A basaloid carcinoma with multilocular thymic cyst mimicking a mediastinal teratoma.

This case report details a rare thymic basaloid carcinoma initially misinterpreted as a mediastinal teratoma, underscoring the diagnostic challenges posed by such tumors. A 71-year-old female presented with an asymptomatic anterior mediastinal tumor discovered incidentally during a routine health examination. Surgical intervention, followed by pathological and immunohistochemical analysis including CK-pan, p63, p40, and CD117 molecules, led to a definitive diagnosis of basaloid carcinoma of the thymus. This case highlights the critical importance of differential diagnosis in mediastinal lesions, especially those presenting with multilocular thymic cysts on chest CT. The subxiphoid video-assisted thoracoscopic surgery enabled complete tumor resection with minimal trauma and favorable postoperative outcomes. The patient opted against further radiotherapy or chemotherapy and she has survived for over eight months without recurrence. This case report contributes to the growing understanding of thymic basaloid carcinoma, a rare and potentially aggressive thymic carcinoma subtype. It emphasizes the necessity for precise surgical techniques and enhanced diagnostic acumen among cardiothoracic surgeons and oncologists.

A case of a shrunken multilocular mediastinal cyst that developed into thymic carcinoma with lung metastases 13 years later.

Multilocular thymic cysts (MTC) are acquired multilocular cysts caused by inflammation. The rarity of such lesions and a lack of recognition make diagnosis and treatment difficult. Herein, we present our experience with a multilocular mediastinal cyst that resulted in the development of thymic cancer with metastasis over a period of 13 years. Computed tomography findings revealed an anterior mediastinal mass that was suspected to be an MTC in a 49-year-old man. The mass shrank gradually over a period of 7 years; however, growth was observed at 10 years after initial detection. At 13 years after detection, thymic carcinoma with multiple lung metastases was diagnosed. Resection was recommended during the follow-up period, but the patient refused treatment. A multilocular wall and location are factors that indicate MTC. However, even if a definitive diagnosis is not made, resection of multilocular anterior mediastinal cysts should be considered as determining the preoperative diagnosis is difficult. Nevertheless, our case suggests that the coexistence of tumors with cysts is possible, and the potential for malignant tumor development exists.

Thoracic Duct Occlusion Leading to Intermittent Left Supraclavicular Swelling and Pancreatitis.

Intermittent left supraclavicular swelling is an uncommon and elusive condition that can lead to extensive diagnostic workups to determine the etiology and treatment. One potential cause is partial, intermittent, or complete thoracic duct occlusion (TDO). We report on a patient who presented with chronic, intermittent left supraclavicular swelling and abdominal pain that was relieved by thoracic duct angioplasty. Thoracic duct occlusion should be included in the differential diagnosis of left supraclavicular swelling. Lymphatic imaging can facilitate the diagnosis and allows for potential percutaneous treatment. Laryngoscope, 134:1313-1315, 2024.

[Giant Pericardial Cyst with Left Ventricular Compression on Echocardiography:Report of a Case].

We report a very rare case of giant pericardial cyst with left ventricular compression on echocardiography. A 61-year-old man visited our hospital with a feeling of chest tightness. A cardiologist ruled out cardiac diseases of the patients and he was referred to us for examination and treatment of an abnormal left lung field shadow on chest x-ray. Chest computed tomography (CT) showed a 16×7.5 cm cystic mass in connect with the heart and diaphragm. Echocardiography showed that the cystic mass was compressing the left ventricle. Surgical resection was attempted by video-assisted thoracoscopic surgery (VATS). We aspirated serous liquid contents in the cyst and partially resected the cyst wall excepting cardiac side. After confirming the cyst was not a pericardial diverticulum, we completely resected its residual wall. His postoperative course was uncomplicated. The cyst was pathologically diagnosed as a pericardial cyst.

Spindle-cell thymoma colliding with a bronchogenic cyst in a Yorkshire terrier.

An 8-year-old male Yorkshire terrier was presented to the Tufts Veterinary Hospital for evaluation of increased respiratory effort. A mediastinal mass composed of a spindle-cell thymoma within a bronchogenic cyst was diagnosed with computed tomography thoracic imaging, ultrasound-guided fine-needle aspirate biopsy, and histopathologic evaluation after surgical removal. Histologic evaluation showed a multilocular cyst structure as well as a mass characterized by spindle to polygonal thymic epithelial cells. The cyst was characterized by a lining of ciliated pseudostratified respiratory epithelium. To the authors' knowledge, this is the first report of a spindle-cell thymoma being associated with a mediastinal bronchogenic cyst in a dog.

A rare and challenging case of intrapericardial hydatidosis.

BACKGROUND: Hydatid cysts are most frequently located in the liver and lungs and very rarely can be found in the pericardium. Diagnosis and treatment are quite challenging, as the disease can present itself in many forms depending to the location and the complications that it might cause. CASE PRESENTATION: A 22-year-old man presented to our hospital with ongoing dry cough for more than 1 month prior to admission. Other symptoms included chest pain, fatigue, low grade fever, and night sweats, which have worsened in the past 2 weeks. Physical examination revealed normal respiratory and heart function. Chest X-ray demonstrated mediastinal enlargement and left pleural effusion. Contrast-enhanced computed tomography images showed a walled cystic mass lesion measuring up to 56 × 50 mm in close proximity to the upper left atrium, ascending aorta and pulmonary artery, potentially localized in the pericardium, with a 10 mm endoatrial filling defect, findings were compatible with hydatid cyst, left pleural effusion and peripheral pulmonary upper left lobe consolidation. Cardiac involvement was excluded on magnetic resonance imaging and trans-esophageal ultrasound. The patient underwent fine needle aspiration of the affected lung and thoracocentesis. No malignancy was found, meanwhile the biopsy confirmed the presence of pulmonary infarction. In view of the imaging findings were highly suspicious of a hydatid cyst, we performed a test of antibody titers that was negative. The patient underwent left anterolateral thoracotomy, and after the opening of the pericardium, a cystic mass of 5 cm in diameter was found next to the left atrium and in close proximity with the left pulmonary veins. The content of the cyst was completely removed after the surgical area was isolated with gauze impregnated with hypertonic solution (NaCl 10%). The mass resulted to be an echinococcal cyst with multiple daughter cysts within it that did not penetrate/involve (perforate) the cardiac wall. CONCLUSION: Pericardial echinococcosis is a very rare pathology in which a high expertise multidisciplinary approach is required. The compression mass effect caused by the cyst can lead to complications, such as in our case where the pulmonary vein was compressed, leading to pulmonary infarction. The value of radiology studies and transoesophageal ultrasound are very important in the diagnosis. Surgery in these cases is always recommended, but preferred surgical approach is questionable. In cases such as ours, we recommend anterolateral thoracotomy.

Non-Neoplastic Thoracic Cysts: A Clinicopathologic Study of 136 Cases.

Benign cysts of the thoracic cavity represent a group of rare lesions, the spectrum of which is expanding. Most of these are congenital in nature, secondary to abnormal development during embryogenesis while a smaller subset represents acquired lesions. We retrospectively reviewed the clinicopathologic features of 136 patients with thoracic cysts that were treated in our institution over a span of 20 years. The patients were 85 female and 51 male patients with an average age of 51 years. Eighty-four of the patients were asymptomatic (62%), the remainder mainly presented with chest pain, shortness of breath, or cough. Surgical resection was performed in 123 patients while 12 patients were treated with aspiration only and 1 underwent core biopsy. The cyst size ranged from 0.5 to 14.8 cm (mean, 4.4 cm); histologically, the lesions included 50 thymic cysts (28 multilocular; 22 unilocular), 37 bronchogenic cysts, 23 pleuropericardial cysts, 12 unclassified cysts, 6 Müllerian cysts, 5 enteric cysts, and 3 parathyroid cysts. Clinical follow-up revealed that 97 patients were alive and well 4 months to 37 years after initial diagnosis; 25 patients were lost to follow-up and 14 patients died of unrelated causes. The current study is one of the largest studies on the subject with emphasis on clinicopathologic characteristics. This series has a higher incidence of thymic cysts compared with prior publications and covers a wider spectrum of different histologic types than previously reported.

A comparative study of robotic surgery and thoracoscopic surgery for mediastinal cysts.

OBJECTIVE: To compare the efficacy and safety of robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS) in the treatment of mediastinal cysts. METHODS: Retrospective analysis on clinical data of 70 cases of minimally invasive surgery for mediastinal cysts completed in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from April 2014 to December 2022. There were 34 cases in the RATS group with a cyst diameter of (3.70 ± 1.16) cm and 36 cases in the VATS group with a cyst diameter of (4.07 ± 1.20) cm. All cysts were evaluated preoperatively using magnetic resonance imaging (MRI) or chest computed tomography (CT) localization. Surgery-related indices were compared among the two groups. RESULTS: All patients in two groups successfully completed resection of mediastinal cysts without perioperative deaths. Compared with the VATS group, the RATS group possessed shorter operative time [(75.32 ± 17.80) min vs. (102.22 ± 19.80) min, P < 0.001], lesser intraoperative bleeding [10 (5.00, 26.00) ml vs. 17.50 (5.00, 50.50) ml, P = 0.009], shorter postoperative chest drainage time [2 (1.00, 6.00) ml vs. 3 (2.00, 6.50) ml, P = 0.006] and shorter postoperative hospital stay [3 (2.00, 6.50) d vs. 4 (3.00, 7.50) d, P = 0.001]. There was no statistically significant discrepancy in intermediate openings and complications in both groups (P > 0.05). CONCLUSION: Compared with VATS, RATS is safety and effectivity in the treatment of mediastinal cysts and thus has advantages in operative time, intraoperative bleeding, postoperative chest drainage time and postoperative hospital stay.

A large pericardial cyst mimicking a unilateral pleural effusion: A case report.

RATIONALE: Pericardial cysts are a rare benign disorder with a variable clinical presentation depending on their size and location. The diagnosis of pericardial cysts is usually based on imaging examinations. The definitive treatment is surgical resection. PATIENT CONCERN: A 36-year-old woman presented with progressive left-sided chest pain and exertional dyspnea, with symptoms resembling pleural effusion. DIAGNOSES: The patient was diagnosed with a pericardial cyst based on imaging and video-assisted thoracoscopic surgery (VATS). INTERVENTION: VATS was performed. OUTCOMES: The patient's symptoms improved after successful removal of the pericardial cyst. Follow-up chest computed tomography exhibited no evidence of recurrence. LESSONS: Clinicians should include pericardial cysts in the differential diagnosis of pseudopleural effusion. VATS is a feasible and safe method to treat symptomatic and large pericardial cysts.

[Posterior Mediastinal Cyst Resection during Cardiac Surgery through Median Sternotomy:Report of a Case].

A 47-year-old man presented with hematuria. Computed tomography( CT) showed a posterior mediastinal cyst. Chest magnetic resonance imaging showed a well defined mass with high intensity on T2-weighted images. Echocardiogram revealed severe aortic regurgitation, moderate mitral regurgitation and no continuity between the cyst and the pericardium. We performed aortic valve replacement, mitral annuloplasty and cyst resection after confirming it was not malignant by intraoperative rapid pathological examination. We performed sufficient and safe cyst resection through full sternotomy under cardiac arrest. Pathological examination revealed that cyst was bronchogenic. Bronchogenic cyst has malignant potential and it is very difficult to resect after presenting symptoms. We need to consider the differential diagnosis, the timing of operation and operative strategy.

Thoracic benign cystic mesothelioma.

BACKGROUND: Benign cystic mesotheliomas (BCMs), also known as multilocular mesothelial inclusion cysts, inflammatory inclusion cysts or multicystic mesothelial proliferation, are frequently observed in females and are localised localised in the pelvic peritoneum. They are rarely present in the thoracic and mediastinal areas; however, these locations have been reported in a few cases in the literature. CASE PRESENTATION: We present the case of a woman with an intrathoracic BCM. A 28-year-old female patient presented with a cystic mass of 8 × 6 × 6 cm in the left hemithorax shown by computed tomography of the thorax. The patient underwent cystic mass excision with video-assisted thoracoscopic surgery (VATS), which was completed without complications. The diagnosis was confirmed histopathologically after the surgical resection. CONCLUSIONS: Due to BCMs' non-specific clinical symptoms and radiological imaging, preoperative diagnosis is difficult, and they are often confused with pericardial cysts. There is no standard treatment protocol; however, VATS and en bloc resection are the most frequently used treatment options for mediastinal localization. Since these lesions slow proliferation rates have the potential for local recurrence and low malignant transformation, close follow-up is recommended. In this case report, we aimed to present a rare BCM case with intrathoracic paracardiac localization was completely excised through VATS. No recurrence has been detected in three years of follow-up.

Cyst of Hattori: A Rare Cyst in the Posterior Mediastinum.

Sixteen years since their initial description in the literature, posterior mediastinal Mullerian cysts - otherwise known as cysts of Hattori, after their discoverer - remain rare, with only 40 patients reported as of 2020. We report a 43 year old obese female that presented with a 2.6 cm cyst found in the posterior mediastinum by endoscopic ultrasound (EUS) and previously by chest magnetic resonance imaging (MRI) originally diagnosed as a congenital enteric duplication cyst of the esophagus radiologically. Upon surgical excision via a DaVinci thoracoscopy, the cyst was confirmed to be of Mullerian origin by PAX8, WT1, and ER staining. It is possible that the majority of cysts of Hattori remain unrecognized and undiagnosed, given their rarity and resemblance to other pathologies. It is important that this entity become a part of every pathologist's differential for a posterior mediastinal cyst in a female.

Swallowing-induced Atrial Tachycardia with a Thymic Cyst.

We herein report a 34-year-old man who presented with recurrent palpitations that occurred while swallowing solid food. Holter monitoring revealed atrial tachycardia (AT) while eating. In addition, chest computed tomography (CT) showed a small nodule in the front of the ascending aorta. Thoracoscopic surgery was performed to remove the nodule; a pathological examination revealed that the nodule was a thymic cyst. The AT disappeared postoperatively. This case demonstrates that a mediastinal nodule can cause swallowing-induced AT.

Mediastinal Thoracic Duct Cyst Infection after Endoscopic Submucosal Dissection for Early Esophageal Cancer.

A mediastinal thoracic duct cyst that originates from the thoracic duct is a very rare disease in the mediastinum. There have been no reports of mediastinal thoracic duct cyst infection caused by endoscopic treatment. This is the first case of mediastinal thoracic duct cyst infection after endoscopic submucosal dissection for early esophageal cancer. We herein report a 75-year-old man with mediastinal thoracic duct cyst infection caused by esophageal endoscopic submucosal dissection. In cases where a mediastinal thoracic duct cyst is found before performing endoscopic esophageal treatment, we should carefully consider the potential risk of post-treatment cyst infection.

[A case of mediastinal bronchial cyst misdiagnosed as schwannoma: a case report].

A case of mediastinal bronchial cyst misdiagnosed as schwannoma is reported. The patient had no chest pain, dyspnea, cough, sputum and hemoptysis in the past. Chest enhanced CT showed mediastinal mass with clear boundary. The larger cross-section was about 3.9 cm × 3.4 cm, and there was no obvious enhancement. The primary diagnosis was considered as schwannoma, tracheal cyst or esophagus cyst. The mediastinal tumor was resected via cervical approach under general anesthesia. During the operation, it was found that the mass was located in the middle and upper mediastinum, with diameter of about 4 cm and a smooth surface, containing gelatinous cystic fluid and adhered to the esophagus and trachea. Postoperative pathological diagnosis was bronchogenic cyst. The patient recovered well after the operation, and has not recurred since follow-up.

Successful management of complex haemorrhagic pericardial cyst with cirrhosis of liver: a case report.

Haemorrhagic pericardial cysts are rare and may be complicated by encasement of the heart, right heart failure and, rarely, cardiac cirrhosis. Surgical management of complicated cysts is challenging and has poor outcomes. We report a case of successful surgical management of a complicated pericardial cyst presenting with cardiac cirrhosis and the challenges associated with this condition.

Special Computed Tomography Imaging Features of Thymic Cyst.

Objective: To explore the features and diagnostic value of computed tomography (CT) imaging in cases of thymic cysts. Methods: A total of 24 cases of the thymic cysts (confirmed by postoperative pathology) were retrospectively analyzed. The location, morphology, and density of the thymic cysts were summarized, and the changes in CT value of the region of interest (ROI) in the thymic cysts between noncontrast enhanced and enhanced chest scans were compared and classified. Results: The average long-axis dimension was 17.50 ± 6.00 mm, the CT value range across the 24 cases was 5-81 HU, and the average CT value of the noncontrast enhanced scans was 39.75 ± 20.66 HU. The CT value in the noncontrast enhanced scan was >20 HU in 79% of the sample cases. The CT value in the ROI of the thymic cysts under enhanced scan showed a significant decrease in 15 cases, a significant increase in 5 cases, and an insignificant change in 4 cases. Conclusion: The CT values of the thymic cysts in the enhanced scans were generally lower than in the noncontrast enhanced scans, which might be a valuable finding for thymic cysts diagnosis.