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Thymopharyngeal duct cyst: an unusual variant of cervical thymic anomalies.
Arch Otolaryngol Head Neck Surg. 2001 Nov; 127(11):1357-60.AO

Abstract

BACKGROUND

The thymus develops from the third pharyngeal pouch and descends from the neck into the anterior-superior mediastinum. Thus, it is possible to have thymic remnants in the neck, which most often present as a cervical mass during childhood. One type of cystic thymic remnant is the thymopharyngeal duct cyst, a remnant of one of the paired tracts of embryological thymic descent. Thymopharyngeal duct cysts are rare lesions that can have a similar presentation to more commonly encountered childhood neck masses.

OBJECTIVES

To review the embryological development of cervical thymic remnants and to report our experience with the thymopharyngeal duct cyst.

DESIGN

Case series.

SETTING

Tertiary care center.

PATIENTS

Two children who presented with asymptomatic neck masses that were caused by cystic remnants of the thymopharyngeal duct.

RESULTS

Both patients underwent preoperative computed tomography, which revealed a multiloculated mass coursing adjacent to the carotid sheath. Surgical treatment was the definitive therapy for both patients, although neither patient had a definitive preoperative diagnosis. In both cases, the mass was approached through an incision anterior to the sternocleidomastoid muscle, and dissection proceeded along the length of the carotid sheath. A fibrous cord extending into the mediastinum was found in both patients. There were no postoperative complications. Histopathologic evaluation revealed the presence of mature thymic elements within the wall of a multiloculated cyst.

CONCLUSIONS

Thymopharyngeal duct cysts must be considered in the differential diagnosis of pediatric neck masses. Computed tomography is helpful to delineate the relationship to the carotid sheath. Complete surgical excision is the appropriate therapy in a majority of cases, with minimal morbidity when careful attention is paid to vital structures.

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Authors+Show Affiliations

Kaufman MR
Department of Otolaryngology, The Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1189, New York, NY 10029, USA. kaufmanmatthew@hotmail.com
Smith S
No affiliation info available
Rothschild MA
No affiliation info available
Som P
No affiliation info available

MeSH

ChildCystsDiagnosis, DifferentialHumansMalePharyngeal DiseasesThymus GlandTomography, X-Ray Computed

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

11701074

Citation

Kaufman, M R., et al. "Thymopharyngeal Duct Cyst: an Unusual Variant of Cervical Thymic Anomalies." Archives of Otolaryngology--head & Neck Surgery, vol. 127, no. 11, 2001, pp. 1357-60.
Kaufman MR, Smith S, Rothschild MA, et al. Thymopharyngeal duct cyst: an unusual variant of cervical thymic anomalies. Arch Otolaryngol Head Neck Surg. 2001;127(11):1357-60.
Kaufman, M. R., Smith, S., Rothschild, M. A., & Som, P. (2001). Thymopharyngeal duct cyst: an unusual variant of cervical thymic anomalies. Archives of Otolaryngology--head & Neck Surgery, 127(11), 1357-60.
Kaufman MR, et al. Thymopharyngeal Duct Cyst: an Unusual Variant of Cervical Thymic Anomalies. Arch Otolaryngol Head Neck Surg. 2001;127(11):1357-60. PubMed PMID: 11701074.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thymopharyngeal duct cyst: an unusual variant of cervical thymic anomalies. AU - Kaufman,M R, AU - Smith,S, AU - Rothschild,M A, AU - Som,P, PY - 2001/12/26/pubmed PY - 2002/1/5/medline PY - 2001/12/26/entrez SP - 1357 EP - 60 JF - Archives of otolaryngology--head & neck surgery JO - Arch Otolaryngol Head Neck Surg VL - 127 IS - 11 N2 - BACKGROUND: The thymus develops from the third pharyngeal pouch and descends from the neck into the anterior-superior mediastinum. Thus, it is possible to have thymic remnants in the neck, which most often present as a cervical mass during childhood. One type of cystic thymic remnant is the thymopharyngeal duct cyst, a remnant of one of the paired tracts of embryological thymic descent. Thymopharyngeal duct cysts are rare lesions that can have a similar presentation to more commonly encountered childhood neck masses. OBJECTIVES: To review the embryological development of cervical thymic remnants and to report our experience with the thymopharyngeal duct cyst. DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: Two children who presented with asymptomatic neck masses that were caused by cystic remnants of the thymopharyngeal duct. RESULTS: Both patients underwent preoperative computed tomography, which revealed a multiloculated mass coursing adjacent to the carotid sheath. Surgical treatment was the definitive therapy for both patients, although neither patient had a definitive preoperative diagnosis. In both cases, the mass was approached through an incision anterior to the sternocleidomastoid muscle, and dissection proceeded along the length of the carotid sheath. A fibrous cord extending into the mediastinum was found in both patients. There were no postoperative complications. Histopathologic evaluation revealed the presence of mature thymic elements within the wall of a multiloculated cyst. CONCLUSIONS: Thymopharyngeal duct cysts must be considered in the differential diagnosis of pediatric neck masses. Computed tomography is helpful to delineate the relationship to the carotid sheath. Complete surgical excision is the appropriate therapy in a majority of cases, with minimal morbidity when careful attention is paid to vital structures. SN - 0886-4470 UR - https://www.unboundmedicine.com/medline/citation/11701074/Thymopharyngeal_duct_cyst:_an_unusual_variant_of_cervical_thymic_anomalies_ L2 - https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/vol/127/pg/1357 DB - PRIME DP - Unbound Medicine ER -