Based on imaging a possibility of ectopic thymic cyst was considered, which was confirmed on histopathology. It showed well-defined, anechoic cyst on ultrasonography and … The three entities, which have been described, are thymic cyst, ectopic cervical thymus and cervical thy-moma. Cyst In cystic lesions the diagnosis can frequently be made based on the location of the lesion (see next figure). The absolute number remains unknown. Cervical thymic cysts are unusual lesions usually presenting in the 1st decade of life. In the literature to date, cross-sectional imaging of cervical thymic cysts has been limited to CT. Burton EM, Mercado-Deane MG, Howell CG, et al. Congenital thymic cysts are uncommon and often misdiagnosed as either branchial cleft cysts or cystic hygromas. We report here a rare case of a patient with CTC in Diagnosis. During embryogenesis thymus gland is the Routine diagnostic evaluation for a neck mass first lymphoid organ to develop and ectopic includes a thorough history, physical examina- cervical thymic cysts are believed to represent tion, ultrasound of the neck and chest X-ray. In conclusion, ectopic cervical thymus is a rare cause of pediatric neck mass. 2017 Jan 11;9(1):e973. The treatment of thymic cyst is surgical because of the general need for histologic confirmation when dealing with mediastinal masses. Diagnostic approach. We present the case of a 10-year-old boy with the sudden onset of a large, painless left neck mass. Background The thymus develops from the third pharyngeal pouch and descends from the neck into the anterior-superior mediastinum. Computed tomography scan can both narrow the preoperative differential diagnosis and aid in surgical planning for thymic cyst excision. Imaging of the Chronically Injured Cervical Spinal Cord Thirteen patients with prior cervical spinal cord injury resulting in quadriplegia were evaluated with magnetic resonance imaging (MRI) long after their initial injury, either because of the relatively recent onset of new and worsening neurologic symptoms or Cervical thymic cysts (CTCs) are unusual lesions usually presenting in the s t decade of life and representing only % of cystic cervical masses [ ]. Benign thymic cysts are uncommon lesions that account for approximately 3% of all anterior mediastinal masses [].Such cysts can be either congenital [2, 3] or acquired in origin [].Congenital cysts are typically unilocular, contain clear fluid, have walls that are thin to the point of translucency, and show no evidence of inflammation on careful histopathologic examination [2, 3]. Cureus. Pediatric Lesions. Wang X, Chen K, Li X, et al. A large proportion of patients with thymic cysts (i.e. link. unusual lesions, representing only 1% of cystic cervical masses. Cervical thymic cysts are uncommon lesions found more on the left side of the neck with a slight male preponderance . 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. Imaging of cystic masses of the mediastinum. Cervical thymic cysts arise from remnants of the thymopharyngeal duct that failed to involute. A midline neck mass in a child might come to attention as either a symptomatic abnormality or an additional finding identified at radiologic imaging performed for other reasons. In a neck lesion in a child, ultrasound can usually determine whether a lesion is cystic or solid. Thymic rebound must be differentiated from recurrent tumor in anterior mediastinal mass patients (leukemia / lymphoma) who have finished their chemotherapy Fat and calcium in a thymus mass usually indicates teratoma , fluid in a thymus mass usually indicates thymic cyst or lymphatic malformation , a solid homogenous thymus mass is usually a thymoma Often more than one lymph node is enlarged. We present a rare case of cervical thymic cyst in the lower left - anterior of the neck in a 50-year-old woman. 4. Approximately 50% of congenital thymic cysts are incidentally discovered during the first 2 decades of life. The prevalence of these lesions varies from common (thyroglossal duct cysts, branchial cleft cysts, and cystic hygromas) to very rare (thymic and cervical bronchogenic cysts). 18 The cysts arise from the third and fourth branchial clefts,and, therefore, thymic cysts may have a similar appearance to third and fourth branchial cleft cysts, being differentiated only by the presence of thymic tissue within thymic cysts. Occasionally it has been necessary for the surgeon to extend the incision into the neck to remove the cervical component of a mediastinal thymic cyst. Cervical thymic cyst: a rare differential diagnosis in lateral neck swelling, Case Rep Otolaryngol. Case report: Cervical thymic cyst. Radiographics 2002;22:S79-93. We report the case … However, magnetic resonance imaging confirmed the diagnosis of a cervicothoracic thymic cyst with fluid shifts within the cervical and thoracic components. Diagnosis and Management of Cervical Thymic Cysts in Children, Cureus. The diagnosis is easily established from the presence of a cystic lesion in the anterior midline portion of the neck. Thymopharyngeal cysts also … Pediatr Radiol 1995;25:363-5. Further imaging by computed tomography was also inconclusive. Both cause posterior cervical space cysts that may appear identical. The differential diagnosis of a midline neck mass in a child or young adult includes inflammatory adenopathy, a Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Cervical Thymic Cyst. Cystic Neck Mass (Ultrasound) Low-Density Neck Lesion (CT) (Head and Neck) Tracheoesophageal Groove Lesion (Head and Neck) Transspatial Mass (Pediatrics) Transspatial Mass in Child (Head and Neck) Sturm JJ et al: Diagnosis and management of cervical thymic cysts in children. Overall, these lesions occur much more commonly in the mediastinum than in the neck (25:1 ratio). However, they may have an appearance on CT that can be characteristic. masses, cervical thymic anomalies must be considered as a differential diagnosis for chil-dren presenting with neck masses. Imaging revealed a multilocular cystic lesion lying in close proximity to carotid vessels. Diagnostic Imaging Head and Neck 2E 2. Most patients with thymic cysts complain of a slowly enlarging asymptomatic cervical mass with few reported cases in adults [ ]. This entity should be included in the differential diagnosis of cystic neck masses in the pediatric age group. Ectopic cervical cyst is an infrequent cause of neck cyst in a child which is rarely diagnosed preoperatively. Cervical thymic cysts are morphologically identical to their mediastinal counterparts. matic cervical mass in a child incidentally found along the path of thymic descent with US and MR imaging fea-tures of ECT, is that there is no need for biopsy or surgi-cal removal [11]. If symptoms are present, the most common have to reported to be Bookmarks (0) Head and Neck. Acquired cysts may present much later. Cervical thymic cysts: CT appearance of two cases including a persistent thymopharyngeal duct cyst. Cervical thymic anomalies are a rare but necessary part of the differential diagnosis of a cervical mass. Cystic masses of neck: A pictorial review, Indian J Radiol Imaging. around 60%) are considered to be asymptomatic. There have been no reports of recurrence. On magnetic resonance imaging, cervical thymic cysts are hyperintense on T1-weighted images. a lymphatic organ that plays a vital role in the development and maturation of the immune system during childhood, specifically T cells, Clinically, in most cases, cervical thymic lesions present as a unilateral asymptomatic neck mass, commonly on the left side of the neck, and 75% of patients present before 20 years of age. Conclusion. Thymic cyst should be included as differential diagnosis of cystic neck masses. reported cervical thymic cysts to be 0.3% of all congenital cervical cysts in children [ 2 ]. Approximately 90 cases have been described, and just a few have been published in Spanish literature. 77 Nearly half of all cervical thymic cysts are continuous with the mediastinal thymus, either via mediastinal extension of the cyst or by a vestigial remnant of thymic tissue or a solid cord. Thymic cysts are unusual causes of cystic cervical masses. However, they should be included as differential diagnosis of cystic neck masses. Imaging, surgical findings, and histopathological correlation play an important role in diagnosing thymic cysts. Heise and al. One type of cystic thymic remnant is the thymopharyngeal duct cyst, a remnant of one of the paired tracts of embryological thymic descent. Cervical thymic cyst after the third decade is so rare that it is very difficult to diagnose in spite of its typical location. Two varieties of thymic cysts have been described, thymopharyngeal duct cysts and cysts arising from degeneration of Hassall’s corpuscles within ectopic thymic remnants. Thymic cysts have a disputed etiology, but most favor the theory that these lesions arise from persistence of the thymopharyngeal duct, 17 adjacent to the carotid sheath from the angle of the mandible to the thoracic inlet. Cervical thymic cysts are a rare form of cervical mass, which are easily overlooked in the differential diagnosis of children presenting with painless … The most common congenital neck mass is the thyroglossal duct cyst. Thymic cysts are considered uncom-mon lesions in the differential diagnosis of pe-diatric neck masses. Cervical locations may suggest a diagnosis of thyroglossal duct cyst, lymphatic vascular malformation, dermoid cyst, branchial cleft cyst, or cervical thymic cyst. The differential diagnosis for a low-attenuation mass in the lower neck includes an enlarged Virchow node, thyroid mass, parathyroid mass, paratracheal lymphadenopathy, thymic cyst, and enlarged distal thoracic duct. Clinical and radiologic criteria rarely allow a definitive preoperative diagnosis. 2012 Oct;22(4):334-43. An unusual case of cervical thymic cysts in a 4‐year‐old boy is presented. Congenital Lesions. Cervical thymic cysts are a rare form of cervical mass in children presenting with painless neck masses. Pathologic findings are usually necessary to differentiate these cysts from other cervical cysts. Ultrasound and MRI, with the imaging findings of the mass along the thymopharyngeal 3. ; Lymph node If the lesion is solid the next step is to assess whether it is a lymph node or something else. The imaging options and the value of each for particular masses, as well as present clinical and radiologic images for each, are discussed. Cervical ectopic thymus, thus, will have a close relationship to the carotid sheath, extending anterolaterally to it. Mediastinal thymic cysts can occur without a cervical component. Cervical thymus cyst is a rare cause of neck mass in children.. 1. Ballal, H. S., Ajit, M., Vinod, H., Rajesh, S., Mohan, B., & Surendra, N. (1999). Congenital cervical cystic masses comprise an uncommon group of lesions that is usually encountered during infancy and childhood. Clinically, in most cases, cervical thymic lesions present as a unilateral asymptomatic neck mass, commonly on the left side of the neck, and 75% of patients present before 20 years of age. Conclusion. Thymic cyst should be included as differential diagnosis of cystic neck masses. Greater awareness among the pathologists may decrease misdiagnosis. FNA of cyst fluid will not differentiate these entities. An elongated cervical thymic cyst that extends along the entire embryologic pathway is called a persistent thymopharyngeal duct cyst; this subset of thymic cysts represents 7 % of fetal cervical thymic remnants [3]. 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. Due to its rarity, it is not generally considered … They usually appear in early children and are diagnosed as brachial cyst. The embryology, histopathology, and clinical presentation is discussed. 9 (1):e973, 2017. Imaging modalities are used to locate the lesion and, when typical, can suggest the diagnosis [2]. If visible thymic cysts often indistinguishable from other non-lobulated thymic/anterior mediastinal lesions on radiographs. Typically manifests as unilocular or multilocular cystic masses with well-defined walls. Most thymic cysts of the neck occur in the first decade of life. The diagnosis of cervical thymic cysts is rarely made preoperatively. Thus, it is possible to have thymic remnants in the neck, which most often present as a cervical mass during childhood. There is a frequent association between cervical thymic cysts and thyroid and parathyroid inclusion cysts, and a fibrous strand is sometimes present between the cervical thymic cyst and the thyroid gland. They are found in the anterior triangle of the neck along the normal path of descent of the thymus. The cervical thymic cyst is an uncommon and poorly known malformation of embryological origin [ 1 ]. Jeung MY, Gasser B, Gangi A, et al. A cervicomediastinal cyst can be labelled as a thymic cyst preoperatively with multimodality radiological imaging in correlation with fine-needle aspiration cytology and immunocytochemistry, excluding a neoplasm with a very high level of confidence. They manifest usually during the first decade of life, as a slow growing painless mass in the region between the angles of the mandible to sternum, in the vicinity of the carotid sheath, located along the path of descent of embryonic tissue [ 1 ]. Findings on magnetic resonance imaging (MRI) and fine needle aspiration (FNA) biopsy suggest a cystic lesion, most likely of thymic origin. Cervical congenital cystic masses constitute an uncommon group of lesions usually diagnosed in infancy and childhood.
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