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Cervical thymic cyst

April 12, 2024

A cervical thymic cyst, also called thymopharyngeal duct cyst, is a fluid-filled mass that occurs when the thymopharyngeal duct, an embryonic structure connecting the nascent thymus with the embryonic pharynx, fails to close and disappear.[1] A thymic cyst is typically a solitary mass on one side of the neck, and is usually found near the carotid sheath.[2] Some cervical thymic cysts may extend into the mediastinum. It is usually asymptomatic.[3] The diagnostic process includes differentiating between other causes of neck masses in infants and children, including branchial cleft cysts and cystic hygromas. The treatment is surgical excision. On histologic examination, the wall of the cyst includes thymic tissue, and may include parathyroid gland tissue because of the parathyroid gland's common embryonic origin with the thymus gland in the third pharyngeal pouch. Fewer than 100 cases of cervical thymic cysts have been reported in the medical literature.[2]

Pathogenesis edit

Thymus is a lymphoid organ that develops from the 3rd and 4th pharyngeal pouches.[1][4]

While the pathogenesis of cervical thymus cyst is still unclear, there are two main mechanisms by which this lesion occurs:

  1. Congenital: During the fetal development, the thymus forms from the third branchial pouch which descends lateral to the mediastinum toward the thyroid gland. A remnant of this thymic tissue can persist during its descent through the thymopharyngeal duct, and later on become the cause of the lesion. This mechanism has been better supported by the authorities.
  2. Acquired: The thymic tissue, mainly the Hassall corpuscles and epithelium reticulum, progressively degenerates and ascends upward to cause the lesion.[4][5][6]

Clinical Features edit

Cervical thymic cyst is a very rare pathology that is often incidentally found due to its asymptomatic nature. The patient usually notices a neck mass that grows slowly which triggers them to see a clinician and be admitted to the hospital.[3] However, it can cause symptoms as it grows in size and compresses on other organs. These symptoms include difficulty breathing, difficulty swallowing, hoarseness of voice, among others.[3][6][7] It causes neck swelling.[3] Males are more commonly affected.[6] Most cases occur in the first decade of life, as the thymus tends to atrophy after puberty.[3] This lesion usually affects the left side of the neck.[6]

The cyst can be small as 1cm and as large as 26cm. The location can vary as well, from the angle of the mandible to as low as the mediastinum.[6]

Diagnosis edit

Differential diagnosis edit

Differential diagnosis include other more common cervical masses, such as branchial cyst, cystic hygroma, dermoid-epidermoid cyst.[6]

This lesion is usually not diagnosed before surgery. Pathology must be obtained for an accurate diagnosis.[3]

Imaging edit

Ultrasound is used as the first imaging modality, and often shows hypo-echoic, sometimes septated cyst that runs along the sternocleidomastoid muscle.

Other imaging techniques such as CT and MRI can also be used. These are more useful for determining the cyst's relationship to the surrounding structures and planning for the surgery.[3]

The cyst may be uni- or multi-loculated.[6]

Pathology edit

The wall of the cyst can have multiple array of pathology. It may have single layered squamous cell to multiple layers of stratified cells. Sometimes the sample includes thyroid or parathyroid tissue. This is thought to be due to the common embryologic origin of thymus and thyroid and parathyroid cells.[3]

The cyst itself contains brown colored fluid.[6]

Treatment edit

Surgery is often the treatment of choice for a complete resection through VATS (Video-assisted thoracoscopic surgery). Because there are important structures surrounding the cyst, such as the carotid sheath, recurrent laryngeal nerve, glossopharyngeal nerve, hypoglossal nerve, and phrenic nerve, the location of the cyst should be carefully established before the operation.[3]

While local resection is usually adequate, thymectomy may be required if there's a suspicion for thymoma or when the cyst is multilocular.[7]

[8]

The prognosis for this type of cyst is considered good.[4] Recurrence is very rare in the post-operative period.[6]

References edit

  1. ^ a b Kaufman, Matthew R.; Smith, Shane; Rothschild, Michael A.; Som, Peter (2001-11-01). "Thymopharyngeal Duct Cyst: An Unusual Variant of Cervical Thymic Anomalies". Archives of Otolaryngology–Head & Neck Surgery. 127 (11): 1357–1360. doi:10.1001/archotol.127.11.1357. ISSN 0886-4470. PMID 11701074.
  2. ^ a b Operative Pediatric Surgery. Ziegler, Moritz M., Azizkhan, Richard G., Von Allmen, Daniel, Weber, Thomas R. (2nd ed.). New York. 18 March 2014. ISBN 9780071627238. OCLC 891571895.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  3. ^ a b c d e f g h i Michalopoulos, Nikolaos; Papavramidis, Theodossis S.; Karayannopoulou, Georgia; Cheva, Angeliki; Pliakos, Ioannis; Triantafilopoulou, Konstantina; Papavramidis, Spiros T. (September 2011). "Cervical Thymic Cysts in Adults". Thyroid. 21 (9): 987–992. doi:10.1089/thy.2010.0142. ISSN 1050-7256. PMID 21595559.
  4. ^ a b c Cigliano, Bruno; Baltogiannis, Nikolaos; De Marco, Marianna; Faviou, Elsa; Antoniou, Dimitrios; De Luca, Ugo; Soutis, Michail; Settimi, Alesandro (2007-10-16). "Cervical thymic cysts". Pediatric Surgery International. 23 (12): 1219–1225. doi:10.1007/s00383-006-1822-5. ISSN 0179-0358. PMID 17938938. S2CID 32159666.
  5. ^ Strollo, Diane C.; Rosado-de-Christenson, Melissa L. (2012), "Disorders of the Mediastinum", Clinical Respiratory Medicine, Elsevier, pp. 846–861, doi:10.1016/b978-1-4557-0792-8.00071-4, ISBN 9781455707928, retrieved 2022-01-10
  6. ^ a b c d e f g h i Shenoy, Vijendra; Kamath, M. Panduranga; Hegde, Mahesh Chandra; Rao Aroor, Raghavendra; Maller, Vijetha V. (2013-02-07). "Cervical Thymic Cyst: A Rare Differential Diagnosis in Lateral Neck Swelling". Case Reports in Otolaryngology. 2013: e350502. doi:10.1155/2013/350502. ISSN 2090-6765. PMC 3580929. PMID 23476854.
  7. ^ a b Wang, Xun; Chen, Kezhong; Li, Xiao; Li, Yun; Yang, Fan; Li, Jianfeng; Jiang, Guanchao; Liu, Jun; Wang, Jun (December 2017). "Clinical features, diagnosis and thoracoscopic surgical treatment of thymic cysts". Journal of Thoracic Disease. 9 (12): 5203–5211. doi:10.21037/jtd.2017.10.148. ISSN 2072-1439. PMC 5756969. PMID 29312727.
  8. ^ Sturm, Joshua J; Dedhia, Kavita; Chi, David H (2017-01-11). "Diagnosis and Management of Cervical Thymic Cysts in Children". Cureus. 9 (1): e973. doi:10.7759/cureus.973. ISSN 2168-8184. PMC 5298914. PMID 28191377.

April 12, 2024
cervical, thymic, cyst, cervical, thymic, cyst, also, called, thymopharyngeal, duct, cyst, fluid, filled, mass, that, occurs, when, thymopharyngeal, duct, embryonic, structure, connecting, nascent, thymus, with, embryonic, pharynx, fails, close, disappear, thy. A cervical thymic cyst also called thymopharyngeal duct cyst is a fluid filled mass that occurs when the thymopharyngeal duct an embryonic structure connecting the nascent thymus with the embryonic pharynx fails to close and disappear 1 A thymic cyst is typically a solitary mass on one side of the neck and is usually found near the carotid sheath 2 Some cervical thymic cysts may extend into the mediastinum It is usually asymptomatic 3 The diagnostic process includes differentiating between other causes of neck masses in infants and children including branchial cleft cysts and cystic hygromas The treatment is surgical excision On histologic examination the wall of the cyst includes thymic tissue and may include parathyroid gland tissue because of the parathyroid gland s common embryonic origin with the thymus gland in the third pharyngeal pouch Fewer than 100 cases of cervical thymic cysts have been reported in the medical literature 2 Contents 1 Pathogenesis 2 Clinical Features 3 Diagnosis 3 1 Differential diagnosis 3 2 Imaging 4 Pathology 5 Treatment 6 ReferencesPathogenesis editThymus is a lymphoid organ that develops from the 3rd and 4th pharyngeal pouches 1 4 While the pathogenesis of cervical thymus cyst is still unclear there are two main mechanisms by which this lesion occurs Congenital During the fetal development the thymus forms from the third branchial pouch which descends lateral to the mediastinum toward the thyroid gland A remnant of this thymic tissue can persist during its descent through the thymopharyngeal duct and later on become the cause of the lesion This mechanism has been better supported by the authorities Acquired The thymic tissue mainly the Hassall corpuscles and epithelium reticulum progressively degenerates and ascends upward to cause the lesion 4 5 6 Clinical Features editCervical thymic cyst is a very rare pathology that is often incidentally found due to its asymptomatic nature The patient usually notices a neck mass that grows slowly which triggers them to see a clinician and be admitted to the hospital 3 However it can cause symptoms as it grows in size and compresses on other organs These symptoms include difficulty breathing difficulty swallowing hoarseness of voice among others 3 6 7 It causes neck swelling 3 Males are more commonly affected 6 Most cases occur in the first decade of life as the thymus tends to atrophy after puberty 3 This lesion usually affects the left side of the neck 6 The cyst can be small as 1cm and as large as 26cm The location can vary as well from the angle of the mandible to as low as the mediastinum 6 Diagnosis editDifferential diagnosis edit Differential diagnosis include other more common cervical masses such as branchial cyst cystic hygroma dermoid epidermoid cyst 6 This lesion is usually not diagnosed before surgery Pathology must be obtained for an accurate diagnosis 3 Imaging edit Ultrasound is used as the first imaging modality and often shows hypo echoic sometimes septated cyst that runs along the sternocleidomastoid muscle Other imaging techniques such as CT and MRI can also be used These are more useful for determining the cyst s relationship to the surrounding structures and planning for the surgery 3 The cyst may be uni or multi loculated 6 Pathology editThe wall of the cyst can have multiple array of pathology It may have single layered squamous cell to multiple layers of stratified cells Sometimes the sample includes thyroid or parathyroid tissue This is thought to be due to the common embryologic origin of thymus and thyroid and parathyroid cells 3 The cyst itself contains brown colored fluid 6 Treatment editSurgery is often the treatment of choice for a complete resection through VATS Video assisted thoracoscopic surgery Because there are important structures surrounding the cyst such as the carotid sheath recurrent laryngeal nerve glossopharyngeal nerve hypoglossal nerve and phrenic nerve the location of the cyst should be carefully established before the operation 3 While local resection is usually adequate thymectomy may be required if there s a suspicion for thymoma or when the cyst is multilocular 7 8 The prognosis for this type of cyst is considered good 4 Recurrence is very rare in the post operative period 6 References edit a b Kaufman Matthew R Smith Shane Rothschild Michael A Som Peter 2001 11 01 Thymopharyngeal Duct Cyst An Unusual Variant of Cervical Thymic Anomalies Archives of Otolaryngology Head amp Neck Surgery 127 11 1357 1360 doi 10 1001 archotol 127 11 1357 ISSN 0886 4470 PMID 11701074 a b Operative Pediatric Surgery Ziegler Moritz M Azizkhan Richard G Von Allmen Daniel Weber Thomas R 2nd ed New York 18 March 2014 ISBN 9780071627238 OCLC 891571895 a href Template Cite book html title Template Cite book cite book a CS1 maint location missing publisher link CS1 maint others link a b c d e f g h i Michalopoulos Nikolaos Papavramidis Theodossis S Karayannopoulou Georgia Cheva Angeliki Pliakos Ioannis Triantafilopoulou Konstantina Papavramidis Spiros T September 2011 Cervical Thymic Cysts in Adults Thyroid 21 9 987 992 doi 10 1089 thy 2010 0142 ISSN 1050 7256 PMID 21595559 a b c Cigliano Bruno Baltogiannis Nikolaos De Marco Marianna Faviou Elsa Antoniou Dimitrios De Luca Ugo Soutis Michail Settimi Alesandro 2007 10 16 Cervical thymic cysts Pediatric Surgery International 23 12 1219 1225 doi 10 1007 s00383 006 1822 5 ISSN 0179 0358 PMID 17938938 S2CID 32159666 Strollo Diane C Rosado de Christenson Melissa L 2012 Disorders of the Mediastinum Clinical Respiratory Medicine Elsevier pp 846 861 doi 10 1016 b978 1 4557 0792 8 00071 4 ISBN 9781455707928 retrieved 2022 01 10 a b c d e f g h i Shenoy Vijendra Kamath M Panduranga Hegde Mahesh Chandra Rao Aroor Raghavendra Maller Vijetha V 2013 02 07 Cervical Thymic Cyst A Rare Differential Diagnosis in Lateral Neck Swelling Case Reports in Otolaryngology 2013 e350502 doi 10 1155 2013 350502 ISSN 2090 6765 PMC 3580929 PMID 23476854 a b Wang Xun Chen Kezhong Li Xiao Li Yun Yang Fan Li Jianfeng Jiang Guanchao Liu Jun Wang Jun December 2017 Clinical features diagnosis and thoracoscopic surgical treatment of thymic cysts Journal of Thoracic Disease 9 12 5203 5211 doi 10 21037 jtd 2017 10 148 ISSN 2072 1439 PMC 5756969 PMID 29312727 Sturm Joshua J Dedhia Kavita Chi David H 2017 01 11 Diagnosis and Management of Cervical Thymic Cysts in Children Cureus 9 1 e973 doi 10 7759 cureus 973 ISSN 2168 8184 PMC 5298914 PMID 28191377 Retrieved from https en wikipedia org w index php title Cervical thymic cyst amp oldid 1194022906, wikipedia, wiki, book, books, library,

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