Video-assisted mediastinoscopic resection of a thymic cyst by sternum lifting.

We performed mediastinoscopic surgery on two patients with a thymic cyst using a new instrument by sternum-lifting with tape. The merits of this technique are that a resection of the thymus and cyst can be achieved without a midline sternotomy, and under bilateral ventilation, and in cases with pleural adhesion. This technique can be applicable to most benign thymic lesions including thymectomy for myasthenia gravis and to selected cases with a malignant thymic tumor.     

A case of thymoma with thymic cyst]

A 43-year-old man was pointed out an abnormal shadow on chest X-ray film. Chest CT showed a solid mass and a cyst at anterior superior mediastinum. Operation revealed a capsulated thymoma and a multilocular thymic cyst. PTH and CA19-9 level in the cystic fluid was elevated. Histological examination demonstrated the clear separation of the mixed type thymoma and the thymic cyst. There were few reports for cases of thymoma with a thymic cyst.     

Invasive thymoma with thymic cyst; report of a case

A 27-year-old woman was pointed out an abnormal shadow on chest X-ray in 1999. Because of the enlargement of the chest abnormal shadow, she was admitted to our hospital in 2000. Chest computed tomography (CT) revealed anterior mediastinal solid mass with cystic lesion. A thymoma was suspected. The tumor was removed in June 2000, through a longitudinal incision of the sternum. There was a severe adhesion between the tumor and the right brachiocephalic vein. Histological examination revealed a thymoma with thymic cyst. The thymoma had a capsular invasion (stage II). There were few reports for cases of thymoma with thymic cyst.     

Thoracoplasty with marlex mesh following total resection of sternum: a case of chondrosarcoma of sternum.

Removal of the whole sternum for malignant tumor results in a large defect, causing a severe deformity and possible paradoxial movement of the chest wall. Many of thoracoplasty cases after total sternectomy require considerably complicated invasion. Recently, we performed on a patient with chondrosarcoma of the sternum total resection of the sternum including bilateral costal cartilage followed by thoracic reconstruction with polyethylene hard mesh (heavy Marlex mesh). In the present paper, we make a report of the case of thoracoplasty reliable to perform which has produced immediate chest wall stability without postoperative thoracic deformation. Postoperative CT confirmed that the mesh is well infiltrated with fibrous granulation tissue which connected chest muscle. Impairment of respiratory function after the operation is not observed.     

Thoracoscopic resection of a thoracic duct cyst that developed during follow-up for a thymic cyst

A 29-year-old man had been diagnosed with an anterior mediastinal cyst 6 years earlier and was undergoing follow-up. At a follow-up visit, a newly developed cystic lesion was found in the middle mediastinum; therefore, the anterior mediastinal cyst and the middle mediastinal cyst were resected by thoracoscopic surgery. It was observed that the middle mediastinal cyst originated from the thoracic duct, and the thoracic duct was clipped. Pathologically, the diagnosis was a thymic cyst of the anterior mediastinum and a thoracic duct cyst of the middle mediastinum. The patient developed chylothorax after surgery, and a second thoracoscopic operation was performed. It revealed that part of the clipping of the caudal thoracic duct was incomplete, and leakage of chyle was observed. Hence, the clipping was performed again. The course after the second surgery was good. Thoracic duct cysts are rare even among mediastinal cysts and thus require caution due to their tendency to expand.     

Cardiac herniation after resection of pericardial thymic cyst

Cardiac herniation following pericardial resection is a rare and potentially fatal complication. We present a case of a cardiac herniation after excision of pericardial thymic cyst. The patient had cardiac arrest one hour after surgery. Re-thoracotomy in the high dependency care unit, and reduction of cardiac herniation were done. There was no case report in the literature of cardiac herniation after excision of pericardial tumor.     

Resected case of thymic cyst with primary lung cancer

Thymic cyst is a rare and benign tumor of mediastinal tumor. A 77-year-old male was pointed out the tumor shadow on Chest X-ray film and diagnosed lung cancer. On admission some examination was performed and revealed mediastinal tumor accidentally. Primary lung cancer was completely resected and mediastinal tumor was extirpated. Pathological examination revealed lung cancer (poorly differentiated squamous cell carcinoma) and thymic cyst. Many methods of examination were tried for diagnosis of thymic cyst, but couldn't diagnose exactly before its resection. Some of the patients with thymic cyst was reported to develop SVC syndrome or change to malignant tumor. Therefore we think complete resection is the best treatment.     

Regression of thymoma associated with a multilocular thymic cyst: report of a case

A 28-year-old male was diagnosed with acute pericarditis after presenting with acute chest pain, fever and an abnormality in an electrocardiogram. No symptoms suggestive of myasthenia gravis were observed. Although the symptoms were alleviated by antibiotics, computed tomography (CT) showed an anterior mediastinal mass with bilateral pleural effusion. He was, therefore, diagnosed with thymoma and referred to our hospital. Surgery was performed, since the pleural effusion disappeared. The pathological examination revealed the mass to be a type B2 thymoma classified as pathological stage I (Masaoka’s classification) with a multilocular thymic cyst.     

A surgically treated case of capsulated thymoma with thymic cyst

A 56-year-old woman was pointed out an abnormal shadow on chest roentgenogram. Chest CT and MRI showed a solid mass with a cyst at right anterior mediastinum. Clinical diagnosis was thymoma with cyst, and surgical excision was performed. The histopathological examination of the resected specimen demonstrated that the epithelia of the cyst wall was single cuboidal or squamous cells and contained some foci of thymic tissue. The solid mass was capsulated and predominantly composed of lymphocytes. The pathological diagnosis was a thymoma (predominantly lymphocytic type) with thymic cyst. She is doing well for 10 years postoperatively.     

Successful resection of dermatomyositis associated with thymic carcinoma: Report of a case

We report a case of thymic carcinoma associated with dermatomyositis (DM) in a 53-year-old man. The patient presented with the characteristic features of a skin rash with Gottron’s papules, proximal muscle weakness, and increased serum levels of the muscle-associated enzymes. Comprehensive clinical examinations revealed an anterior mediastinal tumor. We resected the tumor and histological examination confirmed squamous cell carcinoma of the thymus. Thereafter, his clinical symptoms improved dramatically and his serum levels of muscleassociated enzymes dropped, indicating that the DM was a paraneoplastic phenomenon. Our search of the literature found only one other case report of DM accompanied by thymic carcinoma, and to our knowledge, this is the fi rst documented case of dramatic improvement of DM after resection of thymic carcinoma. We propose that thymic carcinoma should be added to the list of malignancies that can complicate DM as a paraneoplastic disease. The first two authors contributed equally to this study.     

Malignant transformation in a thymic cyst

Thymic cysts have not been previously reported to show malignant transformation. This is the first documented case of well-differentiated papillary squamous cell carcinoma arising in a preexisting thymic cyst. The tumor was treated by surgical excision with no evidence of metastasis 6 1/2 years later.     

Spontaneous hemorrhage of a thymic cyst in an adult: Report of a case

Mediastinal cysts account for about 19% of all mediastinal masses, and thymic cysts represent only about 1.5% of anterior mediastinal masses. Thymic cysts do not usually cause symptoms and are often found incidentally on routine chest radiography. We report the case of a thymic cyst that hemorrhaged into the mediastinum and the right pleural cavity, causing chest pain. The patient, a 55-year-old man, underwent emergency surgical resection and recovered uneventfully.     

Thymoma arising in a thymic cyst.

We present a case of thymoma arising in the wall of the thymic cyst. A 77-year-old asymptomatic woman demonstrated an approximately 3.5 cm sized cystic mass in the left anterior mediastinum in the CT scan. The tumor was extirpated by a total thymectomy. Histologically, the cyst wall was lined by low cuboidal cells, but a markedly thickened wall was observed at the upper site of the mass, which was found to be thymoma. These findings may suggest that the thymoma originated from the wall of the thymic cyst.     

Papillary adenocarcinoma developed in a thymic cyst

In this report, we describe a case of a thymic carcinoma that developed in a thymic cyst, which was resected by video-assisted thoracic surgery (VATS). Chest radiography of a 68-year-old Japanese woman revealed an abnormal shadow. She was asymptomatic with normal physical examination findings. Chest computed tomography demonstrated a well-confined cystic mass that measured 4 cm in diameter occupying the anterior mediastinum. Based on these findings, a thymic cyst was suspected. It was completely resected by VATS. The excised cyst was multiloculated with a partially thick wall. Microscopic examination revealed that the nodular excrescence of the wall to be limited to papillary adenocarcinoma and the cyst wall to be lined by cuboidal cells. On the basis of this diagnosis, we performed multidrug adjuvant chemotherapy. The patient was alive without any sign of recurrence 15 months after the operation.