Moideen Sanu P, Reddy Mopuri Chaitanya Kumar, Joy Jaxin, Sajeev Eldho
Department of ENT, Head and Neck Oncosurgery, Excell ENT Hospital, Muvattupuzha, Kerala India.
Department of Surgical Oncology, Smita Memorial Hospital and Research Centre, Thodupuzha, Kerala India.
Indian J Otolaryngol Head Neck Surg. 2025 Jul;77(7):2612-2617. doi: 10.1007/s12070-025-05504-6. Epub 2025 May 16.
Congenital thymic cysts are rare benign neck masses found primarily in the paediatric population, comprising only 0.3% of congenital neck cysts in children. These cysts arise from embryonal thymic tissue along its descent path, with mediastinal extension seen in approximately 50% of cases. Due to their rarity, thymic cysts are often misdiagnosed as branchial or lymphangiomas. A 10-year-old boy presented with a progressively enlarging, painless neck mass. Imaging studies, including ultrasound and CT scan, revealed a fluid-density lesion in the parapharyngeal space extending to the mediastinum. Fine needle aspiration cytology initially suggested an infected branchial cyst. Surgical excision was performed, revealing a 9.5 × 2.5 × 1.5 cm cystic mass. Histopathology confirmed the diagnosis of a cervical thymic cyst, with features including Hassall's corpuscles and normal thymic tissue. Thymic cysts, often misdiagnosed due to their rarity, should be considered in the differential diagnosis of lateral neck masses in children. While typically found on the left side, they can occur elsewhere. Imaging is crucial for preoperative diagnosis, but surgery poses challenges due to the cyst's proximity to vital structures and due to mediastinal extension. Complete excision is advised; however, in young children, if mediastinal thymic tissue is absent, total removal should be avoided to prevent immune dysfunction. Greater clinician awareness is essential to reduce misdiagnosis and ensure proper management.
先天性胸腺囊肿是一种罕见的良性颈部肿块，主要见于儿童群体，仅占儿童先天性颈部囊肿的0.3%。这些囊肿起源于胚胎胸腺组织沿其下降路径，约50%的病例可见纵隔延伸。由于其罕见性，胸腺囊肿常被误诊为鳃裂囊肿或淋巴管瘤。一名10岁男孩出现逐渐增大的无痛性颈部肿块。包括超声和CT扫描在内的影像学检查显示，咽旁间隙有一个液性密度病变延伸至纵隔。细针穿刺细胞学检查最初提示为感染性鳃裂囊肿。进行了手术切除，发现一个9.5×2.5×1.5厘米的囊性肿块。组织病理学证实为颈胸腺囊肿，特征包括哈氏小体和正常胸腺组织。胸腺囊肿由于其罕见性常被误诊，在儿童侧颈部肿块的鉴别诊断中应予以考虑。虽然通常位于左侧，但也可发生在其他部位。影像学检查对术前诊断至关重要，但由于囊肿靠近重要结构且有纵隔延伸，手术具有挑战性。建议完整切除；然而，对于幼儿，如果没有纵隔胸腺组织，应避免完全切除以防止免疫功能障碍。提高临床医生的认识对于减少误诊和确保正确治疗至关重要。
