Cases reported "Mediastinal Cyst"

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1/14. Mediastinal parathyroid cyst with tracheal constriction.

    A 63-year-old man visiting a physician for slight dyspnea, attributed to a lump on his neck, was found in ultrasonography and computed tomography to have a cyst extending from the left lobe of the thyroid gland to the superior mediastinum. radiography showed right deviation of the trachea. The cyst disappeared after fine-needle aspiration, but cyst fluid subsequently reaccumulated and he was admitted to our hospital. No abnormalities were detected in tests of thyroid and parathyroid function or blood chemical analysis. The cyst was surgically removed and diagnosed as a nonfunctioning parathyroid cyst, based on the high-intact parathyroid hormone in cyst fluid. The patient recovered fully and has shown no recurrence in the 11 months to data since surgery.
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2/14. Cervical thymic cysts.

    Thymic cysts are considered uncommon lesions in the differential diagnosis of pediatric neck masses. They usually present in the 1st decade after the age of 2 years, possibly because the thymus attains its greatest development before puberty. They may be found anywhere along the normal descent route of the thymus gland from the mandible to the sternal notch; 50% extend into the mediastinum. Most patients are asymptomatic, although respiratory complications may occur. A review of the operative records in our hospital over the last 10 years revealed two cases of cervical thymic cysts (CTC) in a 5- and a 9-year-old boy. Both children presented with an atraumatic, painless, enlarging mass in the left side of the neck anterior to the sternocleidomastoid muscle. Neither boy had respiratory problems or swallowing difficulties. Ultrasound and computed tomography showed a lesion consistent with a tentative diagnosis of a branchial cyst in one boy and an extensive cystic hygroma in the other. Both lesions were approached through a transverse cervical incision and, although closely adherent to the internal jugular vein, carotid artery, and vagus nerve, were resected completely. There were no postoperative complications and so far there has been no recurrence. CTCs are uncommon benign lesions that should be considered in the evaluation of neck masses in children. Preoperative diagnosis is unusual and, at this time, there is no preoperative radiologic test that can accurately identify a neck mass as a CTC. Histologic investigation of the excised specimen showing thymic tissue remnants with pathognomonic Hassall's corpuscles and cholesterol clefts in the cyst wall is the only definitive diagnosis. Evolution is benign. Intact, complete surgical excision remains the treatment of choice.
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3/14. Cervical thymic cyst as a cause of acute suppurative thyroiditis.

    A case of acute suppurative thyroiditis following a perithyroidal abscess, which was thought to have resulted from infection of a cervical thymic cyst, is reported herein. The patient was an 8 year old asthmatic Japanese boy who originally presented with tender swelling of the left anterior neck in July, 1986. Although pharyngography could not clearly demonstrate the pyriform sinus fistula, a hypoechoic area around the left lobe of the thyroid gland was noted on ultrasonography. Incisional drainage revealed streptococcus milleri. A diagnosis of acute suppurative thyroiditis was established, and a cystic tubular mass was surgically resected from the left perithyroidal space some time later. Histopathological examination of the specimen revealed partly cystic thymic tissue along with parathyroid tissue. These observations suggested that acute suppurative thyroiditis in this case was caused by a perithyroidal abscess and that a perithyroidal abscess may also result from infection of a cervical thymic cyst.
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4/14. Hemithyroid agenesis associated with a cervical thymic cyst.

    A case is presented of a 7-yr-old boy with left hemithyroid agenesis associated with cervical thymic cyst. No left parathyroid glands were found. The diagnosis was established after surgical excision and histologic examination. Clinical and embryological implications of this condition are briefly discussed. No similar case has been found in the literature.
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5/14. Mediastinal parathyroid cysts.

    OBJECTIVE: To present our experience with mediastinal parathyroid cysts and summarize previously reported cases. DESIGN: We retrospectively reviewed medical records and reviewed the pertinent literature. MATERIAL AND methods: The clinical, operative, and pathologic findings in 7 cases of mediastinal parathyroid cysts encountered at one institution and 31 cases previously reported in the literature are described. RESULTS: Rarely, cysts may arise from an aberrant mediastinal parathyroid gland. Such cysts may manifest as a symptomatic mass, as an asymptomatic finding on roentgenography, or during the assessment of a patient with hyperparathyroidism. The diagnosis may be made by fine-needle aspiration or by excision and pathologic examination. CONCLUSION: Functioning parathyroid cysts represent degeneration of a hyperfunctioning gland, such as an adenoma, and are usually removed through a cervical approach. Nonfunctioning cysts in asymptomatic patients with normal serum calcium levels are considered indeterminate and should be managed accordingly. Excision is usually recommended.
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6/14. Parathyroid cyst of the thymus.

    A case is described of primary hyperparathyroidism in a patient with both a parathyroid cyst within the thymus gland and a concomitant parathyroid adenoma. The parathyroid adenoma contained microcystic areas of degeneration, and it is thought that the parathyroid cyst reflected degenerative change in a pre-existing adenoma. Parathyroid cyst should be considered in the differential diagnosis of cystic lesions within the thymus. Fine needle aspiration and parathyroid hormone assay on cyst fluid may provide a preoperative diagnosis.
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7/14. Thymopharyngeal duct cyst: MR imaging of a third branchial arch anomaly in a neonate.

    Third branchial arch anomalies are rare. The authors present a case report of a neonate with a rapidly growing neck mass due to cystic dilation of a persistent thymopharyngeal duct, which is a derivative of the third branchial arch. The presence of thyroid and thymic tissue in the cyst wall, the communication of the cyst with the piriform sinus, and the relationship of the cyst to carotid vessels and the sternomastoid muscle were consistent with the features of a thymopharyngeal duct cyst embedded in the thyroid gland.
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8/14. 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.
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9/14. Human immunodeficiency virus infection and multilocular thymic cysts.

    PURPOSE: Pathologic changes of the thymus, often seen in children with the human immunodeficiency virus (hiv), reflect direct invasion by the virus, followed by involution of the gland. A previously unknown form of thymic response to hiv infection, that of a multilocular thymic cyst, is reported. MATERIALS AND methods: Findings were examined in three hiv-positive patients, two children and one adult first seen with large thymic masses. RESULTS: All three had large, septate low-attenuation areas at computed tomography consistent with multilocular thymic cysts. The cystic nature of the lesions was confirmed with magnetic resonance imaging in two. Histopathologic examination, performed in two instances, helped establish the diagnosis. All patients remained in clinically stable condition. They all had parotid gland enlargement and lymphocytic interstitial pneumonia. CONCLUSION: Multilocular thymic cysts are probably another manifestation of the diffuse infiltrative lymphocytosis syndrome, usually associated with a milder course of acquired immunodeficiency syndrome.
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10/14. Isolated intra-abdominal esophageal cyst. Case report and review of the literature.

    We describe the first case of an isolated intra-abdominal esophageal cyst. The cyst was unilocular, smooth-surfaced, and attached to the superior border of the pancreas, and it contained clear mucoid material. The gross and in situ features most closely resemble four previously reported cases of isolated intra-abdominal bronchogenic cyst. Histologically, the cyst contained a simple and pseudostratified, ciliated, mucus-secreting, columnar epithelium and a wall composed of two distinct layers of smooth muscle. Both bronchogenic cysts and esophageal cysts may have ciliated epithelium; however, the presence of two smooth-muscle layers, along with the absence of cartilage or respiratory glands, allows for a definitive diagnosis of esophageal cyst.
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