Diagnosis and Management of Cervical Thymic Cysts in Children

Cervical thymic cyst ? A Rare Neck Swelling in an Adolescent

Cystic neck masses in adolescents pose a diagnostic challenge as they be neoplastic or non-neoplastic, congenital, inflammatory, or infectious. Detailed history and examination, anatomical location of the lesion may help narrow down the differential diagnosis of such masses. Cervical thymic cysts contribute to less than 1% cystic lesions in the neck. We present one such case and our management strategy.

Special Computed Tomography Imaging Features of Thymic Cyst

OBJECTIVE

To explore the features and diagnostic value of computed tomography (CT) imaging in cases of thymic cysts.

METHODS

A total of 24 cases of the thymic cysts (confirmed by postoperative pathology) were retrospectively analyzed. The location, morphology, and density of the thymic cysts were summarized, and the changes in CT value of the region of interest (ROI) in the thymic cysts between noncontrast enhanced and enhanced chest scans were compared and classified.

RESULTS

The average long-axis dimension was 17.50 ± 6.00 mm, the CT value range across the 24 cases was 5-81 HU, and the average CT value of the noncontrast enhanced scans was 39.75 ± 20.66 HU. The CT value in the noncontrast enhanced scan was >20 HU in 79% of the sample cases. The CT value in the ROI of the thymic cysts under enhanced scan showed a significant decrease in 15 cases, a significant increase in 5 cases, and an insignificant change in 4 cases.

CONCLUSION

The CT values of the thymic cysts in the enhanced scans were generally lower than in the noncontrast enhanced scans, which might be a valuable finding for thymic cysts diagnosis.

Diagnostic Approach to Congenital Cystic Masses of the Neck from a Clinical and Pathological Perspective

BACKGROUND

neck cysts are frequently encountered in pediatric medicine and can present a diagnostic dilemma for clinicians and pathologists. Several clinical items enable to subclassify neck cyst as age at presentation, anatomical location, including compartments and fascia of the neck, and radiological presentation.

SUMMARY

this review will briefly describe the clinical, imaging, pathological and management features of (I) congenital and developmental pathologies, including thyroglossal duct cyst, branchial cleft cysts, dermoid cyst, thymic cyst, and ectopic thymus; (II) vascular malformations, including lymphangioma. Key Messages: pathologists should be familiar with the diagnostic features and clinicopathologic entities of these neck lesions in order to correctly diagnose them and to provide proper clinical management.

A Rare Case of a Cervical Thymic Cyst Presenting in Adulthood

The cervical thymic cyst (CTC) is a rare, benign neck mass that most commonly presents in the pediatric population. These entities can occur anywhere along the normal path of descent of the thymus from the mandible to the sternal notch, and extension into the mediastinum has been observed. The presentation of these masses is often characterized by a painless, enlarging neck mass in a child during the first decade of life. Although most patients are asymptomatic, abutment of the cyst against local structures has led to a variety of presentations including respiratory distress. These rare lesions are noted to have a male predominance and most commonly present on the left side of the neck. We present the rare case of a 19-year-old male who presented with a left-sided painless, cystic neck mass. He underwent a computed tomography scan of the neck which showed a large cystic mass in the left neck deep to the sternocleidomastoid muscle. Preoperatively, the diagnosis of an infected third branchial cyst was favored. The lesion was completely excised in the operating room. Final pathology was consistent with a CTC. The CTC is an uncommon benign process that often presents as an asymptomatic cystic neck mass. Knowledge of the clinical presentation, diagnostic process, and treatment of these rare lesions is essential for the Otolaryngologist.

Thymic lesions of the paediatric age group: a comprehensive review of non-neoplastic and neoplastic etiologies

Thymus is an important part of the immune system of the paediatric age group. Thymic lesions are rare causes of anterior mediastinal pathology. Their occurrence in children is rarer, nevertheless, knowledge about their pathologies help in clinching the correct diagnosis. All lesions both non-neoplastic as well as neoplastic are found in children, however, they differ from adults not only in the clinical presentation but also in the pathogenesis and natural history of the disease. Thymic hyperplasia may not actually be true if age is taken into consideration. Similarly, a type B thymoma may be mistakenly diagnosed as a lymphoblastic lymphoma especially on small biopsies. This review has been carried out after extensive search of literature using the Google and Pubmed search engines. An attempt has been made to comprehensively cover all aspects of thymic pathology of the paediatric age group having historical significance as well as the recent updates.

Lateral cervical thymic cyst in a child: a case report

BACKGROUND

Cervical thymic cysts are uncommon lesions, rarely considered in the differential diagnosis of neck cysts in children.

CASE PRESENTATION

We report a rare case of multiloculated thymic cyst in an 8-year-old boy on the right side of the neck. Perioperative diagnosis was a cystic hygroma. Macroscopic examination showed a cystic mass measuring 6.5 cm in total length. Histopathology of the excised specimen revealed thymic tissue with prominent Hassall's corpuscles associated with multiloculated cyst. The cyst wall is bordered by a flattened or multilayered epithelium, often abraded.

CONCLUSION

This case is presented here for its rarity and should be included in the differential diagnosis of neck masses in children. So, it's a lesion to be well aware of, particularly by pathologists.