presentation of ectopic cervical thymic tissue as an anterior neck mass is rare. We report 3 similar cases in 3 boys—2 who had a thymic cyst and 1 who had an ectopic cervical thymus. We discuss the radiographic presentation on ultrasound and magnetic resonance imaging in these cases. We also review the typical histologic picture; histology is the only way of diagnosing this condition.

Cervical thymic remnants in children

OBJECTIVE

Define the clinical presentation, diagnostic value of preoperative imaging, surgical management, and outcomes of treatment of congenital cervical thymic remnants in children.

DESIGN

Retrospective cohort.

SETTING

Single tertiary care institution.

PATIENTS

20 children who underwent excision of cervical thymic remnant, 1975-2006.

MAIN OUTCOMES MEASURED

Utility of preoperative imaging to diagnose cervical thymic anomalies; success of surgical treatment of cervical thymic remnants.

RESULTS

A total of 20 children were identified, with an average age of 6.98+/-5.63 years. All ectopic thymus tissue was found in the embryonic distribution area associated with the third branchial pouch. Fourteen patients underwent excision of a cystic ectopic thymus. Four of these patients exhibited lesions isolated to the cervical region, and 10 patients displayed lesions involving cervicomediastinal areas. Six patients underwent excision of solid ectopic cervical thymus, and each of these was an unanticipated mass encountered during surgical dissection for other procedures. 83% of patients with solid ectopic cervical thymus presented at age 3 or younger. Physical exam and preoperative imaging correctly diagnosed thymic remnants in 15% patients. Resection of thymic remnants was successful in all patients, and there were no recurrences.

CONCLUSIONS

Though rare, thymic remnants should be considered in the differential diagnosis of masses presenting in locations associated with derivatives of the third branchial pouch. Though preoperative imaging is helpful in identifying the extent of these lesions, congenital thymic remnants prove difficult to diagnosis radiologically. Surgical excision is the diagnostic and therapeutic treatment of choice in the management of cervical thymic remnants.

Ectopic cervical thymus in an infant

We report a case of accessory cervical thymus presenting as a unilateral neck mass in a 2-month-old boy. Ultrasonography (US) showed a mass isoechogenic to muscle in the left neck. Computed tomography (CT) revealed a well-defined, mildly enhanced mass located anterior to the sternocleidomastoid muscle, anterolateral to the carotid sheath, and posterior to the submandibular gland. On magnetic resonance imaging (MRI), the mass was isointense to muscle on T1-weighted images and hyperintense to muscle on T2-weighted images. Diffusion-weighted images showed relatively low apparent diffusion coefficient (ADC) values, and the mass was slightly enhanced after administration of contrast material. We suspected ectopic thymus, but we could not exclude the possibility of a malignant lesion. Therefore, the tumor was surgically resected. The histological diagnosis was ectopic cervical thymus. Ectopic thymus should be included in the differential diagnosis of a submandibular or cervical mass in infants. US and MRI can provide useful information for the diagnosis of ectopic cervical thymus.

Two cases of ectopic cervical thymus: Case reports and a review of the literature

Ectopic cervical thymic tissue has rarely been reported in the medical literature. However, it should be included in the differential diagnosis of neck masses, and especially for children. This lesion generally occurs in the descent line of the thymus from the angle of the mandible to the superior mediastinum. The preoperative diagnosis of ectopic cervical thymus is seldom considered and this is often misdiagnosed as a possible tumor or as a lymph node. We report here on two cases of ectopic cervical thymus for which the patients underwent complete excision of the masses.

Cervical thymic rebound after cancer treatment

While newly recognized neck masses in children previously treated for malignancy raise the specter of recurrent disease, recent experience with 2 patients has shown us that enlargement of cervical thymic tissue should be considered in the differential diagnosis, especially early after the completion of chemotherapy or immunotherapy.

Ectopic thymus presenting as a subglottic mass: diagnostic and management dilemmas

The commonest subglottic mass in infants is a congenital haemangioma, which is usually managed conservatively without a histological diagnosis. Ectopic cervical thymus is rare and usually presents as a cervical mass, with only one case of subglottic ectopic thymus reported to date. Due to its rarity, the diagnosis in most cases relies on surgical excision and histological examination. However, histological diagnosis may not always be easily reached, as is demonstrated in this case report. In this article, an infant with congenital stridor secondary to a subglottic mass is described and the clinical and diagnostic difficulties in its management are discussed.

Aberrant cervical thymus mimicking a cervical mass

A case of a 9-year-old female with suprasternal extension of the thymus mimicking thyroid gland enlargement is described. Ultrasonography successfully established the diagnosis. Aberrant cervical thymic tissue is an infrequently reported cause of paediatric neck masses. It is important to be aware of this entity to prevent anxiety and inappropriate investigation and/or intervention.

Cervical ectopic thymus: a case report and review of the literature

Ectopic cervical thymic tissue is rarely reported in medical literature, but it should be included in the differential diagnosis of neck masses, especially in children. The authors present the case of a young male with a soft right mid-cervical mass. The patient underwent complete excision of the lesion and histological examination showed an ectopic thymic cyst. The embryological development, clinical presentation and management of ectopic thymic lesions are discussed together with a review of the literature.

Sonographic findings in ectopic cervical thymus in an infant

We present the case of a 28-day-old boy with ectopic thymic tissue in the neck. Sonography showed a well-delineated, homogeneous lesion in the left submandibular region that was isoechoic relative to the mediastinal thymus. The lesion had angular margins and lacked a mass effect despite its large size (3 x 2 cm). On power Doppler imaging, arteries with an intermediate-impedance flow pattern were seen entering the lesion from the inferior and lateral margins. On both T1- and T2-weighted MR images, the lesion was isointense relative to the mediastinal thymus and had higher and lower signal intensity than muscle and fat, respectively. A sonographically guided needle biopsy confirmed the diagnosis of ectopic thymus.

Ectopic thymus presenting as a solid submandibular neck mass in an infant: case report and review of literature

Solid ectopic cervical thymus is an extremely uncommon etiology of a neck mass in an infant. It occurs in the line of descent of the thymus from the angle of the mandible to the superior mediastinum. Nine cases of ectopic cervical thymus in infants have been reported in the literature. Only two of nine cases were solid, the remaining seven were thymic cysts. A preoperative diagnosis is seldom considered and is often misdiagnosed as a possible malignancy or a lymph node. We present a case of a 2-month-old infant with an asymptomatic enlarging right neck mass. Patient underwent complete excision of the mass.