| A healthy 34-year-old man had a mediastinal cyst on the imaging study. Surgical treatment was performed. The cyst was diagnosed as a thoracic duct cyst from its anatomic location and contents. Pathologic examination found it to be consistent with thoracic duct cyst. endothelial cells on its luminal surface were identified by an immunohistologic stain with the factor viii-related antigen. Twenty-six cases of thoracic duct cysts have been reported. We report an additional case and review the previously reported cases. We found that the ligation of the inferior pedicle of the cyst is essential to prevent postoperative chylothorax. ( info) |
2/326. Mediastinal parathyroid cysts revisited. BACKGROUND: A case of a functioning mediastinal cyst is presented. methods: A comprehensive review of the literature found 93 patients in whom a parathyroid cyst or cysts extended into, or was completely contained within, the mediastinum. Including our patient, there were 46 men and 45 women, and the gender was not recorded in three. RESULTS: The cysts were located in the anterosuperior region in 56 patients, in the middle region of the mediastinum in 26, and in the anterior, prevascular region in 12. Thirty-nine patients had functioning cysts associated with hyperparathyroidism of varying severity; seven patients presented with a hypercalcemic crisis. Local symptomatology consisted of a neck mass, respiratory distress, and occasional dysphagia or chest pain. recurrent laryngeal nerve paresis was present in nine patients, and innominate vein compression or thrombosis was present in two. The cysts in all but four patients were treated by open surgical excision; two were treated by thoracoscopy, and two patients only had fine-needle aspiration of the cyst. The cyst was excised via a cervical approach in 67 patients and by a thoracotomy or median sternotomy or a variation thereof in 23. There was no operative mortality and morbidity was minimal. CONCLUSION: Surgical resection was successful in all and remains the treatment of choice for mediastinal parathyroid cysts. ( info) |
3/326. Cervical thymic anomalies. Because of its infrequent occurrence, cervical thymic tissue is rarely considered in the differential diagnosis of neck masses. Consequently, diagnosis is most often made by pathologic examination of the excised specimen. The preponderance of reported patients have been children and adolescents, typically asymptomatic. The clinical presentation, evaluation and surgical management of five new cases of cervical thymic anomalies ranging from infancy to adulthood are described. The authors also review the embryology and histopathology of these lesions and discuss their recommended approach to the evaluation and management of cervical thymic anomalies. ( info) |
4/326. Hydatid pulmonary embolism from a ruptured mediastinal cyst: high-resolution computed tomography, angiographic, and pathologic findings. Hydatid disease is a parasitic infestation caused by the larval stage of a tapeworm of the genus echinococcus. This report describes an extremely rare complication of echinococcal disease in which severe pulmonary hypertension developed after massive hydatid pulmonary embolism. ( info) |
5/326. thoracic duct cyst: a case report and review of 29 cases. cysts of the thoracic duct are rare. We report a case of a cervical thoracic duct cyst and review 29 thoracic duct cysts reported previously (19 mediastinal, 9 cervical, and 1 abdominal). The mean age of the patients was 47.6 years (range 17 to 86 years). Fourteen (46.7%) of the patients were asymptomatic. When symptoms were present, they ranged from retrosternal pain, dysphagia, and dyspnea to respiratory insufficiency and superior vena cava compression. diagnosis of the cyst can be made after computed tomography or ultrasonography. The cystic fluid contains T lymphocytes and triglycerides in excess. The symptoms in a patient with a thoracic duct cyst are related to compression of adjacent structures. The most profound symptoms are likely to be produced by mediastinal cysts above the aortic arch. Treatment consists of surgical removal of the cyst and ligation of all lymphatics connected to the cyst. ( info) |
| The unusual case of acute respiratory insufficiency in an infant of 5 months caused by a large cyst of true tracheal origin is presented. ( info) |
7/326. Cervical thymic cyst in the elderly: a case report. Cervical thymic cyst is uncommon and usually occurs in the first and second decades. Cervical thymic cyst after the third decade is so rare that it is very difficult to diagnose in spite of its typical location. We present a rare case of cervical thymic cyst in the lower left - anterior of the neck in a 50-year-old woman. It showed well-defined, anechoic cyst on ultrasonography and non-enhancing low attenuation mass on CT. A typical anatomic relationship was noted between the mass and carotid sheath. ( info) |
8/326. Multilocular thymic cyst with follicular lymphoid hyperplasia in a male infected with HIV. A case report with fine needle aspiration cytology. BACKGROUND: Multilocular thymic cyst with follicular lymphoid hyperplasia is a rare complication in HIV-infected patients, causing pseudotumorous enlargement of the anterior mediastinum. There have been six reported cases, all with only histologic findings. This paper reports another such case and includes perhaps the first cytologic findings on this rare entity. CASE: A 35-year-old, HIV-infected male intravenous drug abuser, who complained of worsening central chest discomfort and pain on deep inspiration, was found to have a large, septated anterior mediastinal mass. Computed tomography-guided fine needle aspiration biopsy was performed. The cytologic presentation mimicked that of thymoma, with cystic degeneration and a dual population of epithelial cells and lymphocytes as well as large aggregates of "epithelial" cells intermixed with lymphocytes in a background of macrophages and cyst fluid. Histologic examination of the resected mass revealed a multilocular thymic cyst with follicular lymphoid hyperplasia. hiv-1 core protein p24 was localized immunohistochemically in the dendritic follicular cells of the germinal centers. In retrospect, the quantity of epithelium derived from the cyst lining was too scanty for thymoma, and the presence of plasma cells and lymphohistiocytic aggregates suggested follicular lymphoid hyperplasia. CONCLUSION: Multilocular thymic cyst with follicular lymphoid hyperplasia should be considered in the differential diagnosis of an anterior mediastinal mass in HIV-infected patients after lymphoma and tuberculosis. ( info) |
9/326. Basaloid carcinoma of the thymus. A 58-year-old man was found to have a basaloid carcinoma of the thymus, initially detected as an abnormal shadow on chest radiograph. The patient underwent resection followed by radiotherapy, and has survived 25 months without recurrence. Although this rare tumor may be related to multilocular thymic cyst, its pathogenesis is obscure. We discuss clinicopathologic features of our case and others. ( info) |
10/326. Thymic cystectomy through subxyphoid by video-assisted thoracic surgery. In this paper we present a new technique for thymic cystectomy by video-assisted thoracic surgery. The thoracoscope was inserted using a Vein Harvest (Ethicon Endo-Surgery Co, Ltd, Cincinnati, OH) through a 5-cm subxyphoid incision. A Harmonic Scalpel (Ethicon Endo-Surgery) and Cherry Dissector (Ethicon Endo-Surgery) were used for dissection. The thymic cyst was successfully removed through the incision without thoracotomy. The advantage of this technique is that it is less invasive than video-assisted thoracic surgery through the thorax, removing the need for a thoracotomy. ( info) |