International Journal of Pediatric Otorhinolaryngology
Case reportCervical ectopic thymus: a case report and review of the literature
Introduction
Ectopic cervical thymic tissue is a rare cause of neck masses. It may be found at any level of the pathway of normal thymic descent, from the angle of the mandible to the superior mediastinum. Seldom considered in the differential diagnosis of neck masses, its presence is often revealed by pathologic examination of an excised specimen. Adolescents and children comprise the majority of the typically asymptomatic patients. As such, the presence of a mediastinal thymus must be confirmed prior to the surgical resection of a neck mass to prevent inadvertent total thymectomy with possible negative effects on the developing immune system. We report the clinical presentation, diagnostic evaluation and therapeutic management of one case of ectopic cervical thymic tissue, accompanied by a short review of the relative literature.
Section snippets
Case report
A 6-year-old child was referred to the Otolaryngology Clinic of S. Orsola-Malpighi Hospital, Bologna, Italy, for the evaluation of a large right mid-cervical mass with the suspicion of lymphadenopathy. The mass was asymptomatic and was noted by the parents in conjunction with a previous upper respiratory tract infection. Although the patient followed an antibiotic therapy regime, the lesion failed to change significantly. The family history and past medical history were unremarkable. Physical
Discussion
Cervical thymic anomalies may occur as a consequence of an arrest in descent during the 9th week of embryonic growth, a sequestration of thymic tissue during descent or a failure of involution [1], [2], [3], [4]. Of the more specific origins proposed [5], the two favored theories for the development of cervical thymic cysts are the persistence of thymopharyngeal ducts (congenital) and the degeneration of Hassall's corpuscles within ectopic thymic remnants (acquired) [6].
A cervical thymic cyst
Conclusion
Ectopic cervical thymus cysts are uncommon but should be included in the differential diagnosis of neck masses, especially in the young. Such anomalies are rarely diagnosed pre-operatively and can be easily confused with other neck lesions. Once diagnosed, surgery is the definitive treatment if the mass is symptomatic and cosmetically unbecoming. Prior to surgery, the presence of a mediastinal thymus should be confirmed to prevent the risk of a total thymectomy. The prognosis after removal of
References (13)
- et al.
The aberrant cervical thymus. Embryology, pathology, and clinical implications
Am. J. Surg.
(1978) - et al.
Ectopic thymus presenting as a solid submandibular neck mass in an infant: casereport and review of literature
Int. J. Pediatr. Otorhinolaryngol.
(1999) - et al.
Cervical presentation of thymic cysts
Am. J. Surg.
(1978) - et al.
Cervical thymic cysts in children
Am. J. Surg.
(1980) - et al.
Cervical thymic anomalies
Int. J. Pediatr. Otorhinolaryngol.
(1999) - et al.
Ectopic cervical thymic masses in infants: a case report and review of the literature
Int. J. Pediatr. Otorhinolaryngol.
(1998)
Cited by (52)
Diagnosis and management of ectopic cervical thymus in children: Systematic review of the literature
2021, Journal of Pediatric SurgeryCitation Excerpt :After the removal of duplicates, a total of 313 full-text journal articles were retrieved. Of these, 71 contained adequate data on ECT in children and were therefore included in the final review [4–8,10–13,15–76]. These included both case series and case reports.
The paediatric thymus: recognising normal and ectopic thymic tissue
2021, Clinical RadiologyCitation Excerpt :Although most patients with ectopic thymus are asymptomatic, there are reported cases of ectopic thymus causing dyspnoea, stridor, hoarseness, and dysphagia.10,11,24–26 The recommended management of ectopic thymic tissue is “watchful waiting” anticipating thymic involution unless the patient is symptomatic with dysphagia and/or severe respiratory symptoms; however, due to diagnostic difficulty, most reports of ectopic thymus in the literature were confirmed postoperatively.7,24,27–30 The thymus can undergo acute involution with reduction of thymic volume in response to stressful biological conditions, which include chemotherapy, systemic corticosteroid treatment, and malnutrition.1
Cervical thymic cyst: A rare cause of neck mass in a female adolescent
2020, Journal of Pediatric Surgery Case ReportsCervical mass in a 3-year-old child: raising awareness of an unusual diagnosis
2018, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :CETs are found on the left side in more than two-thirds of patients. These masses are often located anteriorly and beneath the sternocleidomastoid muscle and usually extend into the retropharyngeal and carotid space, as in our patient.6 CT findings in patients with CETs may reveal a homogeneous mass with intimate attachment to the carotid sheath.
Cervical thymic cysts
2017, Operative Techniques in Otolaryngology - Head and Neck SurgeryCitation Excerpt :A babcock or other gentle soft tissue grasper can be used to grasp the cyst wall and provide counter traction to blunt dissection. Other structures that can frequently be attached or adjacent to the cyst include the pyriform sinus, the SCM muscle, the retropharyngeal space, the thyroid, and the parathyroids.34,35 Regardless of where the mass is located, care needs to be taken using blunt dissection techniques to remove all thymic tissues without violating the capsule.36
Ectopic cervical thymus: A clinicopathological study of consecutive, unselected infant autopsies
2014, International Journal of Pediatric Otorhinolaryngology