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12 November 2014 - Case of the Week #333

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Thanks to Dr. Govindaswamy Koteeswaran, Mahatma Gandhi Medical College and Research Institute (India), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.



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Case of the Week #333

Clinical History:
A 6 year old boy had a swelling on the right side of the neck, clinically thought to be a cystic lymphangioma, which was excised.

Gross images:

Multilocular cyst, 6 x 4.5 cm with thin and thick-walled septa



Micro images:



Additional images:



What is your diagnosis?































Diagnosis:
Ectopic cervical thymic cyst

Discussion:
Histology shows multiple cystic areas lined by a low cuboidal epithelium with focal squamous epithelium. There is also thymic lymphoid tissue with Hassal's corpuscles (degenerated, calcified and cystic), areas with cholesterol clefts, foreign body giant cells and chronic inflammatory cells.

Thymic cysts are among the rarest cysts found in the neck, although thymic nests may be found along the descent of the thymic primordia from the angle of the mandible to the mediastinum (Case Rep Otolaryngol 2013;2013:350502, JBR-BTR 2007;90:178). The origin of multilocular cysts may be cystic transformation in ductular epithelial formations of branchial pouch or related derivation by an acquired inflammatory process (Am J Surg Pathol 1991;15:388). The histologic features are as described above. In addition, cases may show pseudoepitheliomatous hyperplasia. No cartilage or smooth muscle is present.

Cervical thymic anomalies include ectopic thymic tissue, thymic cyst, and thymoma (Thyroid 2011;21:987). Due to their rarity, thymic cysts are usually not diagnosed before surgery.

The clinical and histologic differential diagnosis also includes bronchiogenic cyst, cystic degeneration in Hodgkin lymphoma, cystic lymphangioma, lymphocele and seminoma.


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