Anterior Mediastinal Cyst Research Articles

A Cyst Close to the Heart

A 49-year-old Lebanese man presented to the hospital with right-sided pleuritic chest pain without associated respiratory or systemic symptoms. His vitals on presentation were stable, and examination was unremarkable. He had mild leukocytosis with 9.8% eosinophils. Imaging including cardiac magnetic resonance imaging with and without contrast revealed an extra pericardial, multiloculated anterior mediastinal cyst (Figure 1). A diagnosis of hydatid cyst was suspected based on epidemiologic history and radiologic appearance. Echinococcus serology was found to be positive. Patient was started on empiric anthelminthic treatment followed by surgical excision. Intraoperatively, the wall of the excised cyst showed calcification and sebaceous contents (Figure 2). Histopathologic exam showed multilocular cyst lined by squamous epithelial cells and foci of mature bone tissue (Figure 3), pancreatic acini, and ciliated columnar epithelial ducts consistent with a diagnosis of benign mature cystic teratoma. No parasite was seen. Anthelminthic therapy was discontinued, and the patient reported to be doing well on the follow-up visit. Similar cases have been reported in the past.1Patel I.J. Hsiao E. Ahmad A.H. Schroeder C. Gilkeson R.C. AIRP Best Cases in radiologic-pathologic correlation: mediastinal mature cystic teratoma.RadioGraphics. 2013; 33: 797-801Crossref PubMed Scopus (19) Google Scholar, 2Jaakik B. Benjelloun H. A Rare pericardial cyst resembling hydatid cyst on echocardiography.Intern Med. 2010; 49: 1673-1674Google Scholar, 3Montebello A. Mizzi A. Cassar P.J. Cassar K. Benign cystic mediastinal teratoma presenting as a massive pleural effusion in a 17-year–old boy.BMJ Case Reports. 2017; 2017 (bcr2016217439)Google ScholarFigure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3View Large Image Figure ViewerDownload Hi-res image Download (PPT) The authors wish to acknowledge Dr Khushi Nagori, MBBS, Department of Pathology, Ascension St John Hospital, Detroit, Michigan.

Mediastinal foregut duplication cyst of enteric type containing a persistent thymus, imitating a pericardial cyst

Mediastinal foregut duplication cysts are rare congenital masses caused by developmental disorders of the anterior part of the embryonic primitive gut. In adults they can be discovered as an incidental finding on chest radiograph. They can mimic other intrathoracic pathologies as it was initially the case in our patient. A 51-year-old woman was incidentally found to have homogenous mass at the right cardiophrenic angle on the chest radiograph. Based on that finding and echocardiography a pericardial cyst was suspected. Computed tomography demonstrated a simple anterior mediastinal cyst. Because of the growth with a mild progression of the compression of the right atrium, the cyst was resected. Histology and immunohistochemistry revealed the mass to be a mediastinal foregut duplicatory cyst of enteric type containing persistent thymus. To our knowledge, this is the first report in which a mediastinal foregut cyst contained both enteric mucosa and ectopic persistent thymus (Fig. 9, Ref. 13). foregut cyst, mediastinal cyst, thymus, enteric cyst, pericardial cyst.

Thoracoscopic resection of a thoracic duct cyst that developed during follow-up for a thymic cyst

A 29-year-old man had been diagnosed with an anterior mediastinal cyst 6 years earlier and was undergoing follow-up. At a follow-up visit, a newly developed cystic lesion was found in the middle mediastinum; therefore, the anterior mediastinal cyst and the middle mediastinal cyst were resected by thoracoscopic surgery. It was observed that the middle mediastinal cyst originated from the thoracic duct, and the thoracic duct was clipped. Pathologically, the diagnosis was a thymic cyst of the anterior mediastinum and a thoracic duct cyst of the middle mediastinum. The patient developed chylothorax after surgery, and a second thoracoscopic operation was performed. It revealed that part of the clipping of the caudal thoracic duct was incomplete, and leakage of chyle was observed. Hence, the clipping was performed again. The course after the second surgery was good. Thoracic duct cysts are rare even among mediastinal cysts and thus require caution due to their tendency to expand.

The Figure-L Unilateral Transternal Incision for the Treatment of Anterior Mediastinal Tumor

Objective To explore the feasibility of the small figure-L unilateral transternal incision for the treatment of anterior mediastinal tumor and cyst. Methods Eighteen patients with anterior mediastinal tumor or cyst were enrolled in the study. Under general anesthesia, after a 8 to 10 cm middle skin incision was made, a unilateral figure-L partial sternotomy on the side occupied by the tumors was made in the third or forth intercestals space,taking into account the tumors size and location. Tumors were resected with excellent exposure. Results All but one tumors were completely resected during the operation. In 3 cases,tumors encroached on the adjacent lung tissue,and lung tissue was partially resected. In 2 cases, tumors invaded the pericardium, and the pericardium was partially removed.Mean operating time was 120 minutes( 80～140 minutes). The mean time of hospital stay was 10 days after the operation, and there was no complications. All patients were alive with a mean follow-up period of 24 months ( 8～36 months). Conclusion The figure-L unilateral sternotomy is an effective and useful minimally invasive approach for anterior mediastinal tumors. Key words: Mediastina Neoplasms; Surgical procedures

Massive benign pericardial cyst presenting with simultaneous superior vena cava and middle lobe syndromes

A 66 year old woman presented in extremis with symptoms and clinical and radiological signs of simultaneous obstruction of superior vena cava and middle lobe of right lung secondary to compression by a massive benign anterior mediastinal cyst. Excision of the cyst at median sternotomy resulted in complete resolution of all symptoms. This report is unusual on account of a) the concomitant presence of superior vena cava and middle lobe syndromes caused by a benign cyst because of its sheer size producing obstruction of these structures and b) the complete resolution of all symptoms and signs after removal of the cyst. Benign anterior mediastinal cysts are unknown to cause either of the two syndromes. To our knowledge, it is the first report of a benign anterior mediastinal cyst causing either superior vena cava syndrome or middle lobe syndrome or both simultaneously. Etiologies of both superior vena cava and middle lobe syndromes are discussed in detail.

Multilocular Mediastinal Cyst with Rim Calcification: Report of a Case

We report a case of a multilocular anterior mediastinal cyst with rim calcification and severe adhesion to the adjacent organs. We excised the cyst completely, with resection of the left phrenic nerve, pericardium, and left lung because of the severe adhesion. Histological examination revealed that the multilocular cystic walls were composed of fibrous connective tissue and calcifications, but the lining epithelial cells were absent because of dystrophic calcification resulting from chronic inflammation. On the basis of the location and pathological findings, we diagnosed a multilocular mediastinal cystic tumor; most likely a multilocular thymic cyst. It is important to distinguish a multilocular thymic cyst from a unilocular thymic cyst because a multilocular thymic cyst may recur postoperatively and coexist with a thymic epithelial tumor. Dense adhesion to the surrounding mediastinal structures may make removal difficult, especially if there is rim calcification.

Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum

A 67-year-old woman underwent a thoracoscopic resection of a large anterior mediastinal cyst. Before surgery, artificial pneumomediastinum was performed with a retrosternal technique. Injection of 400 ml of air from the sternal notch caused emphysema throughout the mediastinum. In those areas, dissection of loose connective tissue was mostly accomplished by the injected air, which formed an air layer around the cyst. On the other hand, emphysema was not apparent in the areas around the left innominate and thymic veins. Artificial pneumomediastinum may be useful as a supplementary technique in a thoracoscopic surgery setting.

Thymic Cyst Extending into the Pericardium: A Case Report and Review of Thymic Cysts

The cases of 8 patients with cyst of the thymus are reviewed. The patients were all asymptomatic. Pathological features are described that emphasize the spectrum of findings depending on the degree of cyst degeneration. A case of pericardial extension of a thymic cyst, thought to represent rupture of an anterior mediastinal thymic cyst into the pericardium, is described.