Prenatal diagnosis of a large, cervical, intraspinal, neurenteric cyst and postnatal outcome

Neurenteric cysts are rare congenital anomalies derived from the notochord and located in front of the spinal column, mostly at the cervical level. They consist of an intraspinal cystic component that is connected to a mediastinal or thoracic cyst. A case of a cervical, intraspinal, neurenteric cyst, diagnosed at 28 weeks of gestation and operated on at 3 and half months after birth, is reported. Herein, we discuss important features of this case including its rare occurrence, intrauterine diagnosis, and early surgical intervention. In conclusion, the nature of prenatal intradural cysts should be fully evaluated and differentiated between neurenteric cyst and other types of cysts with fetal ultrasonography. Therefore, it is essential to be aware of this potential cyst in fetal ultrasonography in utero. Neurenteric cyst should be considered in the differential diagnosis of cervical intradural cystic lesions. In infants, successful surgery provides a cure in patients with cervical neurenteric cysts.     

Retroperitoneal alimentary tract duplications detected in utero.

The prenatal diagnosis of numerous congenital anomalies has become routine. The prenatal diagnosis of cystic lesions of the retroperitoneum can be due to a variety of renal, gastrointestinal, or adrenal lesions. This finding demands aggressive postnatal follow-up to rule out the possibility of cystic adrenal neuroblastoma. We report the first cases of retroperitoneal cystic masses diagnosed in utero that ultimately proved to be enteric duplications. Therefore, the differential diagnosis of cystic masses of the retroperitoneum found prenatally should be expanded to include enteric duplication cysts.     

Respiratory complications in cervical thymic cysts

Thymic cysts are considered uncommon lesions in the differential diagnosis of pediatric neck masses. They have been described as asymptomatic and of little clinical consequence. Recent reports have stressed the possibility of respiratory compromise associated with these lesions. We reviewed our experience with cervical thymic cysts with emphasis on respiratory problems. Ten pediatric patients underwent surgery and were found to have cervical thymic cysts. Ages ranged from newborn to 14 years. There were four boys and six girls. Two were found to have the thymic cysts at time of neck exploration for Grave's disease and hyperparathyroidism. Of the remaining eight patients, all had mobile cystic masses, located anterior to but extending beneath the lower third of the sternocleidomastoid muscle. The size of the mass ranged from 3.0 to 8.5 cm. Preoperative diagnosis included cystic hygroma/branchial cleft cyst (five), lymphoma (one), teratoma (one), and thymic cyst (one). All had a history of rapidly developing neck mass. Seven of the eight gave a history of upper respiratory tract infection (URI) prior to the development of the mass. Five had imaging studies that showed tracheal compression. Three of these required airway management in the early postoperative period. All were excised through a neck incision, with two requiring sternal extension. Histology showed cholesterol crystals, Hassall's corpuscles, and giant cell reaction diagnosis of thymic cysts. There has been no recurrence and no permanent respiratory sequela in the ten patients. Cervical thymic cysts are benign lesions that may be more common than literature suggests.(ABSTRACT TRUNCATED AT 250 WORDS)     

Thoracic duct cyst: sclerotherapy as alternative for surgical treatment

BACKGROUND: Thoracic duct cysts of the cervical portion are rare benign lesions for which surgery is the treatment of choice. METHODS: We present 2 cases of a thoracic duct cyst of the cervical portion. One patient was treated by surgery and the other patient by ethanol sclerotherapy. RESULTS: After establishing diagnosis by radiologic assessment and chemical and cytological fine-needle aspirate of the cystic masses, both patients were treated successfully. CONCLUSION: Ethanol sclerotherapy provides an alternative therapy for thoracic duct cyst when evaluation establishes a high likelihood of clinical diagnosis.     

Aberrant cervical thymus in children: three case reports and review of the literature

Aberrant migration of thymic tissue occurs with ectopic thymus in the mediastinum, base of the skull, tracheal bifurcation, and cervical region. A recent review of the literature showed a total of 76 reported cases of aberrant thymus or thymic cysts in patients who presented with primary neck masses. We report three additional cases of ectopic cervical thymus. All three patients presented with asymptomatic cervical masses, and preoperative diagnosis included branchial cleft cyst, cervical lymphangioma, and cervical teratoma. All patients underwent complete surgical resection of the masses. Aberrant cervical thymus rarely produces symptoms because it does not invade contiguous strictures. Despite its rarity, it should be considered in the differential diagnosis of asymptomatic neck masses in children.     

Papillary carcinoma arising on cervico-mediastinal thyroglossal ductal cyst resected via transcervical and partial upper sternotomy incision.

Thyroglossal cyst is the most common congenital cervical pathology of childhood. Malign transformation in thyroglossal cyst is very rare and seen generally in adults. Here, we report on a 40-year-old female patient who presented with progressive dyspnea and enlarging cervical masses. Radiological examination revealed multiple cystic lesions in cervical and mediastinal region. The cysts were resected surgically via transcervical and partial upper sternotomy incision. Pathological examination revealed malignant change in the cervico-mediastinal thyroglossal cysts.     

Subdiaphragmatic foregut cyst: case report, differential diagnosis, and review of the literature.

Foregut-derived cysts are uncommon lesions, particularly when located below the diaphragm. When so encountered, they enter into the differential diagnosis of upper retroperitoneal masses. We report a case of such a lesion presenting as a pancreatic mass and review the current literature on this topic.     

Parathyroid cyst: a rare case report

Parathyroid cysts are rare lesions arising in the neck and anterior mediastinum. Fewer than 250 cases have been pub lished in the literature. Parathyroid cysts constitute only 0.6% of all thyroid and parathyroid lesions, but should be considered in the differential diagnosis of anterior neck masses, particularly in the presence of hypercalcaemia.     

Thymic cyst presented as a painless cervical mass in a child

An 11-year old boy presented with a painless mass in the left side of the posterior cervical triangle and reported dyspnoea during physical exercise. Total surgical resection and histological examination of the mass confirmed the diagnosis of a cervical thymic cyst. With just few reported cases, cervical thymic cysts represent a rare entity. They usually present as painless masses. The clinical symptoms, differential diagnosis and therapeutic approach are discussed herein.     

Cystic lesion of the thymus. An occasionally malignant cervical and/or anterior mediastinal mass

Between 1965 and 1982, we treated 46 patients with cystic lesions of the thymus. Thirty patients had anterior mediastinal cysts, nine had cysts which were large enough to be both cervical and mediastinal, and seven had cervical cysts. The majority (40/46) presented with asymptomatic masses. Six patients presented with distinct complaints: dysphagia (four patients), hoarseness owing to vocal cord paralysis (one patient), and cervical pain (one patient). All six had benign thymic cysts. The diagnosis of a cystic mass was established prior to operation by ultrasonography and computed axial tomography in our last three patients. These two techniques delineated the capsule and the central fluid in those three cases. All 46 patients had the mass resected without mortality or significant morbidity, except for resection of the phrenic nerve in one patient with malignant cystic thymoma. Cervical cysts were excised through cervical incisions. Cysts located in the anterior mediastinum and cervical-mediastinal cysts required median sternotomy or right thoracotomy for successful resection. Pathological examination showed that 39 patients had benign thymic cysts, three had benign cystic thymoma, two had malignant thymoma, one had a seminoma arising in the thymus, and one had a lymphoblastoma. We believe that a cystic thymic mass which can be detected by ultrasonography and computed tomography, although usually benign, does not eliminate the possibility of malignancy, and resection, therefore, is indicated.     

Unusual presentations of branchial cysts: a trap for the unwary.

Twenty-three cases of branchial cysts seen over 4 years are described. Only 11 patients presented with simple non-tender fluid swellings of the neck. Five patients presented with tender masses during infections and were diagnosed as acute abscesses. Seven patients presented with hard fixed masses mimicking lymphadenopathy. None of these were diagnosed correctly before surgery. Misdiagnosis led to significant morbidity from persistent cervical discharges. One patient had a partial nerve palsy. Infection of branchial cysts was common in this series and caused difficulties in diagnosis due to thickening of cysts walls following chronic inflammation in lymphoid tissue.     

Congenital neck masses in children and their embryologic and clinical features

Congenital neck masses in children and their embryologic and clinical features. Neck masses of congenital origin can be diagnostic and therapeutic challenges for internists, paediatricians and surgeons. Treatment modalities of congenital neck masses are different depending on their nature, symptoms and location. Differential diagnosis includes a variety of diseases that can cause cervical masses such as infectious and neoplastic neck tumours. Our objective is to review the embryologic and clinical features of some of the most common congenital neck masses such as the haemangioma, branchial cleft anomalies, thyroglossal duct cyst, ectopic thyroid, congenital midline cervical cleft, congenital cervical teratoma, lymphangioma, cervical thymic cyst, dermoid cyst and congenital muscular torticollis.     

Symptomatic glial cysts of the pineal gland

Two cases of symptomatic glial cysts of the pineal gland are reported. An origin similar to that proposed for paraventricular glial cysts of the brain is accepted. These unusual lesions could be considered in the differential diagnosis of cystic pineal masses.     

高频超声诊断浅表组织表皮样囊肿120例

目的探讨高频超声诊断浅表组织表皮样囊肿的价值。方法对120例经病理证实的浅表组织表皮样囊肿的高频超声声像图进行回顾性分析。结果超声病变全部病变均发现为单房性,其中58例超声提示表皮样囊肿,43例误诊为实性包块,12例误诊为囊实性混合性肿块,7例无法判断囊实性。109例肿块边界清楚,49例内部呈低、中回声,分布均匀;59例内部为细密强回声夹杂小管道样低回声;12例回声不均匀,内可见到小片状无回声区。92例肿块探头加压可产生形变,但内部细密强回声缺乏流动感。所有肿块内部均未见血流信号。结论表皮样囊肿具有特征性声像图表现;超声在表皮样囊肿的诊断中可以发挥重要作用。     

Testicular epidermoid cyst: uncommon lesion of difficult preoperative diagnosis

Intratesticular epidermoid cysts are rare tumours that constitute one percent of all testicular masses. They are bening lesions that make differential diagnosis from malignant testicular tumours difficult. The absence of serum markers elevation and ultrasound imaging could support these lesions being bening epidermoid cysts, and in that case, conservative surgery is adequate. We present the case of a 22 years old patient who complains of a left testicular mass. In this case ultrasound diagnosis was non-specific and a left radical inguinal orchiectomy was performed.     

Exuberant transverse ligament degeneration causing high cervical myelopathy

Two patients with cervical myelopathy and C1-C2 retro-odontoid masses were examined. Preoperative magnetic resonance imaging studies suggested soft tissue pannus, as might be seen in rheumatoid arthritis; however, the results of serologic testing for rheumatoid factor were negative in both patients. Intraoperative findings and pathologic examination revealed degenerative fibrocartilage without inflammation or neoplasia. Similar lesions reported in the literature have been described as retro-odontoid disk hernia, damaged transverse ligaments, transverse ligament degeneration, synovial cysts, ganglion cysts, and degenerative articular cysts. These lesions may share a common pathophysiologic origin and represent a single disease process, namely exuberant degeneration of the transverse ligament.     

Tailgut cysts

Retrorectal cystic hamartomas (tailgut cysts) are rare congenital lesions thought to arise from remnants of the embryonic postanal gut. They predominantly occur as asymptomatic retrorectal multicystic masses in women. The treatment of choice is by complete surgical excision. The most important complications of these cysts are infection with a secondary fistula and malignant degeneration. The differential diagnosis includes a wide variety of conditions that occur in the retrorectal space. In this article, 3 cases showing different surgical technical aspects of treatment are presented. In addition, the aetiopathogenic features and histopathological appearance, clinical presentation and complications, imaging features and differential diagnosis of tailgut cysts are described.     

Nasal dermoid sinus cysts: a retrospective review and discussion of investigation and management

Nasal dermoid sinus cysts are uncommon congenital anomalies presenting either as cysts or sinuses. They are frequently associated with extension into the intracranial space, requiring craniotomy for adequate resection. At the Royal Children's Hospital in Melbourne, Australia, we have managed 25 patients with nasal dermoid sinus cysts over 8 years and present details of clinical features, preoperative assessment, and surgical management. Six patients presented with infection, including 1 with osteomyelitis. Four of our patients had intracranial extension of their lesions, and all were treated successfully with tailored investigation and appropriate surgical procedures. Insights into diagnosis, investigation, and surgery are offered to facilitate the management of these challenging lesions.     

Intrascrotal Epidermoid Cyst: Report of Two Cases

A 70-year-old man and a 52-year-old man each presented with a painless extratesticular, intrascrotal mass. Magnetic resonance imaging revealed a cystic mass and was the most useful modality for the diagnosis. Complete excisions were performed, and the lesions were histologically diagnosed as epidermoid cysts. Intrascrotal, extratesticular epidermoid cysts are uncommon lesions believed to be teratomas or the result of abnormal embryological closure of the median raphe. However, it is difficult to explain the etiology of some masses by either of these mechanisms.     

Infections of congenital cervical neck masses associated with bacteremia

Congenital cervical neck masses are usually benign lesions. However, cystic hygromas and cervical teratomas are associated with a high risk for potentially life-threatening complications, primarily that of respiratory distress secondary to tracheal compression. Children with unoperated teratomas are also at high risk for malignant changes. A third potential complication is that of infection of the lesion. We present two newborns with infections of cervical neck masses associated with bacteremia. One lesion was a teratoma, the other a cystic hygroma. In both infants, surgical excision had been delayed. These cases illustrate the need for prompt, accurate diagnosis and treatment of congenital cervical neck masses.