Thymic cyst as a diagnostic challenge

Abstract

Thymic cysts are rare, benign, mostly congenital anomalies and represent 1-3% of all mediastinal masses, most frequently found in the front mediastinum. They can be congenital or acquired, as part of various immunological and malignant diseases. About 60% of patients with thymic cysts are asymptomatic and if symptoms are present, they are not specific, such as cough, dyspnoea and chest pain. Case report. A 48-year-old patient in March 2018 came with a high temperature, persistent dry cough, and blood in the sputum. Radiography and computerized tomography showed a clearly limited change to the right paratracheal, with a diameter of 64 x 53 mm, clear edges, without invasion and continuity on the surrounding tissue. The initial bronchoscopy indicated compression of the trachea, and the other seven lymph nodes were explored with a nonspecific finding, as well as five milliliters of yellowish liquid content were obtained. Meanwhile, the patient's respiratory infections, coughing and expectoration of blood clots were gone and he felt good. Video-assisted thoracoscopic surgery performed a complete resection of the change while preserving the thymus. The change was clearly separated from the environment, encapsulated, with a thin wall. Pathohistological, no malignant cells were found, the wall consisted of fibrocystic tissue with fragments of the thymic tissue. It was a benign, simple, congenital thymic cyst. Conclusion. Each patient with a suspicion of thymic cyst should be referred to a multidisciplinary team with experience in mediastinal pathology. Surgical resection of our patient was conducted for diagnostic and therapeutic purposes.

Keywords

• mediastinum
• thoracoscopic surgery
• thymic cyst