Thymic carcinoma which developed in a thymic cyst

Thymic squamous cell carcinoma lurking in a growing large cyst A case report

An 81-year-old man was admitted for resection of an asymptomatic left anterior mediastinal tumor. Chest computed tomography showed that a small, homogeneous lesion had grown to a large, cystic lesion (80 mm) over a 5-year period. The cystic tumor was removed with adherent structures such as the left upper pulmonary parenchyma and lower part of the left innominate vein via median sternotomy with assistance from a left thoracoscopic procedure. Macroscopically, a solid tumor was located within the large multilocular cyst. The pathological diagnosis was cystic squamous cell carcinoma (12 mm), which had not infiltrated any surrounding organs. The patient has remained well without recurrence as of 4 years postoperatively.

Thymic carcinoma developing in a multilocular thymic cyst

Thymic carcinoma developing in a pre-existing thymic cyst has rarely been reported in literature. The diagnosis of this entity in the past has always been established after surgery. We are reporting a case of thymic carcinoma that developed in a pre-existing multilocular thymic cyst in an elderly male. The diagnosis was based on imaging findings and confirmed on fine needle aspiration cytology (FNAC).

Cervical thymic cysts in adults

BACKGROUND

Three types of cervical thymic anomalies have been described: ectopia, thymic cyst, and thymoma. Thymic cysts are very rare causes of benign neck masses in adults and are usually not diagnosed before surgery. Their prevalence is less than 1% of all cervical masses, and they are usually noted in childhood. We systematically reviewed the literature concerning cervical thymic cysts (CTCs) in adults.

SUMMARY

We identified 36 adult patients with a CTC. Our analysis included age, gender, cyst size, location, type, symptoms, time from cyst appearance, treatment, pathology, and follow-up. The male/female ratio was 4/5, the mean age was 36 years. Most of the cysts were asymptomatic masses diagnosed by pathology. In only one case did the differential diagnosis include a thymic cyst. Surgery should be considered the treatment of choice, but the size and location of the lesion and its relationship to nearby vital structures should be defined as clearly as possible preoperatively. Excision can be made via a transverse cervical incision. It may be a demanding procedure because of the close anatomical relationship of the CTCs with the carotid sheath and major nerves of the neck (recurrent laryngeal nerve, glossopharyngeal nerve, hypoglossic nerve, and phrenic nerve), particularly if there is adherence of the CTC with those structures.

CONCLUSIONS

CTCs are uncommon lesions causing neck swelling and are often misdiagnosed preoperatively. Surgical excision and histological examination of the specimen usually makes the diagnosis. The existence of normal thymus gland in the mediastinum should be confirmed intraoperatively, but this is not critical in adult patients. A CTC should be included in the differential diagnosis of cervical cystic masses.

Calcified multilocular thymic cyst associated with thymoma: a case report

INTRODUCTION

There are few case reports of thymoma with a thymic cyst. Such an association renders it difficult for any pathologist to differentiate from other neoplasms, such as a cystic thymoma.

CASE PRESENTATION

A 50-year-old Berber woman from Morocco was admitted with a chronic cough of more than 10 years duration. Her medical history and physical examination were normal. Anterior chest radiography demonstrated a calcified opacity in her right anterior mediastinum. A chest-computed tomogram revealed a round cystic tumor, with significant calcification in her right anterior mediastinum. A surgical exploration was performed. The tumor seemed to be a well-encapsulated and totally calcified lesion, arising from the right lobe of her thymus. It was removed by partial resection of her thymus. Through histology, the calcified tumor exhibited some areas of multilocular fibrous-wall cysts. These cysts were partially lined by small cuboidal cells with severe chronic inflammation and an AB thymoma that arose from the wall of the cyst.

CONCLUSION

Greater attention should be given to multilocular thymic cysts, to exclude the possibility of neoplasm, especially when the cyst wall is thickened.

[Benign primary cystic lesions of mediastinum in adult: the clinical spectrum and surgical treatment]

BACKGROUND AND OBJECTIVE

The mediastinal cysts form a group of heterogeneous and uncommon benign lesions of neoplastic, congenital, or inflammatory conditions. The forgoing controversy is how to manage them; surgical removal or observation. We reviewed our experience including some rare conditions, emphasizing the clinical spectrum and surgical treatment. PATIENTES AND METHODS: This is a retrospective review between 2000 and 2007 included 34 cases of primary mediastinal cystic lesions. Clinical features, imaging techniques, surgical operation, morbidity, mortality and follow-up were analyzed.

RESULTS

There were 18 females (53%) and 16 males (47%), with a mean age+/-standard deviation of 45.3+/-14.1 years (range: 22-74). Most of cysts were congenital (94%), except patients with hydatid disease (6%). 24% of cysts (n=8) were detected in anterior mediastinum. Rest of them (n=26) were located in visceral mediastinum. Patients usually were symptomatic (61%). Chest pain and discomfort was most common symptom, others were dyspnea, cough and hemoptysis, respectively. Cysts excision was performed in all cases with an uneventful recovery and with no recurrence in long term follow up.

CONCLUSIONS

Asymptomatic mediastinal cysts are not rare. Surgery is a reliable method of treatment of mediastinal cysts with acceptable mortality and morbidity.

Congenital neck masses

Congenital neck lesions reflect abnormal embryogenesis in head and neck development. A thorough knowledge of embryology and anatomy is critical in the diagnosis and treatment of these lesions. The appropriate diagnosis of these lesions is necessary to provide appropriate treatment and long-term follow up, because some of these lesions may undergo malignant transformation or be harbingers of malignant disease.

Cervical thymic cysts

Thymic cysts are rare embryonic remnants along the course of thymic migration in the neck or the anterior mediastinum which may result in cervical masses in children, often misdiagnosed. We present the experience gained by three European tertiary care medical centers in the treatment of thymic cysts as well as the current data on the embryology, clinical presentation, diagnosis and management of thymic cysts. A retrospective study was carried out in nine patients with thymic cysts during the period 1986-2002 at the departments of Pediatric Surgery of Children's University Hospital "Federico II" and "Santobono" Pediatric Hospital of Naples in Italy and "Aghia Sophia" Children's Hospital of Athens in Greece. All cases were asymptomatic, appearing mainly as masses resembling branchial cyst or lymphatic malformation. Laboratory and imaging investigations were not useful for preoperative diagnosis. In one case the mass extended into the mediastinum. The histological findings of thymic tissue and Hassal's corpuscles in the cystic wall were diagnostic. In all cases, surgery was successful and uneventful. Surgical excision was accomplished by dissection of the cystic masses from the jugular vein, carotid artery and vagus nerve and from the sternocleidomastoid muscle. The presence of a normal thymus in the mediastinum must be documented preoperatively in order to avoid the risk of total thymectomy. If a cervical thymic cyst extends into the normal thymus, attempts should be made to preserve the thymus, especially in younger patients. Thymic cysts should always be included in the differential diagnosis of lateral cervical masses, especially in children.

Thymic cyst in the neck

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.

Papillary adenocarcinoma in a thymic cyst: a pitfall of thoracoscopic excision

Carcinoma arising in a thymic cyst is very rare. We performed thoracoscopic subtotal resection of an assumed benign cyst. The patient had a reoperation when the diagnosis of papillary adenocarcinoma was established. Complete resection and pleural thermochemotherapy were performed. The patient died 26 months later from systemic metastases. Caution must be exercised when managing nontypical thymic cysts.

Multilocular cervical thymic cyst: an unusual neck mass in children

Thymic cysts are usually considered uncommon lesions in the differential diagnosis of neck masses. Approximately 100 cases have been reported to date and most of these cases have occurred asymptomatically. Herein, the authors report a 4-year-old boy with cervical thymic cyst, which was misdiagnosed preoperatively as conglomerated lymph nodes. The correct diagnosis was made after surgical excision and through determination of specific histopathological findings of the thymic cyst. The etiologic theories, differential diagnosis and the treatment of thymic cysts are discussed.

Congenital thymic cysts in children--mostly misdiagnosed

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.