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Journal of Pediatric Surgery Nov 2021Ectopic cervical thymus (ECT) is a rare cause of neck swelling in children. Our aim was to evaluate the diagnostic and management challenges of this condition. (Review)
Review
BACKGROUND/PURPOSE
Ectopic cervical thymus (ECT) is a rare cause of neck swelling in children. Our aim was to evaluate the diagnostic and management challenges of this condition.
METHODS
Systematic review of the literature (1997-2020) using PRISMA guidelines.
RESULTS
A total of 192 cases of ECT were identified. Forty-two cases (4 studies) were excluded because of insufficient data resulting in 150 cases (7 bilateral) in a total of 143 patients. ECT presented as a solid mass in 71 cases (10 incidentally found at autopsy, 33 conservatively managed and 28 excised) and as a cystic mass in 79 cases (all excised). A total of 165 imaging studies in 123 patients were performed (65 ultrasound scans (USS), 51 magnetic resonance imaging (MRI) scans and 49 computer tomography (CT) scans). ECT was diagnosed by imaging in 18.7% (23/123) of patients. Fine needle aspiration cytology or incisional/needle biopsy were performed in 16% (23/140) cases; a correct diagnosis of ECT was obtained in 52% (12/23) of those cases. There were no reports of malignancy in 143 specimens analysed. A normal mediastinal thymus was absent in 2.5% (1/40) of patients investigated.
CONCLUSIONS
ECT is a benign and relatively rare condition in children that is seldom diagnosed on imaging before tissue sampling or surgical excision. ECT might be the only active thymus in 2.5% of cases and careful consideration should be taken prior to its excision in young children. We recommend that ECT should be considered in the differential diagnosis of neck masses in children. Conservative management might be appropriate in selected cases and the presence of a normal mediastinal thymus in the thorax should be investigated before planning surgical excision.
Topics: Biopsy, Fine-Needle; Child; Child, Preschool; Choristoma; Diagnosis, Differential; Humans; Neck; Thymus Gland; Ultrasonography
PubMed: 33789804
DOI: 10.1016/j.jpedsurg.2021.03.003 -
Journal of Bronchology & Interventional... Jul 2015Although surgical resection of mediastinal bronchogenic cysts is considered the treatment of choice, there is increasing interest in minimally invasive approaches of... (Review)
Review
BACKGROUND
Although surgical resection of mediastinal bronchogenic cysts is considered the treatment of choice, there is increasing interest in minimally invasive approaches of management. The purpose of this study was to review the literature on the role of transbronchial needle aspiration (TBNA), either conventional or endobronchial ultrasound (EBUS)-guided, in the diagnosis and management of bronchogenic cysts.
METHODS
We systematically searched the PubMed and EmBase databases for studies (until July 2014) reporting TBNA of bronchogenic cysts. Data were recorded on a standard data extraction form and is presented in a descriptive manner.
RESULTS
Our search yielded 26 studies (32 patients). The median age of the patients was 43 years. Most were men (n=15), symptomatic at presentation (n=19), and had cysts in the paratracheal location (n=14). Endosonography was performed on 16 patients. The EBUS appearance of the lesion was hypoechoic and anechoic in 11 and 5 patients, respectively. Thirty-one patients underwent TBNA (conventional: 16; EBUS-guided: 15). The intent of TBNA was therapeutic in 19 patients and diagnostic or symptomatic palliation in the others. Complications were reported in 5 (16.1%) patients [infective (n=4), bradycardia (n=1)] after TBNA; there were no deaths. The median duration of follow-up was 14 months and no recurrences were detected during the follow-up period.
CONCLUSIONS
Bronchoscopy is a useful tool in the diagnosis of bronchogenic cysts, both for confirmation of the cystic nature of the lesion by EBUS and diagnosis by TBNA (preferably EBUS-guided) of the cyst fluid. Therapeutic aspiration of the cyst may be an alternative to surgery in adults with mediastinal bronchogenic cysts.
Topics: Biopsy, Fine-Needle; Bronchogenic Cyst; Bronchoscopy; Endosonography; Humans; Mediastinum; Ultrasonography, Interventional
PubMed: 26165889
DOI: 10.1097/LBR.0000000000000174