Mediastinal Cyst Research Articles

Case report: Mullerian cyst of mediastinum: report of two cases

Posterior mediastinal Mullerian cyst is rare. Due to its special location, it is easy to be misdiagnosed clinically, imaging and pathologically. Imaging is often misdiagnosed as a bronchial cyst or neurogenic tumor. The postoperative misdiagnosis rate is high and it is easy to be misdiagnosed as a bronchogenic cyst. Careful histopathological observation and necessary immunohistochemical marker staining of the resected specimens, such as PAX 8, WT1, ER and PR positivity, can confirm the diagnosis and avoid misdiagnosis of other lesions. This article introduces the clinical, imaging characteristics, histopathological morphology, and immunohistochemical characteristics of 2 cases of posterior mediastinal Mullerian duct cysts. To explore the clinicopathological characteristics, diagnosis and differential diagnosis of posterior mediastinal Mullerian duct cysts.

Differential diagnosis of mediastinal cysts: a case series.

Mediastinal cysts are common mediastinal lesions in which diagnostic and therapeutic choices are not always unambiguously presented. Usually, these cysts are asymptomatic and detected by coincidence. The question remains whether, if symptoms are present, the cyst is responsible and whether it should be treated. Unfortunately, there is a lack of standardised guidelines concerning diagnostic, therapeutic management and follow-up. In this case series we reported five patients with mediastinal cysts. All patients received a thoracic CT during the initial diagnostic assessment. Four out of five patients were symptomatic and were surgically treated during a uniportal video-assisted thoracoscopy. One patient was asymptomatic and receives a biennial follow-up. Most often, histopathological examination confirmed the already presumed type of non-neoplastic mediastinal cyst based on anatomical location and tissue characteristics (one thymic cyst, one bronchogenic cyst and two pericardial cysts). Except for one patient, all surgically treated patients experienced improvement in symptoms. Regarding diagnosis and treatment of this entity, a systematic approach in accordance with the most recent literature is important. The diagnosis can only be confirmed on histopathological examination, but several imaging techniques, with contrast-enhanced CT as the first-choice technique, could guide the differential diagnosis. In large, symptomatic cysts or present potential malignant features, surgical removal is indicated. This case series encourages further substantial research concerning the selection and timing of therapy.

Treatment of mediastinal bronchogenic cyst by rigid bronchoscopy and laser

Treatment of mediastinal bronchogenic cyst by rigid bronchoscopy and laser

Surgical tactics of mediastinal bronchogenic cysts. A rare complication – cystobronchial fistula

Surgical tactics of mediastinal bronchogenic cysts. A rare complication – cystobronchial fistula

Unusually severe neonatal presentation of mediastinal bronchogenic cyst.

Bronchogenic cysts are rare congenital malformations that occur in adults and children, with differences in distribution and presentation. We present the case of a newborn who initiated respiratory distress from the first minutes of life, presenting with hypoventilation and rightward displacement of the cardiac impulse, requiring oxygen therapy and intubation. The first radiograph shows a left pulmonary emphysema. The computerized axial tomography revealed a large mediastinal mass causing an obstructive syndrome of the left bronchus. The mass was successfully excised, resulting in a favorable clinical evolution. Although the presentation of our case is exceptional, it is worth noting that while most bronchogenic cysts are asymptomatic, they can occur in childhood, even from birth, as in our case.

Analysis of the prenatal ultrasound diagnostic value and prognostic factors of fetal mediastinal cysts.

A prenatal fetal mediastinal cyst is a benign disease. However, if a cyst enlargement grows, it may compress the adjacent organs and affect the fetal cardiopulmonary function. This study aimed to compare and analyze the prenatal ultrasound characteristics of different mediastinal cysts, and to evaluate the pregnancy outcome of the fetus and the factors affecting the prognostic of the fetus. To compare and analyze the prenatal ultrasound characteristics of different types of mediastinal cysts, and to evaluate the fetal pregnancy outcome and the influencing factors of fetal prognosis. A retrospective analysis of patients with prenatal diagnoses of mediastinal cysts was conducted to evaluate the ultrasound characteristics and to monitor the pregnancy outcomes to identify prognostic influences and provide a reliable basis for patient prognosis. In total, 30 patients were diagnosed with mediastinal cysts [including bronchogenic cysts (n=12), esophageal cysts (n=9), pericardial cysts (n=5), and thymic cysts (n=4)] on prenatal ultrasonography. The diagnostic accuracy rate was 93.33%; two cases of esophageal cysts were misdiagnosed as bronchial cysts. In total, 4 (44.44%) of 9 esophageal cysts and 4 thymic cysts were located in the anterior mediastinum, 10 (83.33%) of 12 bronchogenic cysts and 5 pericardial cysts were located in the middle mediastinum, and 2 (16.67%) of 12 bronchogenic cysts and 5 (55.56%) of 9 esophageal cysts were located in the posterior mediastinum. There were significant differences in the distribution of the cyst location, morphology, and cyst wall thickness (P<0.05). After delivery, 17 patients had clinical symptoms. There was a significant difference in the clinical symptoms between patients with a maximum diameter of postpartum cysts <5 and ≥5 cm (P<0.05), and children with a low gestational age and birth weight were more likely to have clinical symptoms. The prenatal ultrasound features of fetal mediastinal cysts were similar. However, the ultrasound characteristics related to the cyst location, morphology, and cyst wall thickness were helpful in providing an accurate diagnosis. In addition, the postpartum cyst size, location, adjacent relationship with the surrounding tissues, volume, gestational age, and weight were related to patient prognosis.

Mediastinal dumbbell hydatid cyst compressing the thoracic spinal cord: A case report and literature review

Introduction: Hydatid disease, or echinococcosis, is a parasitic infection of humans caused by tapeworms of the genus Echinococcus. The liver and lungs are the most common organs to be involved. Mediastinal and bone involvement were reported to be rare, 0.1% and 0.5–4%, respectively. Spine involvement has been reported in 50% of patients with bone involvement. Case Report: We presented a rare case of an 18-year-old male patient with a recurrent mediastinal hydatid cyst which widened the neural foramina, extended into the spinal canal, and compressed the spinal cord. He presented with back pain, spastic paraparesis, and bowel/bladder incontinence. Computed tomography (CT) and magnetic resonance imaging (MRI) showed polycystic mediastinal mass with erosion of the upper thoracic vertebra and the rib; widening of the neural foramina; extension into the spinal canal and compression of the spinal cord. The patient was operated on. Through a posterior approach, the polycystic mass was removed totally. The mass in the mediastinal (paravertebral) area was removed totally through the widened neural foramen. The cavity was washed with 3% hydrogen peroxide. The histopathology confirmed the diagnosis of a hydatid cyst. Postoperatively the patient was treated with oral albendazole for six months. On the sixth month follow-up, the neurologic status had only mild improvement and the follow-up scan did not show any recurrence of the infection. Conclusion: Hydatid cysts can rarely involve the mediastinal (paravertebral) area and can extend to the spinal epidural space causing neurologic compromise.

Spatiotemporal distribution of mediastinal neoplasms: A comprehensive multi-center study

ObjectivesMediastinal neoplasms are typical but uncommon thoracic diseases with increasing incidence and unfavorable prognoses. A comprehensive understanding of their spatiotemporal distribution is essential for accurate diagnosis and timely treatment. However, previous studies are limited in scale and data coverage. Therefore, this study aims to elucidate the distribution of mediastinal lesions, offering valuable insights into this disease. Materials and methodsThis multi-center, hospital-based observational study included 20 nationwide institutions. A retrospective search of electronic medical records from January 1st, 2009, to December 31st, 2020, was conducted, collecting sociodemographic data, computed tomography images, and pathologic diagnoses. Analysis focused on age, sex, time, location, and geographical region. Comparative assessments were made with global data from a multi-center database. ResultsAmong 7,765 cases, thymomas (30.7%), benign mediastinal cysts (23.4%), and neurogenic tumors (10.0%) were predominant. Distribution varied across mediastinal compartments, with thymomas (39.6%), benign cysts (28.1%), and neurogenic tumors (51.9%) most prevalent in the prevascular, visceral, and paravertebral mediastinum, respectively. Age-specific variations were notable, with germ cell tumors prominent in patients under 18 and aged 18–29, while thymomas were more common in patients over 30. The composition of mediastinal lesions across different regions of China remained relatively consistent, but it differs from that of the global population. ConclusionThis study revealed significant heterogeneity in the spatiotemporal distribution of mediastinal neoplasms. These findings provide useful demographic data when considering the differential diagnosis of mediastinal lesions, and would be beneficial for tailoring disease prevention and control strategies.

Ghost Passenger in the Heart: The Story of an Intracardiac Cyst Dancing with Coronary and Peripheral Embolisms

Cardiac localization of hydatid cyst, which is a parasitic disease, is rare. In this article, a case of mediastinal hydatid cyst invading the left atrium is presented. A 62-year-old male patient with risk factors for coronary artery disease presented with epigatric pain, nausea and vomiting. Coronary imaging was performed because ongoing epigatric pain was accompanied by ischemic changes and elevated troponin on electrocardiography. No occlusive lesion was observed in the epicardial coronary arteries. Mesenteric embolism was detected in the patient whose epigatric pain continued. The patient, who did not accept surgery after the initial diagnosis, developed peripheral and cerebral emboli in the following period, and the patient was referred for surgery.

An important finding for differential diagnosis in thymic cyst mimicking pericardial cyst: punctate calcification.

Mediastinal cysts are usually congenital but present in adulthood. A pericardial cyst is usually localized in the right cardiophrenic region. Thymic cysts are less common and are located in the cervical region or anterior mediastinal region. While thoracoscopic excision or aspiration can be applied in pericardial cysts, excision is recommended in thymic cysts. We present a case of a thymic cyst located in the localization of the pericardial cyst and radiologically containing wall punctate calcification.

Complete resection of a recurrent bronchogenic cyst tightly adhered to the left atrium using cardiopulmonary bypass: a case report.

Most surgeons agree that symptomatic mediastinal bronchogenic cysts should be resected, and complete resection is considered mandatory to avoid recurrence. However, a symptomatic mediastinal bronchogenic cyst sometimes adheres to a vital organ, making complete resection hazardous. In such case, surgical resection using cardiopulmonary bypass should be performed to achieve complete resection. A 65-year-old female patient had undergone surgical drainage of a mediastinal bronchogenic cyst 30 years ago. Recently, she presented with complaints of orthopnea, and computed tomography revealed a few days later a subcarinal bronchogenic cyst markedly compressing the left atrium. Complete resection of the mediastinal bronchogenic cyst was performed using cardiopulmonary bypass. The postoperative course was uneventful. The patient was followed up for 1 year, with no recurrence of the bronchogenic cyst. For patients with mediastinal bronchogenic cysts compressing the left atrium, we recommend complete resection using cardiopulmonary bypass.

Thoracoscopic Excision of Mediastinal Bronchogenic Cysts in Children: A Case Series.

Background: Bronchogenic cysts result from a congenital anomalous budding of the tracheobronchial tree. Resection is usually recommended to avoid complications. Mediastinal bronchogenic cysts present a unique challenge due to their proximity to vital structures. The purpose of this study is to review our experience with mediastinal bronchogenic cysts. Methods: A single-institution retrospective review evaluated all mediastinal bronchogenic cyst excisions between January 2012 and November 2022. Patient demographics were assessed, including age at diagnosis, presenting symptoms, imaging workup, and cyst characteristics. Operative approach, complications, and surgical pathology were reported. Results: Five patients were identified. Age at diagnosis ranged from 18 to 27 months. No patient was diagnosed prenatally. All patients had symptoms at the time of diagnosis, including cough, wheezing, and respiratory distress. Three cysts were paratracheal, and two were paraesophageal. Age at surgery ranged from 26 to 30 months. All bronchogenic cysts were successfully resected thoracoscopically. Individual technical challenges included narrowing of the mainstem bronchus preventing lung isolation, significant mediastinal inflammation, the necessity for cyst evacuation to delineate the extent of the cyst, adherence of cyst wall to bronchus or trachea requiring cold dissection, and a stalk of tissue with an intimate connection to the carina that was amputated. No intraoperative or postoperative complication occurred. Surgical pathology was consistent with a bronchogenic cyst in all cases. Median length of hospital stay was two days. Conclusion: Thoracoscopy is a safe and effective procedure for mediastinal bronchogenic cyst excision in children. Certain technical maneuvers are highlighted, which may facilitate resection.

A giant mediastinal coelomic cyst resected by uni-portal VATS

médiastinal Coelomic cysts are rare cysts of mesothelial origin. They represent 4 to 11% of all mediastinal tumors. It affects both men and women. The diagnosis is often made in adulthood. They are often asymptomatic We repport the rare case of mesothelial cyst of mediastinum. A 38-year-old woman with no medical history, she was reffered to our department after chest X-ray showed a giant anterior madiastinum. The lesion was resected by VATS, which revealed a médiastinal cystic that extends from the top of the anterior mediastinum to the diaphragm. On histological section, the cystic wall is seat of a significant inflammatory, lined by a flattened epithelial lining of mesothelial type, conclusive to mediastinal pleural mesothelial cyst. The prognosis is excellent in the short and long term.

Presumed mediastinal cysts have a low prevalence in canine thoracic computed tomographic studies.

Mediastinal cysts (MCs) are rare lesions that can arise from embryonic remnants of various mediastinal structures. MCs usually are incidental findings in dogs and cats; however, they can reach a mass-like appearance. The description of MCs on CT in dogs is limited. This retrospective, single-center, descriptive, prevalence study aimed to determine the prevalence of presumed mediastinal cysts (PMCs) in dogs and assess their CT characteristics. Dogs that underwent a thoracic CT scan from January 2019 to August 2021 were included. CT images were evaluated for the presence of PMCs by two diagnostic imaging interns, two last year diagnostic imaging residents, and a board-certified veterinary radiologist. Number, location, margins, shape, volume, size, mass effect, and attenuation values of PMCs were assessed. A total of 866 CT scans were reviewed, and 49 PMCs were identified. The prevalence of PMCs in dogs was 5.66%. English Bulldog and mixed-breed dogs were subjectively overrepresented; however, the possibility of population bias could not be excluded. PMCs were subjectively more frequently observed in male dogs. The PMCs were predominantly round, small, solitary fluid-filled findings localized in the cranioventral mediastinum, with well-defined margins, homogeneous attenuation, and no contrast enhancement. The median attenuation value was 6.32 HU (range: -20.16 to 23.45 HU) precontrast and 7.58 HU (range: -2.45 to 20.79 HU) postcontrast, and the median volume was 1.19 cm3 (range: 0.02-45.32 cm3). Although the prevalence of PMCs was low in our sample population, findings supported prioritizing a differential diagnosis of incidental PMC for dogs with the above imaging characteristics.

Symptomatic pericardial cysts and dilemmas in their diagnosis.

Pericardial cysts (PCs) or pleuropericardial cysts are rare congenital mediastinal lesions with an approximate incidence of one in 100 000 persons. Usually, they are asymptomatic, being incidentally discovered during a routine chest imaging examination or an autopsy exam. The study involved a retrospective evaluation of clinicopathological findings in a 6-year series of PCs, treated in the Clinic of Pulmonary Diseases, Iaşi, Romania. A group of five cases of PCs, four females and one male, were evaluated. All patients displayed different symptoms, such as dyspnea, chest pain, chronic cough, fatigue, palpitation, and epigastric pain. The cystic lesions were located in the right and left cardiophrenic angle, in four cases, and in the central mediastinum in a single case. The lesions had a fluid content and a maximum diameter that ranged between 35 and 95 mm. The microscopic examination of the surgical resection tissues revealed a thin connective tissue wall without any associated smooth muscle cells. The loose connective tissue band was lined by a layer of mesothelial cells with no cellular atypia, which displayed discrete papillary projections, in one case. Although PCs are rare incidental findings, they should be considered in differential diagnoses of mediastinal cysts, especially as they are associated with non-specific symptoms. Furthermore, considering the possibility of development of severe complications, PCs should be thoroughly explored for suitable patients' management.

Initial experience with robotic technology for thoracic surgery using the da Vinci Xi system in Tibet, China.

Although the robotic surgical system has accumulated rich experience in the development of thoracic surgery, its application in Tibet area is relatively late. We report our experience concerning da Vinci Xi system in thoracic surgery and observe its practicability and surgical effect. We retrospectively analyzed 26 patients who underwent robotic thoracic surgery including: twelve lung resection, two esophagectomies, ten mediastinal surgeries and two rib mass resection. The data of patient characteristics, operative time, perioperative complications were collected. Of the 26 patients, 22 cases were completed with da Vinci system successfully, including 7 segmentectomies, 4 lobectomies, 1 subsegmentectomy, 2 esophagectomies, 10 mediastinal surgeries (6 thymic resections, 3 posterior mediastinal tumor resection, 1 mediastinal cyst resection) and 2 rib mass resection. In which, 3 cases of lung resection begun with robotic technique were converted to thoracoscopic surgery (due to calcification of hilar lymph node), 1 case of bilobectomy was converted to thoracotomy due to thoracic adhesion. All the operations went well and no patients need blood transfusion. All patients had satisfactory postoperative recovery. It is safe, reliable and effective to carry out robotic thoracic surgery on the plateau. On the premise of carefully and seriously discussing the indications of surgery, we should actively carry out the application of da Vinci robotic surgery system in Tibet Plateau.

Role of esophageal ultrasound with a bronchoscope (EUS-B) with fine needle aspiration in the diagnosis of mediastinal Bronchogenic cyst.

A 12-year-old adolescent boy presented with complaints of persisting dry cough and exertional dyspnea. A CT chest revealed a cystic lesion posterior to the trachea and a flexible bronchoscopy revealed extrinsic compression of the posterior trachea and partial obstruction of the left main bronchus. He underwent an Endoscopic Ultrasound with a Bronchoscope. A Hypoechoic cystic lesion was seen just in front of the esophagus. Fine needle aspiration yielded thick mucoid aspirate and cytology revealed ciliated columnar epithelium, confirming the diagnosis of a Bronchogenic cyst.

Giant middle mediastinal lesions: when tumor size correlates with mesenchymal origin-a retrospective single-center analysis.

The International Thymic Malignancy Interest Group (ITMIG) proposed an internationally accepted division of the mediastinum into three compartments based on computed tomography (CT): anterior (prevascular), middle (visceral) and posterior (paravertebral) compartment. There is no generally accepted definition for the term "giant" when applied to middle mediastinal lesions. We defined the term "giant" and described our surgical experience in treating patients with giant lesions of the middle mediastinum. CT imaging of patients operated in our center from January 2016 to August 2021 for mediastinal lesions was reviewed. Lesions were categorized to one of the ITMIG-defined compartments. Lesion size at diagnosis was measured at its largest diameter on axial CT imaging. Giant middle mediastinal lesions were defined as lesions having a size ≥90th percentile of our middle mediastinal lesion cohort. Patients with giant middle mediastinal lesions were further analyzed. Thirty-six patients (23%) had lesions located in the middle mediastinal compartment. Most common diagnoses were mediastinal cysts (n=10, 28%), metastatic lesions (n=6, 17%), lymphomas (n=5, 14%), and sarcomas (n=3, 8%). Ninetieth percentile lesion size was 73 mm. As per definition, four patients had giant middle mediastinal lesions. All these four lesions were of mesenchymal origin including oesophageal leiomyoma, synovial sarcoma, leiomyosarcoma and undifferentiated round cell sarcoma. Resection was performed through posterolateral thoracotomy or sternotomy, with or without cardiopulmonary bypass. The term "giant" could be defined as a mass larger or equal to 73 mm. This definition selected specifically lesions with mesenchymal origin and may therefore guide diagnostic algorithm and patient management.

Mediastinal Thoracic Duct Cyst Infection after Endoscopic Submucosal Dissection for Early Esophageal Cancer: A Case Report.

A mediastinal thoracic duct cyst that originates from the thoracic duct is a very rare disease in the mediastinum. There have been no reports of mediastinal thoracic duct cyst infection caused by endoscopic treatment. This is the first case of mediastinal thoracic duct cyst infection after endoscopic submucosal dissection for early esophageal cancer. We herein report a 75-year-old man with mediastinal thoracic duct cyst infection caused by esophageal endoscopic submucosal dissection. In cases where a mediastinal thoracic duct cyst is found before performing endoscopic esophageal treatment, we should carefully consider the potential risk of post-treatment cyst infection.

P129 RARE CASE OF A GIANT THYMIC CYST: A CHALLENGING DIFFERENTIAL DIAGNOSIS OF A PARACARDIAC CYSTIC LESION

Abstract Background Benign thymic cysts are a rare clinical entity, representing approximately 3% of all mediastinal masses and can be congenital or acquired. We report a case of a 58–year–old female with a giant benign thymic cyst which entered in differential diagnosis with pericardial cyst and pericardial effusion. Case presentation: A 58–year–old female was brought to our hospital due to new onset dyspnoea and fatigue. She had a history of a mediastinal liquid mass incidentally discovered 9 years before which was interpreted at that time as a loculated pericardial effusion (Fig. 1). An echocardiogram was performed and it revealed increased size of the known lesion without any signs of hemodynamic compromise (Fig. 2). A magnetic resonance showed a voluminous liquid lesion that originated from the anterior mediastinum, extending caudally to the diaphragm with maximum dimension on the right hemithorax of 16 x 12 x 9 cm and on the left hemithorax of 10 x 5 x 13 cm (antero–posteriorly, transversely and cranio–caudally respectively) (Fig. 3). It was initially interpreted as a pericardial cyst. All the findings were then collegially reviewed and it was suspected of being a giant thymic cyst especially due to its rapid growth and spatial evolution over time. The cyst was surgically removed using a thoracoscopic approach. Histological examination confirmed the thymic origin of the cyst and excluded malignancy. At three month follow up, the patient presented no symptoms, and the echocardiogram was normal. Discussion The echocardiographic features of mediastinal cysts are not specific for the type of cystic lesion, so the origin and location of the cyst can be used for differential diagnosis. Computed tomography has the best spatial resolution, while the magnetic resonance has better capacity to differentiate the content of the cyst, especially when it is not a homogeneous liquid lesion. In our case, the growth over nine years was a crucial hint to suspect the thymic origin of the lesion. On the other hand, the sole evaluation of the last imaging exam would have made the diagnosis more challenging because of its huge dimensions, which made the exact site of origin almost impossible to identify. Conclusion Our case is a rare example of a giant thymic cyst which was extremely difficult to differentiate from other paracardiac cystic lesions and required integrated imaging and discussion by a team of experts of different specialties to make the correct diagnosis.