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Advances in Anatomic Pathology Sep 2020Primary mediastinal cysts are infrequent lesions that can arise from a variety of mediastinal organs or structures. Most of these are congenital in origin and incidental... (Review)
Review
Primary mediastinal cysts are infrequent lesions that can arise from a variety of mediastinal organs or structures. Most of these are congenital in origin and incidental findings during investigations for unrelated conditions. Histologically, the cysts may be composed of various tissues, including bronchogenic, pericardial, thymic, enteric, Müllerian, lymphatic, and parathyroid types. Mediastinal cysts typically demonstrate a benign clinical course and patients are cured after complete surgical resection. In this review, the embryogenesis, clinical, radiologic, and pathologic characteristics of non-neoplastic mediastinal cysts are examined with discussion of the role of immunohistochemistry and the most pertinent differential diagnosis.
Topics: Diagnosis, Differential; Humans; Immunohistochemistry; Mediastinal Cyst; Tomography, X-Ray Computed
PubMed: 31972565
DOI: 10.1097/PAP.0000000000000261 -
The Surgical Clinics of North America Jun 2015Benign esophageal and paraesophageal masses and cysts are a rare but important group of pathologies. Although often asymptomatic, these lesions can cause a variety of... (Review)
Review
Benign esophageal and paraesophageal masses and cysts are a rare but important group of pathologies. Although often asymptomatic, these lesions can cause a variety of symptoms and, in some cases, demonstrate variable biological behavior. Contemporary categorization relies heavily on endoscopic ultrasound and other imaging modalities and immunohistochemical analysis when appropriate. Minimally invasive options including endoscopic, laparoscopic, and thoracoscopic methods are increasingly used for symptomatic or indeterminate lesions.
Topics: Adenoma; Diagnosis, Differential; Endosonography; Esophageal Neoplasms; Esophagoscopy; Gastrointestinal Neoplasms; Gastrointestinal Stromal Tumors; Granular Cell Tumor; Granuloma, Plasma Cell; Hemangioendothelioma; Humans; Immunohistochemistry; Laparoscopy; Leiomyoma; Mediastinal Cyst; Neurilemmoma; Polyps; Thoracoscopy; Tomography, X-Ray Computed
PubMed: 25965126
DOI: 10.1016/j.suc.2015.02.005 -
Mediastinum (Hong Kong, China) 2023
PubMed: 37261098
DOI: 10.21037/med-22-30 -
Radiologic Clinics of North America Mar 2021Prevascular mediastinal masses include a wide range of benign and malignant entities. Localization of mediastinal masses to specific compartments together with... (Review)
Review
Prevascular mediastinal masses include a wide range of benign and malignant entities. Localization of mediastinal masses to specific compartments together with characteristic imaging findings and demographic and clinical information allows formulation of a focused differential diagnosis. Radiologists may use these methods to distinguish between surgical and nonsurgical cases and thus inform patient management and have an impact on outcomes. Treatment of choice varies based on the pathology, ranging from no intervention or serial imaging follow-up to surgical excision, chemotherapy, and/or radiation.
Topics: Diagnostic Imaging; Humans; Mediastinal Neoplasms; Mediastinum
PubMed: 33551078
DOI: 10.1016/j.rcl.2020.10.003 -
Mediastinum (Hong Kong, China) 2022Mediastinal thymic cysts are a relatively rare pathology. With the expansion of eligible individuals screened with cross-sectional imaging for lung cancer, it is likely... (Review)
Review
BACKGROUND AND OBJECTIVE
Mediastinal thymic cysts are a relatively rare pathology. With the expansion of eligible individuals screened with cross-sectional imaging for lung cancer, it is likely that there will be an increase in the number of individuals presenting with these cysts. Understanding this rare pathology will become more important when this incidental pathology is encountered.
METHODS
Search of PubMed was undertaken using keywords "mediastinal", "mediastinum", "thymic", "thymus", "cyst". Relevant literature was reviewed and selected for this comprehensive narrative review, including case reports, case series, and retrospective reviews.
KEY CONTENT AND FINDINGS
Thymic cysts in the mediastinum can be classified into two broad categories, congenital and inflammatory. Accurate diagnosis by imaging is challenging and the majority of patients are asymptomatic. Literature suggests that the majority of cysts are benign, however an unknown percentage may harbor neoplastic processes and over time can cause significant compressive symptoms. Definitive treatment and diagnosis is surgical, with overall excellent outcomes. The decision to pursue surgical treatment versus surveillance requires a shared decision making approach with patients.
CONCLUSIONS
Given the scarcity of available high quality evidence regarding the management of mediastinal thymic cysts, this review provides practitioners a broad knowledge base to guide patients to make informed decisions.
PubMed: 36582977
DOI: 10.21037/med-22-25 -
Mediastinum (Hong Kong, China) 2023Bronchogenic cysts represent a rare form of cystic malformation of the respiratory tract. Primarily located in the mediastinum if occurring early in gestation as opposed... (Review)
Review
BACKGROUND AND OBJECTIVE
Bronchogenic cysts represent a rare form of cystic malformation of the respiratory tract. Primarily located in the mediastinum if occurring early in gestation as opposed to the thoracic cavity if arising later in development. However, they can arise from any site along the foregut. They exhibit a variety of clinical and radiologic presentations, representing a diagnostic challenge, especially in areas with endemic hydatid disease. Endoscopic drainage has emerged as a diagnostic and potentially therapeutic option but has been complicated by reports of infection. Surgical excision remains the standard of care allowing for symptomatic resolution and definitive diagnosis via pathologic examination; minimally invasive approaches such as robotic and thoracoscopic approaches aiding treatment. Following complete resection, prognosis is excellent with essentially no recurrence.
METHODS
A review of the available electronic literature was performed from 1975 through 2022, using PubMed and Google Scholar, with an emphasis on more recent series. We included all retrospective series and case reports. A single author identified the studies, and all authors reviewed the selection until there was a consensus on which studies to include.
KEY CONTENT AND FINDINGS
The literature consisted of relatively small series, mixed between adult and pediatric patients, and the consensus remains that all symptomatic lesions should be excised via minimally invasive approach where feasible.
CONCLUSIONS
Surgical excision of symptomatic bronchogenic cysts remains the gold standard, with endoscopic drainage being reserved for diagnosis or as a temporizing measure in clinically unstable patients.
PubMed: 37701638
DOI: 10.21037/med-22-46 -
Mediastinum (Hong Kong, China) 2022Whether and when surgical intervention is indicated for mediastinal cysts is a matter of some debate. While most mediastinal cysts are found incidentally, the anatomic... (Review)
Review
BACKGROUND AND OBJECTIVE
Whether and when surgical intervention is indicated for mediastinal cysts is a matter of some debate. While most mediastinal cysts are found incidentally, the anatomic location, clinical presentation, and symptoms, as well as the potential for malignancy, are important considerations that inform decisions related to whether to intervene surgically. The objective of this review is to summarize the current literature regarding the criteria for surgical excision of mediastinal cysts and provide a framework for the clinician and surgeon to arrive at a decision regarding the appropriateness of surgical intervention of mediastinal cysts.
METHODS
A review of the published literature in the last 45 years (1977-2022) was conducted through PubMed, MeSh and Google Scholar. We included retrospective reviews, meta-analyses, and case studies published in the English language. A single author identified eligible studies, and those identified were reviewed by the team until consensus was met. Pediatric literature was excluded from this review.
KEY CONTENT AND FINDINGS
The current literature predominantly contains case studies, small retrospective studies, and meta-analyses describing mediastinal cysts. In the anterior mediastinum, multiloculated thymic cysts should be resected to rule out thymic malignancy. Intralesional fat, smooth borders, and a more midline location are features suggestive of a benign process, while asymmetric cystic wall thickening has been associated with malignancy. Both esophageal and bronchogenic cysts should be excised, taking into account the risk of complications (up to a 45% risk) of infection, rupture, or compression, as well as the rare risk of associated malignancy. Simple thymic and small pericardial cysts can be observed and followed with serial radiographic tools and should be resected if they increase in size, compress surrounding structures, or lead the patient to develop symptoms.
CONCLUSIONS
Since mediastinal cysts are rare and often asymptomatic, there are no formal guidelines outlining when surgical intervention should be undertaken. Based on our review of the literature, surgical intervention should be pursued if the patient's symptoms correlate with radiographic findings of a mediastinal cyst, there is compression of the surrounding structures, and concern of malignancy is present.
PubMed: 36582980
DOI: 10.21037/med-22-27 -
JPMA. the Journal of the Pakistan... Sep 2014A 20-year-old female presented with complaints of right-sided chest pain, cough, fever and shortness of breath for the preceding one-and-a-half year. Air entry was...
A 20-year-old female presented with complaints of right-sided chest pain, cough, fever and shortness of breath for the preceding one-and-a-half year. Air entry was decreased over the middle and lower chest. Computed tomography scan of the chest revealed a cystic lesion with thick margins present in the right hemi-thorax. The cyst was excised by posterolateral thoracotomy. Histopathology revealed it to be mediastinal enteric cyst with intestinal and pancreatic tissue.
Topics: Adult; Female; Humans; Intestinal Diseases; Mediastinal Cyst; Pancreatic Cyst; Radiography, Thoracic; Tomography, X-Ray Computed; Young Adult
PubMed: 25823194
DOI: No ID Found -
Revue Medicale de Liege Nov 2019Mediastinal hydatid cyst is an exceptional pathology that poses a problem of diagnosis with the other cystic lesions of the mediastinum. Diagnosis is suspected on...
Mediastinal hydatid cyst is an exceptional pathology that poses a problem of diagnosis with the other cystic lesions of the mediastinum. Diagnosis is suspected on ultrasound and CT exams and confirmed by surgical findings and histopathological characteristics.
Topics: Echinococcosis; Humans; Mediastinal Cyst; Mediastinum; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31729842
DOI: No ID Found -
Current Cardiology Reports May 2019This is an in-depth review on the etiology, clinical manifestation, differential diagnosis, diagnostic modalities, complications, and management of pericardial cysts... (Review)
Review
PURPOSE OF REVIEW
This is an in-depth review on the etiology, clinical manifestation, differential diagnosis, diagnostic modalities, complications, and management of pericardial cysts (PCs).
RECENT FINDINGS
PCs are the third most common type of mediastinal masses and are usually identified incidentally by chest x-ray (CXR) or transthoracic echocardiography (TTE). Although most PCs are asymptomatic, they might lead to serious complications such as cardiac tamponade. Diagnosis is confirmed by cardiac computed tomography or cardiac magnetic resonance. Cysts need to be followed by imaging every 1 to 2 years; however, a recent report suggested less frequent follow-up. Most cases resolve spontaneously, but if needed, aspiration or surgical resection can be done. PCs are rare entities and are usually detected incidentally after CXR or TTE. Providers should be aware of this condition since it could potentially lead to serious complications.
Topics: Cardiac Tamponade; Diagnosis, Differential; Echocardiography; Humans; Magnetic Resonance Imaging; Mediastinal Cyst; Pericardium; Tomography, X-Ray Computed
PubMed: 31147788
DOI: 10.1007/s11886-019-1153-5