12 November 2014 - Case #333
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
Thanks to Dr. Govindaswamy Koteeswaran, Mahatma Gandhi Medical College and Research Institute (India), for contributing this case.
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Case #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:
Microscopic 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.
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
Thanks to Dr. Govindaswamy Koteeswaran, Mahatma Gandhi Medical College and Research Institute (India), for contributing this case.
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Website news:
(1) Our Feature page for November is Consumable Lab Products / Clinical Lab Analyzers, and highlights our advertisers Leica Biosystems and Ventana Medical. It also contains an original short article, "Laboratory Consumables: Pathology Glass Slides", by Jaleh Mansouri, M.D.
(2) October traffic broke another record, with 661,468 total visits, 2,000,307 total page views and average daily visits of 21,337. Thanks for your support!
(3) We have now posted the Pathologist Jobs Report for the third quarter of 2014. For this quarter, there were 86 job postings for full time or part time pathologists at PathologyOutlines.com. This is a 19% increase from the 72 postings in the third quarter of 2013. For the first 3 quarters of 2014, there were 230 postings, a 17% increase from the 196 postings for the first 3 quarters of 2013.
(4) We have posted the ten most popular books sold through Amazon.com from January to September 2014 on our Top Books page.
Visit and follow our Blog to see recent updates to the website.
(1) Our Feature page for November is Consumable Lab Products / Clinical Lab Analyzers, and highlights our advertisers Leica Biosystems and Ventana Medical. It also contains an original short article, "Laboratory Consumables: Pathology Glass Slides", by Jaleh Mansouri, M.D.
(2) October traffic broke another record, with 661,468 total visits, 2,000,307 total page views and average daily visits of 21,337. Thanks for your support!
(3) We have now posted the Pathologist Jobs Report for the third quarter of 2014. For this quarter, there were 86 job postings for full time or part time pathologists at PathologyOutlines.com. This is a 19% increase from the 72 postings in the third quarter of 2013. For the first 3 quarters of 2014, there were 230 postings, a 17% increase from the 196 postings for the first 3 quarters of 2013.
(4) We have posted the ten most popular books sold through Amazon.com from January to September 2014 on our Top Books page.
Visit and follow our Blog to see recent updates to the website.
Case #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:
Microscopic images:
What is your diagnosis?
Click here for diagnosis and discussion:
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.
