Ectopic Cervical Thymus Research Articles

Submandibular Ectopic Thymic Mass in a 6-Month-Old Infant

AbstractInfant ectopic cervical thymus is a relatively uncommon diagnosis and, in many cases, subclinical. If not subclinical, it may present as a palpable swelling or with compressive symptoms (i.e., stridor or dysphagia). Standard radiologic workup includes an ultrasound followed by magnetic resonance imaging (MRI) with tissue sampling if the ultrasound is indeterminate. In this case, an incidental submandibular mass was noted on a noncontrast MRI for seizures in a 6-month-old male infant. A radiologic and pathologic workup was performed for evaluation. However, this case is unique as fluorodeoxyglucose positron emission tomography/computed tomography was also utilized to potentially aid in the establishment of a diagnosis.

Ectopic Cervical Thymus in Adult: An Incidental Finding.

Thymus is a paired organ which develops during the sixth week of fetal life, attains maximum size by three years and involutes in adult life. Anatomically it is situated in superior mediastinum. Thymus can be present at ectopic sites like neck, skull base, middle ear, submandibular gland and tonsil. Ectopic Cervical Thymus (ECT) is very rare in adults and can present as a solid mass, cyst or thymoma. ECT occurs due to failure of descent during embryonic development. ECT can mimic any pathologic mass, metastatic deposit or lymph node enlargement. We report a case of ECT discovered incidentally in an adult during histopathological examination of thyroid carcinoma. In addition, we described the role of immunohistochemistry markers to confirm the various thymic components.

Timo ectopico: quando pensarci, la diagnosi per immagini, la gestione

Ectopic thymic tissue is a rare occurrence in clinical practice. However, it could cause di- agnostic difficulties, especially in the paediatric age group, as it can mimic a cervical mass. In most cases, thymic ectopia is asymptomatic and the ectopic thymic tissue presents as a painless cervical mass. It could rarely cause stridor, dyspnoea, dysphonia and dys- phagia. Ultrasound is the first-level diagnostic investigation. Only in doubtful cases, mag- netic resonance imaging is almost always diagnostic, as the ectopic tissue shows signal intensity comparable to the normal thymus. The fine-needle aspiration may be avoided and conservative treatment may be performed through ultrasound follow-up. Surgical exci- sion is reserved when imaging and biopsy are still inconclusive or in the presence of symptoms. The paper presents a clinical case of asymptomatic cervical ectopic thymus in a healthy girl, suspected on ultrasound examination and confirmed on magnetic reso- nance imaging.

Solid ectopic cervical thymus in an infant

Introduction. Ectopic cervical thymus (ECT) occurs as a result of incomplete migration of the thymic primordia during embryogenesis. In the majority of cases, ECT is asymptomatic; however, in 10% of patients, there are different kinds of symptoms. Case report. A four-month-old baby boy was referred to our clinic for an evaluation of a growing large mass on the right side of the neck, present since birth. Physical examination revealed a solid, painless, soft, moderately mobile mass of irregular round shape localized on the right side of the neck, in front of the sternocleidomastoid muscle, below the parotid gland, and above the carotid lodge. The skin above the mass was unchanged. The dimensions of the mass were 40 ? 32 ? 15 mm. Based on the clinical and ultrasonographic findings, as well as the findings of the magnetic resonance imaging, it was suspected that the mass was an ECT. The mass was removed by surgical excision. The pathohistology report confirmed the presence of an ECT, with Hassall?s corpuscles in the medulla. The postoperative course went smoothly, and the wound healed well. During the regular clinical, immunological, and ultrasound follow-ups over a period of six months, normal findings were registered. Conclusion. Congenital ECT is a rare congenital anomaly that must be, however, taken into account when considering the differential diagnosis of cervical tumor masses.

New-born with Cervical Ectopic Thymus: An Uncommon Developmental Disorder Which Has to be Consider in the Differential Diagnosis of Unilateral Neck Mass in Children

New-born with Cervical Ectopic Thymus: An Uncommon Developmental Disorder Which Has to be Consider in the Differential Diagnosis of Unilateral Neck Mass in Children

Neck cervical ectopic thymus in adult: a case report

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Ectopic cervical thymus in children: Clinical and radiographic features.

Ectopic thymus is rare and can be a diagnostic challenge. This study evaluated the management of children radiographically diagnosed with ectopic cervical thymus. A retrospective review of 100 patients was performed. Data related to clinical presentation, radiological imaging, pathology, and management were collected. Changes in lesion volume were tracked over time. Clinical characteristics were compared based on lesion location in the neck using analysis of variance modelling. There were 115 lesions with radiographic features of ectopic cervical thymus (15 children had bilateral lesions). Diagnosis was based on ultrasound in 98% of patients, magnetic resonance imaging in 18%, and computed tomography in 11%. Mean (SD) follow-up duration was 2 (2.2) years. Forty-four percent (51/115) of lesions involved the thyroid gland, 29% (33/115) were in the central neck but separate from the thyroid, 18% (21/115) had mediastinal extension, and 8% (9/115) involved the submandibular region. Location was unclear for two patients. Submandibular lesions were on average 12.4 cm3 larger (95% CI, 8.2, 16.6) than mediastinal lesions at diagnosis, P ≤ .001. Volume of thymic tissue decreased over time, from a mean (standard deviation [SD]) volume of 4.3 cm3 (9.2) at initial ultrasound to 2.7 cm3 (6.1) at final ultrasound (paired t-test, P = .008). Only two patients required surgery: one for compressive symptoms, and the other to rule out malignancy. Ninety-eight percent of children with ectopic cervical thymus were managed conservatively without issues. We propose a classification system based on location to ease communication among clinicians and to help follow these lesions over time. 4, case series Laryngoscope, 130:1577-1582, 2020.

Ultrasonography and magnetic resonance imaging findings in the case of bilateral ectopic cervical thymus

Ultrasonography and magnetic resonance imaging findings in the case of bilateral ectopic cervical thymus

Ectopic Cervical Thymus in an Infant with Normal Orthotopic Thymus: Role of Imaging in Diagnosis and Management.

Ectopic cervical thymus (ECT) is a rare cause of solid cervical mass in the pediatric age group. The location of the mass along the path of thymic descent (thymopharyngeal duct), sonographic echo pattern and MR signal intensity identical to that of normal orthotopic thymus in the anterior mediastinum help us in making a confident diagnosis. To the best of our knowledge only nine cases have been reported in infants in the literature. We present a case of ECT presenting as a right upper neck mass in a 2month old child.

Thymus ectopique : une cause rare de tuméfaction cervicale chez le nourrisson

Ectopic cervical thymus (ECT) is a rare embryological abnormality in children. It can be revealed by a compressive neck mass mistaken for a malignant tumor. Through a new case of ECT, we review the embryopathogenesis, diagnostic difficulties and therapeutic features. A 19-month-old girl presented a right cervical mass that quickly increased in size, causing intermittent dyspnea. The physical examination objectified a 6-cm, soft and compressible, painless right cervical tumefaction, extending from the mastoid area to the ipsilateral supraclavicular fossa. The diagnosis suggested based on CT was a cervicomediastinal cystic lymphangioma. The diagnoses discussed based on MRI were a collection of necrotic lymphadenopathy, rhabdomyosarcoma or neurofibroma debris. The mass was surgically excised through a laterocervical incision. A whitish multilobular tissular mass was found, adherent to the neurovascular axis of the neck. Pathological examination concluded in normal ectopic thymus tissue. The postoperative course was uneventful. Although ECT is a rare benign anomaly, it should be considered as a possible cause of a neck mass in children. Surgery is the curative treatment. Before surgery, the presence of a mediastinal thymus must be confirmed to avoid the risk of a total thymectomy in children. MRI is helpful in delineating thymic ectopia compared to the mediastinal thymus.

Adult-Onset Hyperplasia of An Ectopic Cervical Thymus Associated with Uncontrolled Hyperthyroidism: A Case Report

: Ectopic cervical thymus (ECT) is an essentially benign condition that is identified during the development of the thymus, and is rare among the adult population. Thymic hyperplasia is another thymus-associated condition, which is known to occur secondary to hyperthyroidism. A 39-year-old woman with hyperthyroidism presented with an enlarging submandibular mass, which was diagnosed as a benign hyperplasia of the ECT. Computed tomography and magnetic resonance imaging largely contributed to its diagnosis, and an unnecessary surgical resection was avoided. To the best of our knowledge, this is the first report that describes clinically significant hyperthyroidism-induced ECT hyperplasia during adulthood.

Accessory cervical thymus presenting in conjunction with a thyroglossal duct cyst

Abstract We present an unusual case of a lateral neck mass presenting in conjunction with a thyroglossal duct cyst with review of literature. A 7-year-old boy presented with a midline mass consistent with a thyroglossal duct cyst and a second lesion adjacent to the left inferior lobe of the thyroid confirmed to be ectopic thymus after excision. This is the first reported case of ectopic cervical thymus diagnosed in conjunction with a thyroglossal duct cyst. It is possible that both lesions developed by a similar mechanism. The treatment of choice for both masses is surgical excision.

Ectopic cervical thymus: A clinicopathological study of consecutive, unselected infant autopsies

ObjectivesAn ectopic cervical thymus (ECT) is regarded as a rare congenital anomaly; therefore, the optimal diagnostic and therapeutic strategy remains a debatable matter. We designed a study to elucidate the clinicopathological characteristics of ECTs in consecutive, unselected infant autopsies, to help guide case management. MethodsWe searched for ECTs in all of the 21 consecutive, unselected infant autopsy cases performed at our institution over a period of 3 years, and all ECT consensus diagnoses were confirmed by histological examination. The following clinical characteristics were evaluated in cases with ECTs: age, gender, birth week and weight, clinical symptoms due to the ECT(s), position on discovery of death, cause of death, ECT contribution to the cause of death, and concomitant congenital disorders. The anatomical features evaluated included the location, number, size, color, shape, and margins of the ECTs, and the presence of a mediastinal thymus. Histological findings of the ECT(s) and the mediastinal thymus were compared within each individual. Fusion of the parathyroid and the ECT was also investigated histologically. Spearman's rank correlation coefficient (ρ) and the corresponding P value were calculated to determine if there was an association between ECT diameter and age. ResultsWe detected 10 ECT lesions in seven cases (33%) among the 21 infant autopsy cases. The ECT cases involved five boys and two girls, with ages ranging from 1 day to 4 months. There were no reports of a positive family history of sudden death or antemortem clinical symptoms due to ECT in any of the cases. The ECTs were considered incidental regarding the cause of death, with the exception of one case that was extremely rare. Most ECTs were localized to the inferior thyroid, ranging from 0.4 to 1.9cm in size. Size demonstrated a significant negative correlation with age (ρ=−0.75 and P=0.034). ConclusionsThis study revealed that ECT is an essentially benign anomaly that occurs frequently during the development of the thymus, and may disappear over the first few years of life. These results suggest a conservative approach to the management of ECTs would be appropriate.

Ectopic Parathyroid in an Ectopic Cervical Thymus in a Patient with Parathyroid Adenoma

The development of the thymus is linked to that of the parathyroid glands, which are small endocrine glands in the neck and produce parathyroid hormone which is responsible for calcium homeostasis (1). The thymus is a lymphoepithelial organ derived embryologically from the third and fourth pharyngeal pouches, which descend to the anterior mediastinum by the sixth week of gestation (2). Because the parathyroid glands are derived from the dorsal wing of the third pharyngeal pouch and descend with the thymus, an ectopic thymus-parathyroid complex, mechanistically suggests aberrant migration (3). Inthis paper, we report these rare concomitant events and discuss the other literature, briefly.

Ectopic Thymus Presenting as a Retropharyngeal Mass: Surgical Approach

Cervical ectopic thymus is a rare cause of solid neck masses in children. Most children are asymptomatic, but some may present with a palpable neck mass, with or without compressive symptoms. Cervical ectopic thymus is often discovered incidentally and mistaken for an infection or neoplasm. We present the case of an infant with retropharyngeal ectopic thymus and describe our intraoral surgical approach.

Solid Ectopic Cervical Thymus in Neonates With Thyroid Agenesis

We report a series of ectopic thymus glands as detected by sonography in infants with thyroid agenesis. The patients were children who underwent nuclear medicine and sonography for congenital hypothyroidism. Of the 12 patients with a diagnosis of thyroid agenesis over a 5-year period, 4 (33%) were shown to have ectopic thymic tissue. Although a cervical ectopic thymus has been previously reported, there is very little discussion of it occurring in conjunction with thyroid agenesis. This case series highlights the importance of recognition of ectopic thymic tissue when examining for thyroid tissue in the setting of congenital hypothyroidism.

Coexistence of pyriform sinus fistula, ectopic lingual thyroid, and ectopic cervical thymus

We report an extremely rare case of coexistence of pyriform sinus fistula, ectopic lingual thyroid, and ectopic cervical thymus. A 16-year-old girl with ectopic lingual thyroid had suffered repetitive painful swelling in the left anterior neck. Barium swallow radiography and computed tomography revealed a fistula arising from the pyriform sinus running down to the anterior neck. She underwent transcervical fistulectomy with preservation of the recurrent laryngeal nerve. Histopathological examination of the surgical specimen showed coexisting thymic tissue. This illustrative case exemplifies the different embryological origin of the thyroid from that of the third and fourth pharyngeal pouch derivatives.

Infant ectopic cervical thymus one case report: Diagnostic and management difficulties

Cervical ectopic thymus (CET), an embryological anomaly detected incidentally at autopsy, is rarely described in clinical patients. Furthermore, aberrant cervical thymic tissue is an infrequently reported cause of neck masses, and especially for pediatric patients. However, according to clinical work, it should be included in the differential diagnosis of neck masses, particularly for children patients. Thymic tissue rests can be found all along the route of thymic descent from the neck into the anterior mediastinum. In routine practice, the preoperative diagnosis of ectopic cervical thymus is seldom considered and it is often misdiagnosed as a possible tumor or as a lymph node, which leads to biopsy or surgical removal. Here, a case of ectopic thymic tissue was presented in the neck misdiagnosed as cystic hydroma (one type of lymphatic malformation). Our misdiagnosis was introduced, the literature about diagnosis and management controversy were reviewed in recent years.

Clinical management of cervical ectopic thymus in children

Objective Cervical ectopic thymus (CET) is an extremely uncommon etiology of a neck mass in an infant. The aim of this study was to study and analyze the clinical manifestations, management principles, and pathological diagnosis of CET. Methods From 1995 to 2010, a total of 25,237 cases of head and neck lesions were treated in the Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital. Among these huge numbers of lesions, there were only 3 cases of pathological-diagnosed CET presenting as neck masses. These 3 rare cases were interesting, and here, we report their clinical management and pathological diagnosis. Result Three patients had a pathological diagnosis of CET. Their ages ranged from 4 months to 4 years. Clinically, all 3 patients presented with a painless neck mass and received surgical resection. Pathological diagnoses are based on hematoxylin and eosin and immunohistochemical staining. Conclusion Painless swelling or neck mass is the major complaint for CET. Radiologic imaging can help determine the extent of the mass and relationship with adjacent structures. Surgery with frozen section remains the main method for pathological diagnosis and management.

Rebound enlargement of an ectopic cervical thymus mimicking relapse of lymphoblastic lymphoma

A previously healthy 6-year-old boy was referred to our hospital with a tumor in the right upper mediastinum on chest X-ray. Physical examination showed no abnormal respiratory sounds, hepatosplenomegaly, or palpable tumor. On MRI, a right mediastinal tumor, 37 9 38 9 25 mm in size, with low intensity on T1-weighted images and high intensity on T2-weighted images was seen. A left-sided cervical mass, 27 9 29 9 10 mm in size, and several small lesions were seen in the liver and kidneys; all were of intensities similar to those of the mediastinal tumor (Fig. 1a, b). On histopathological examination of the biopsied samples from the mediastinal tumor, diffuse proliferation of medium-sized atypical lymphocytes with scant cytoplasm and fine chromatin was seen (Fig. 2); immunohistochemistry was positive for CD79a, CD10, and CD34, and negative for CD3, CD7, and CD20. Bone marrow aspiration showed a normocellular marrow with 5.4% lymphoblasts, suggesting involvement of lymphoma cells. These findings led to a diagnosis of precursor B-cell lymphoblastic lymphoma (LBL) stage IV. After the induction phase of chemotherapy (vincristine, cyclophosphamide, daunorubicin, L-asparaginase, and prednisolone), all of the tumors disappeared on MRI (Fig. 1c, d), and lymphoblasts were undetectable in the bone marrow. The patient subsequently received chemotherapy that included an early intensification phase, a central nervous system prophylaxis phase, a late intensification phase, and a maintenance phase. Follow-up MRI revealed no tumor at the beginning of maintenance chemotherapy, but the cervical mass re-emerged at the ninth month (Fig. 1e, f), at which time the mass was 35 9 40 9 11 mm in size and larger than at the onset of LBL. An ultrasound of the neck detected a lobulated, low-density structure with hyperechoic lines. The patient was asymptomatic. The reappearance of the enlarged cervical mass was initially suspected to be a relapse of LBL. An open biopsy was performed. On histopathological examination of the mass, normal thymic tissue with no evidence of lymphoma cell involvement was seen (Fig. 3). Flow cytometry confirmed cells positive for CD3, CD4, CD7, and CD8, and negative for CD10, CD19, and CD20. The cervical mass was diagnosed as an ectopic thymus. In accordance with the protocol, chemotherapy was continued for the following 6 months. The patient achieved complete remission, and the ectopic thymus remained unchanged in size 7 months after chemotherapy. The MRI and ultrasound can be used to diagnose ectopic thymus. MRI is the most accurate diagnostic method, showing slightly higher signal intensity than that of muscle on T1-weighted images and signal intensity close to that of fat on T2-weighted images. Ultrasound is the most convenient and non-invasive diagnostic modality. Ultrasound examination of normal thymic tissue shows multiple echogenic linear structures and foci. In the present patient, the ultrasound characteristics were potentially compatible with those of cervical ectopic thymus. However, it was difficult to differentiate a relapse of LBL from a non-neoplastic lesion as MRI revealed close similarities between the mediastinal LBL and the cervical mass. Therefore, a biopsy was performed to allow histopathological confirmation and surface marker analysis. T. Matsubayashi (&) H. Kitazawa R. Matsubayashi Department of Pediatrics, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-ku, Hamamatsu, Shizuoka 430-8558, Japan e-mail: matr@sis.seirei.or.jp