Congenital cystic neck mass of thymic origin

Neck masses are frequently seen in children. The differential diagnosis includes infectious, congenital and neoplastic lesions. We report a case of rare thymic neck mass in a boy in his middle childhood presented with a history of a left anterolateral neck mass not associated with fever, dysphagia or shortness of breath. The radiographic evaluation showed a picture of a thymopharyngeal duct cyst. Thymic remnant and thymopharyngeal duct cyst are caused by the failure of obliteration and might appear as a lateral neck mass in children. The most effective treatment for a thymopharyngeal duct cyst is total surgical excision. This particular case highlights the importance for clinicians to have a high index of suspicion for a broad differential diagnosis when evaluating paediatric patients who present with neck mass. Additionally, we emphasise the importance of consistently considering thymopharyngeal cyst as differential diagnosis.

Foregut duplication cyst: a novel computed tomography finding mimicking a small bowel hernia: A case report

RATIONALE

A foregut duplication cyst (FDC) is an uncommon congenital disease. This report presents a case of mediastinal foregut duplication cyst that mimicked a diaphragmatic small bowel hernia.

PATIENT CONCERN

A 27-month-old girl was first referred for a mediastinal lesion found incidentally on a chest radiograph. At that time, our impression was cystic lung lesion such as congenital pulmonary airway malformation or pulmonary sequestration. At the age 6 years, she presented with recurrent vomiting. The physical examination and laboratory studies were within normal limits.

DIAGNOSES

Chest CT revealed a thin- and smooth-walled cystic mass containing an air-fluid level in the left paravertebral space. It had several inner circular folds and characteristic double-layer enhancement and inner circular fold. Our radiological impression was a type I congenital cystic adenomatoid malformation.

INTERVENTIONS

The patients undergone video-assisted thoracoscopic surgery for excision. The operative finding was the cystic mass with smooth bowel-like outer surface and located between the aorta and heart. The cyst was excised and confirmed to be a foregut duplication cyst pathologically.

OUTCOMES

The patient was doing well with no postoperative complications during follow-up. Recurrent vomiting was improved. This is the first case report describing foregut duplication cyst mimicking a small bowel hernia.

LESSONS

Foregut duplication cysts are rare congenital anomalies of primitive foregut origin. They can occur at any level of the alimentary track and comprise approximately 10% of all mediastinal tumors. Its characteristic double-layered histopathological nature, an FDC can show a double-layered enhancement pattern, which is typical in the alimentary tract.

The tale of spring water cysts: a historical outline of surgery for congenital pericardial diverticula and cysts

Congenital pericardial diverticula and cysts are extremely uncommon lesions within the anterior mediastinum. Both lesions derive from the pericardial celom and represent different stages of a common embryogenesis. Initial reports date from the 19th century. Surgical pioneers were Otto Pickhardt, who removed a pericardial cyst at Lenox Hill Hospital in New York in 1931, and Richard Sweet, who accomplished the first resection of a pericardial diverticulum at Massachusetts General Hospital in Boston in 1943. These lesions were also called spring water cysts because they usually contain watery, crystal-clear fluid. This history outlines the milestones of evolving surgical management, from the first report in 1837 up to the present time.

Large cervicothoracic thymic cyst causing prominent airway deviation in a 3-day-old neonate

Cervicothoracic mass in the pediatric population is uncommon and has a broad differential diagnosis. Frequently, masses in the cervical region present with airway compromise, particularly in younger patients. We present a case of an extremely large cervicothoracic mass causing airway obstruction in a 3-day-old, otherwise healthy male infant. Following awake intubation for airway protection, a 4.5 cm x 2.5 cm x 1.5 cm thymic cyst was removed. This case illustrates the wide differential diagnosis of cervicothoracic masses and shows the difficulty of preoperative diagnosis, especially in the case of thymic cysts with extension into the cervical space.

Congenital cystic lesions of the head and neck

This article presents clinical characteristics and radiologic features of congenital cervical cystic masses, among them thyroglossal duct cysts, cystic hygromas, branchial cleft cysts, and the some of the rare congenital cysts, such as thymic and cervical bronchogenic cysts. The imaging options and the value of each for particular masses, as well as present clinical and radiologic images for each, are discussed.

Congenital pericardial cyst in a naval special warfare candidate; clearance for diving after resection

INTRODUCTION

We report the case of a 19-year-old male military recruit who presented for a screening physical for U.S. Naval Special Warfare and Diving Duty. During his screening physical examination, an exophytic pericardial cyst was discovered. Subsequent work-up revealed normal cardiopulmonary function despite this large 7-cm mass, but the candidate was disqualified due to concerns regarding the risk of complications. He underwent successful elective surgical resection without post-operative complications. One year post-operatively, he repeated his cardiopulmonary work-up with normal results and successfully completed training.

METHODS

Literature search was conducted using PubMed/Medline. Keywords included pericardial/um, cyst, mediastinum, special operations, military, diving, thoracoscopy/ic resection. Results that included cases of pericardial cysts or other mediastinal tumors were included.

RESULTS

Review of the literature reveals that complications are rare and range widely in severity. Analysis of the physiology of diving, together with absence of reported cases, suggest that there is little to no, increased risk in recreational scuba diving for subjects with asymptomatic lesions. While no cases of morbidity or mortality have been reported in elite athletes, the severe and repetitive trauma experienced by Special Operators raises clinical concern for these lesions.

CONCLUSION

Because of the increased risk of morbidity and mortality in the Special Operations environment, clearance for duty should not be granted those individuals. However, in the general population, as well as with low-impact activities such as recreational scuba diving, periodic observation without resection seems reasonable.

Congenital neck masses in children and their embryologic and clinical features

Congenital neck masses in children and their embryologic and clinical features. Neck masses of congenital origin can be diagnostic and therapeutic challenges for internists, paediatricians and surgeons. Treatment modalities of congenital neck masses are different depending on their nature, symptoms and location. Differential diagnosis includes a variety of diseases that can cause cervical masses such as infectious and neoplastic neck tumours. Our objective is to review the embryologic and clinical features of some of the most common congenital neck masses such as the haemangioma, branchial cleft anomalies, thyroglossal duct cyst, ectopic thyroid, congenital midline cervical cleft, congenital cervical teratoma, lymphangioma, cervical thymic cyst, dermoid cyst and congenital muscular torticollis.

Mediastinal foregut duplication cyst presenting as a rare cause of breathing difficulties in an adult

Foregut duplication cysts are rare congenital anomalies of enteric origin. The diagnosis is usually made in infancy. We report the unusual case of a 71-year-old female presenting to the ENT department with shortness of breath and stridor due to an oesophageal reduplication cyst. The presentation, diagnosis and management of this potential pitfall for the unwary are outlined.

Cardiac compression by a thymic cyst

A patient with a giant thymic cyst, causing cardiac compression, is presented. Thymic cysts are uncommon and often asymptomatic.

Cervicomediastinal Thymic Cyst: Report of a Case

Congenital thymic cysts are rare. Consequently, they are often misdiagnosed and not included in the preoperative differential diagnosis of neck masses. We report the case of a 7-year-old boy with a large cervicomediastinal thymic cyst to increase the awareness of this unusual entity. We discuss the clinical features, presentation, and pathogenesis of thymic cysts.

Gross mural cartilage in a congenital bronchogenic cyst: MRI features

An infant who had a cardiac murmur after the delivery was evaluated with echocardiogram. A 1 cm cystic area was incidentally identified in the upper right mediastinum, that was not related with the heart. A 4 x 4.5 x 8 cm cystic mass in the superior mediastinum and lower neck was demonstrated on the magnetic resonance imaging (MRI). At surgery, a small solid structure corresponding to the nodule seen on MRI was identified, which was firm and cartilaginous in nature and attached to the wall of the cyst. Grossly visible cartilage in association with a bronchogenic cyst has not been previously reported. In conclusion, the bronchogenic cysts can have grossly visible cartilage in their wall and extend to extrathoracic spaces in a contiguous fashion, mimicking other entities such as teratomas and cystic lymphangiomas.

Video-assisted thoracoscopic surgery of mediastinal bronchogenic cysts in adults: A single-center experience

BACKGROUND

Mediastinal bronchogenic cysts are rarely diagnosed in adults, hence surgical experience is limited particularly with regard to video-assisted thoracoscopic surgery. In support of the thoracoscopic approach we report our single-center experience in this rare entity.

METHODS

Between June 1995 and December 2002, a nonselected series of 12 consecutive patients presenting with mediastinal bronchogenic cysts underwent video-assisted thoracoscopic surgery. Six cysts (50%) had been diagnosed 2 to 22 years prior, only three of which became symptomatic. In asymptomatic patients (n = 7) surgery was performed because of increasing cyst size (n = 3), patient's request (n = 3), or suspected metastasis (n = 1).

RESULTS

Mediastinal bronchogenic cysts were correctly diagnosed by computed tomography in 83% (10/12) and by magnetic resonance imaging in 100% (9/9). Using a three-trocar technique thoracoscopic surgery was successfully performed in 11 of 12 cases (92%). We noted no signs of acute cyst infection. No serious postoperative complications were observed. In 1 patient conversion to open thoracotomy was necessary due to extensive pleural adhesions. In another case thoracoscopic excision of the cyst wall was incomplete. Patients with thoracoscopic excision were discharged after a median of 5.5 days (range 4 to 14 days). No recurrences or complications were observed during a mean follow-up of 40.5 months.

CONCLUSIONS

Considering the low conversion and complication rate in our series, video-assisted thoracoscopic surgery should be the primary therapeutic choice among adults with symptomatic mediastinal bronchogenic cysts. Surgical intervention in patients with asymptomatic and uncomplicated cysts appears optional.

Posterior mediastinal gastoenteric cyst in neonate

Posterior mediastinal enteric cysts are infrequently reported. They are mostly asymptomatic 1. The incidence of gastroenteric cysts presenting during immediate neonatal period is rare. Alimentary tract duplications are other rare congenital anomalies and are commonly seen in relation to the ileum. However, the high incidence of associated thoracic or cervical vertebral anomalies with foregut cysts provide an early clue to the diagnosis 2. A detailed timely antenatal scan can increase the awareness regarding such rare condition and help in diagnosis and better outcome. The purpose of this case report is to highlight the clinical diagnosis and management of a neonate with posterior mediastinal gastroenteric cyst.

Mediastinal foregut duplication cysts

Foregut duplication cysts are rare congenital anomalies of enteric origin. In majority of the patients, the diagnosis is made in infancy. The authors report 4 cases of mediastinal foregut duplication cyst in children diagnosed on CT/MRI and confirmed on histopathology. In none of the cases the cysts had intraspinal extension nor heterotopic gastric mucosa.

Mediastinal bronchogenic cyst treated by mediastinoscopic drainage

Bronchogenic cysts are rare congenital anomalies located in the mediastinum and lung parenchyma. We present the clinical findings and describe the mediastinoscopic treatment of a bronchogenic cyst at the subcarinal space in a 50-year-old man. CT revealed a lesion at the subcarinal space with soft tissue density. Initially, mediastinoscopy was performed for diagnostic purposes. Histopathological evaluation of biopsy material taken from the cyst wall confirmed that the lesion was a bronchogenic cyst. The cyst contents were drained and a sclerosant agent was applied to the cyst lumen via the drainage tube. Mediastinoscopy not only provides diagnostic information but can also be used safely in the treatment of anterior bronchogenic cysts in patients not amenable to a second operation.

Clinical spectrum of mediastinal cysts

OBJECTIVES

Congenital cysts of the mediastinum are an uncommon but important diagnostic group, representing 12 to 30% of all mediastinal masses. The purpose of this study was to review our institutional experience with congenital cysts of the mediastinum, emphasizing the clinical spectrum of the disease.

DESIGN

Retrospective study.

OBJECTIVES

University hospital unit of general thoracic surgery.

METHODS

We retrospectively reviewed the records of 105 patients with cysts of the mediastinum (50 male and 55 female patients) who comprised 13.0% of mediastinal masses over the past 50 years.

RESULTS

There were 10 pediatric patients (< 15 years old) and 95 adult patients. The prevalence of cysts in the adult populations was higher than that in children (14.1% vs 7.7%, p < 0.05). There were 47 bronchogenic cysts, 30 thymic cysts, 12 pericardial cysts, 7 pleural cysts, 4 esophageal duplications, 2 meningoceles, 1 thoracic duct cyst, and 2 others. MRI has become a useful tool for providing supplemental data in combination with CT. Overall, 38 patients (36.2%) with mediastinal cysts were symptomatic, including 39.2% with bronchogenic/esophageal cysts, 40% with thymic cysts, and 15.8% with pericardial/pleural cysts. One hundred patients had complete resection of their masses, 3 patients with pericardial diverticulum received a thoracoscopic fenestration without mortality, and 2 patients refused surgery.

CONCLUSION

Early recognition of these relatively rare lesions would lead to immediate and appropriate surgical intervention. Early surgical intervention is also important because definitive histologic diagnosis can only be established by means of surgical extirpation.

Pericardial cystic mass with fetal tachycardia

A pericardial cystic mass is a rare congenital anomaly and may be mistaken for other pericardial and pleural masses. A 31-year-old pregnant woman at 38 weeks of gestation presented with fetal pericardial cyst and fetal tachycardia, which were confirmed by transthoracal echocardiography after delivery. Tachycardia did not persist after delivery. The case is being followed up without any clinical problems at the pediatric cardiology clinic.

The congenital duplication cyst: a rare differential diagnosis of retrosternal pain and dysphagia in a young patient

Congenital cysts are malformations developing from the endoderm and mesoderm of the digestive and respiratory system in the early weeks of gestation. Unilocular or multilocular dysontogenic cysts are most commonly thoracically located adjacent to the trachea and bronchus and the development of an oesophageal duplication cyst in the oesophageal wall is extremely rare. The duplication cyst in the adult is usually asymptomatic and an incidental diagnosis. Potential symptoms include dysphagia and retrosternal pain. Next to endoscopy and computer tomography, endoscopic ultrasonography is mandatory for a distinguished and accurate preoperative evaluation. Transthoracic excision is crucial for definitive diagnosis and inhibition of complications.

Pathological analysis of congenital cervical cysts in children: 20 years of experience at Chang Gung Memorial Hospital

BACKGROUND

Congenital cervical cysts are frequently encountered in pediatric populations, and constitute one of the most intriguing areas of pediatric pathology. This report analyzes cervical cysts in Taiwanese children diagnosed at Chang Gung Memorial Hospital (CGMH) over the past 20 years. The pathologic and clinical findings are reviewed.

METHODS

Files on 331 patients under the age of 18 years, with a diagnosis of congenital cervical cyst at CGMH from January 1, 1983 to June 30, 2002, were retrieved from the Department of Pathology. There were 204 boys and 127 girls. We reviewed the histology of all cases and correlated it with clinical information in the medical records.

RESULTS

Thyroglossal duct cysts, the most common congenital neck cyst, accounted for 54.68% of all cases, followed by cystic hygromas (25.08%), branchial cleft cysts (16.31%), bronchogenic cysts (0.91%), and thymic cysts (0.30%). Nine cases (2.72%) remained unclassified.

CONCLUSIONS

This is the largest series regarding pediatric cervical cysts in the literature to date. Thyroglossal duct cysts were the most common congenital cervical cyst encountered. Our experience indicates that each type of cyst has its unique location in the neck and is highly associated with its embryonic origin. Complete and precise clinical information is a prerequisite in order for pathologists to make accurate diagnoses of congenital cervical cysts.

Mediastinal enteric duplication cyst containing aberrant pancreas

OBJECTIVE

The purpose of the study is to report a unique association of clinical and pathological findings in a neonate. Foregut enteric duplication cysts--rare developmental anomalies that are associated with midline vertebral fusion anomalies.

METHODS

We had a neonate with foregut duplication cyst who presented at birth with respiratory distress. The child also had associated communicating hydrocephalus. The patient underwent excision of the duplication cyst along with a ventriculo-peritoneal shunt.

RESULT

The excised specimen revealed a duplication cyst lined by aberrant pancreatic tissue.

CONCLUSION

The present case demonstrates histologically the presence of both pancreatic and gastric tissue.

Concurrent cysts of the mediastinum, pleura and neck

A 14-year-old male was found to have a mediastinal mass on chest radiograph. Chest computed tomography scans showed a cystic lesion behind the left main bronchus. Magnetic resonance imaging revealed additional cystic lesions in the left chest and root of the neck. He underwent excision of mediastinal mass and a pleural cyst. The neck lesion was presumed to be a cystic hygroma. Histological examination of the two lesions resected showed them to be a foregut cyst and a benign mesothelial cyst. We know of no other report of concurrent multicystic lesions in the chest and neck and hypothesize that these cysts may have a common embryonic origin.

An unusual cervical swelling in a child

Congenital thymic cysts are rare benign lesions, frequently seen in the neck and mediastinum, but because of their infrequent occurrence and similarity to other more common cystic swellings, their preoperative diagnosis is not considered. Congenital thymic cysts although rare should be considered in the differential diagnosis of cervical and mediastinal cystic swellings in children. This is a case report of a multilocular cervical thymic cyst in a child.

Congenital cysts and fistulas of the neck

This retrospective study describes a series of 191 children treated for congenital cysts and fistulas of the neck between 1984 and 1999 in the pediatric ORL Department of La Timone Children's Hospital. Preauricular fistulas and cystic hygromas were not included. The anomalies in this series were classified as either malformations of the midline or malformations of laterocervical region. Malformations of the midline included the thyroglossal duct cysts (n=102) and dermoid cysts (n=21). The most common malformations of the laterocervical region were cysts and fistulas of the second cleft (n=37) followed by those of the first cleft (n=20),those of the fourth pouch (n=7), and thymic cysts (n=4). Diagnosis of malformations of the midline is usually straightforward. However, diagnosis of malformation of the laterocervical region can be problematic. Misdiagnosis often leads to inadequate treatment with recurrence and functional as well as cosmetic sequelae.

First-trimester prenatal diagnosis of a thoracic cystic lesion associated with fetal skin edema

An unusual case of chest cyst diagnosed at the end of the first trimester in a dizygotic twin pregnancy and managed conservatively is reported. Between 11 and 14 weeks of gestation, ultrasound revealed a relatively large echopoor lung cyst occupying the left side of the chest, displacing the mediastinum and the heart. This was associated with increased nuchal translucency thickness and generalized skin edema. Subsequent sonograms showed complete resolution of the cyst together with the skin edema. The fetuses were delivered at term and had an uncomplicated postnatal outcome. This case emphasizes the role of reduced venous return as a cause of early fetal hydrops. Diagnosis and follow-up of a congenital lung cyst from the end of the first trimester should enable early intervention to be made.

[The anesthetic management of a patient with a congenital mediastinal cyst undergoing video-assisted thoracoscopic surgery (VATS)]

We recently conducted video-assisted thoracoscopic surgery (VATS) on an 8-day-old boy in whom a congenital mediastinal cyst had caused obstruction of the left main bronchus. After the surgery, the cyst recurred and caused reobstruction of the airway. When he was 51-day-old, we conducted VATS again. We could not perform cystectomy by VATS because the left lung was inflated, and we conducted cystectomy by thoracotomy.

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.

Occipital encephalocele associated with mediastinal enteric duplication cyst

Enteric duplication is a rare developmental anomaly. This anomaly can be seen anywhere along the gastrointestinal tract, and less than 2% of the cases extend to the mediastinum. Developmental neuroectodermal and cutaneous ectodermal abnormalities, especially vertebral midline fusion abnormalities, are frequently associated with enteric duplications. We report a case of a newborn with occipital encephalocele, also having a mediastinal enteric duplication cyst. The clinical course of this case is described in detail to emphasize the occurrence of life-threatening complications of these associated developmental abnormalities during the treatment of the primary pathology in the neurosurgery practice. In the literature, we failed to demonstrate any co-existence of these two developmental abnormalities and review the embryogenesis of the association of these congenital malformations presented here.

Cervicomediastinal thymic cysts

Cervical thymic cysts are among the rarest congenital neck masses. They are probably more frequent than the number of cases reported as many of these lesions are asymptomatic and only discovered incidentally. The initial embryologic development of the thymus begins in the neck, followed by migration into the superior mediastinum. For this reason, extension of cervical thymic anomalies into the mediastinum is possible. Although it is the least common lateral cystic neck mass, it must be differentiated from other pediatric cystic neck masses, the majority of which are anomalies of the branchial system. Due to the possibility of mediastinal extension, the management of these lesions is different than other congenital neck masses. We report two cases of thymic anomalies with mediastinal extension and review the embryology, diagnosis, and management of cervicomediastinal thymic cysts.

Giant pericardial cysts

Pericardial cysts are most commonly incidental radiologic findings of little clinical consequence. We present the unusual history of 2 patients in whom pericardial cysts were of massive sizes and caused significant symptoms; in 1, progression of the cyst size had been documented over 25 years. Diagnostic difficulties encountered and the utility of video-assisted thoracoscopy are described.

A case of a mediastinal neurenteric cyst demonstrated by prenatal ultrasound

We report the case of a posterior large mediastinal neurenteric cyst demonstrated by prenatal ultrasound (US). Postnatal chest radiography and CT studies demonstrated a posterior, large cystic mediastinal mass associated with vertebral abnormalities including scoliosis, hemivertebrae and anterior spina bifida. Because postnatally respiratory distress developed and rapidly progressed, an emergency operation was performed 12 hours after delivery. The cyst was excised via right posterolateral thoracotomy. Postoperatively, respiratory distress regressed. This is the third reported case of a neurenteric cyst demonstrated by prenatal ultrasound.

Congenital intraluminal tracheal cyst causing an obstructed left lung in a newborn

Intraluminal tracheal or bronchial cysts are rare. We present a congenital cyst of the distal trachea which caused obstruction of the left main-stem bronchus. The chest radiograph obtained at birth showed an expanded, irregularly opaque left lung. Within several hours, the opacity cleared and the lung became markedly hyperexpanded. The cyst ruptured spontaneously with resolution of the symptoms.

Cervical thymic cysts: CT appearance of two cases including a persistent thymopharyngeal duct cyst

The differential diagnosis of cervical cysts in children includes common entities such as branchial cleft cysts, thyroglossal duct cysts, and cystic hygromas. Congenital thymic cysts are uncommon and often misdiagnosed as either branchial cleft cysts or cystic hygromas. However, they may have an appearance on CT that can be characteristic. The course of the descent of embryologic thymic tissue in the neck to the mediastinum indicates the potential site of deposition of an ectopic cervical thymic cyst. In a child, a cystic lesion that has an intimate relationship to the carotid sheath is likely to be a thymic cyst. Of the approximately 100 cases of vestigial cervical thymus or thymic cysts that have been reported in children, only 5 cases of a persistent thymopharyngeal duct cyst have been described [1-5]. In two of these five, the persistent thymopharyngeal duct cyst was demonstrated by CT [1,2]. We report one additional case of a cervical thymic cyst and one case of a persistent thymopharyngeal duct cyst both depicted by CT.

[Surgical treatment and diagnosis of adult bronchogenic cysts]

Between 1974 and 1993, 22 adults with bronchogenic cysts were operated in our hospital: 14 men and 8 women, ranging from 11 to 62 years old. The location was mediastinal in 13 (59.1%) and intrapulmonary in 9 (40.9%). Cysts were symptomatic (chest pain and recurrent bronchiolitis) in 20 patients (91%). The perioperative complications include infection in lungs and in the cysts and dysphagia due to esophageal compression. Chest pain was the main symptom in mediastinal cyst and recurrent infection of lungs in intrapulmonary cysts. Plain chest radiographs showed round shadows. Occasional air-fluid levels, peripheral calcification may be found. Operation is the best method for treating cysts. All cysts were completely excised. No perioperative, late complication or recurrence developed in our patients. Operation was recommended in most instances to confirm the diagnosis, to relieve symptoms, and to prevent complications.

Thymic carcinoma with glandular differentiation arising in a congenital thymic cyst

A case of thymic carcinoma with glandular differentiation arising in congenital thymic cyst in a 50-year-old male is reported. Neoplasia in congenital thymic cyst is a rare phenomenon and is seldom associated with glandular differentiation. It is important to differentiate these neoplasms from carcinomas of the lower respiratory tract and from thymic carcinomas with secondary cystic degeneration, in view of their relatively good prognosis and the therapeutic implications.

Endoscopic unroofing of a bronchogenic cyst

Flexible fiberoptic bronchoscopy (FFB) has become common practice for pediatric pulmonologists, allowing easier detection of certain abnormalities at an earlier stage. We report the endoscopic diagnosis of a large mediastinal bronchogenic cyst and its successful endoscopic unroofing in a symptomatic baby.

[Pleuro-pericardial cysts, treatment by video-assisted surgery]

Three cases of symptomatic pleuro-pericardic cysts were treated with video-assisted surgery. Complete exercises of the cysts was possible in all cases. The follow-up was uneventful and hospitalization was 4 to 5 days. Pleuro-pericardic cysts represent 5 to 10% of the mediastinal tumours. Clinical latency and a constantly benign course are characteristic features. In most cases, tomodensitometry confirms the diagnosis. The diagnosis may be uncertain only in symptomatic forms (atypical localization, high density on tomodensitometry). In these cases, video-assisted surgery is an interesting alternative to transparietal punction-evacuation or to exeresis via thoracotomy.

[Eight cases of thymic cyst]

Eight cases of thymic cyst were treated in our hospital from Jan. 1967 to Oct. 1989, which were 5.6% of all mediastinal tumors and 35% of congenital cysts. All cases were discovered incidentally by routine chest roentgenograms. All but one had no respiratory symptoms. There were no associated autoimmunological disorders such as myasthenia gravis. These tumors showed water density in computed tomography, low intensity area in T1 and high intensity area in T2 weighted magnetic resonance image. Garium scans were negative in all cases. Operations were performed in all cases for their diagnosis and treatment. All of our cases had no signs of malignancy on pathological examinations, and they are free of recurrence during subsequent follow ups. Study of intracystic fluid revealed high titer of CA19-9 and CEA in spite of normal titer in serum, which might be useful clue to preoperative diagnosis. For the poor risk patients with thymic cyst, percutaneous aspiration might be diagnostic and therapeutic when there is no sign of malignancy.

[Bronchogenic cysts of the mediastinum]

The case of a bronchial cyst found on the mediastinal carina whose early symptoms resulted from compression of the airways is reported. The clinical, pathogenic and diagnostic aspects of these often congenital cystic malformations of the mediastinum are discussed.

Pseudopericardial cyst in a neonate--a case report and review of the literature

Report on a pericardial cyst called a pseudopericardial cyst. In a female newborn with cyanosis a mediastinal tumour was noticed on a thorax x-ray, interpreted at first as an enteral duplication. Surgery revealed a pericardial cyst. This was confirmed by histological examination.