Case Reports: EPITHELIOMA OF UNDESCENDED THYMUS IN A CHILD

Pirkey, W. P.

doi:10.1001/archotol.1954.00710050249015

Cited by 33 publications

(10 citation statements)

References 5 publications

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“…It becomes obvious that there are no preoperative exams that can accurately identify a cervical mass as being a thymic cyst and diagnosis has to be confirmed by histological examination of the resected specimens. Their evaluation will confirm the benign nature of the cysts as opposed to other malignant forms such as thymoma with cystic degeneration [34,35].…”

Section: Discussionmentioning

confidence: 99%

Cervical thymic cysts

et al. 2007

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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.

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Section: Discussionmentioning

confidence: 99%

Cervical thymic cysts

et al. 2007

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“…3,11 MRI is helpful in delineating the presence, position, and extent of thymic tissue. A normal thymus in T 1 -weighted images has intermediate signal intensity that becomes brighter in T 2 -weighted images.…”

Section: Discussionmentioning

confidence: 99%

Retropharyngeal Aberrant Thymus

Shah¹,

Lai²,

Ruchelli³

et al. 2001

Pediatrics

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ABSTRACT. Introduction. Upper airway obstruction from a retropharyngeal mass requires urgent evaluation. In children, the differential diagnosis includes infection, trauma, neoplasm, and congenital abnormalities. Aberrant cervical thymic tissue, although occasionally observed on autopsy examination, is rarely clinically significant. We present the case of an infant with respiratory distress attributed to aberrant thymic tissue located in the retropharyngeal space.Case. A 6-week-old infant was brought to the emergency department for evaluation of stridor associated with periodic episodes of cyanosis. Lateral neck radiograph revealed widening of the retropharyngeal soft tissues. The patient's symptoms did not improve with intravenous ampicillin-sulbactam. Magnetic resonance imaging (MRI) performed on the seventh day of hospitalization revealed a retropharyngeal mass that extended to the carotid space. The mass was easily resected using an intraoral approach. Microscopic examination demonstrated thymic tissue. A normal thymus was also observed in the anterior mediastinum on MRI. The patient recovered uneventfully and had no further episodes of stridor or cyanosis.Discussion. Aberrant cervical thymic tissue may be cystic or solid. Cystic cervical thymus is more common, and 6% of these patients present with symptoms of dyspnea or dysphagia. Aberrant solid cervical thymus usually presents as an asymptomatic anterior neck mass. This case is unusual in that solid thymic tissue was located in the retropharynx, a finding not previously reported in the English literature. Additionally, the patient presented in acute respiratory distress, and the diagnosis was confounded by the presence of mild laryngomalacia. In retrospect, our patient likely had symptoms of intermittent upper airway obstruction since birth. The acute respiratory distress at presentation was likely the result of laryngomalacia exacerbated by the presence of aberrant thymic tissue and a superimposed viral infection.Aberrantly located thymic tissue arises as a consequence of migrational defects during thymic embryogenesis. The thymus is a paired organ derived from the third and, to a lesser extent, fourth pharyngeal pouches. After its appearance during the sixth week of fetal life, it descends to a final position in the anterior mediastinum, adjacent to the parietal pericardium. Aberrant thymic tissue results when this tissue breaks free from the thymus as it migrates caudally. Therefore, aberrant thymic tissue may be found in any position along a line from the angle of the mandible to the sternal notch, and in the anterior mediastinum to the level of the diaphragm. In an autopsy study of 3236 children, abnormally positioned thymic tissue was found in 34 cases (1%). The aberrant thymus was most often located near the thyroid gland (n ‫؍‬ 19 cases) but was also detected lower in the anterior neck (n ‫؍‬ 6 cases), higher in the anterior neck (n ‫؍‬ 8 cases), and at the left base of the skull (n ‫؍‬ 1 case). The presence of thymic tissue in the retropharyngeal ...

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“…There have been two reported cases of malignant degeneration of cervical thymic masses [9,10]. In the case of cervical thymoma, surgical resection is a must due to potential aggressive behavior.…”

Section: Treatmentmentioning

confidence: 99%