Ectopic Cervical Thymus: A Common, yet Rarely Symptomatic Pediatric Neck Mass

2020 ◽  
Vol 16 ◽  
Author(s):  
Lee Rousslang ◽  
Jaren Meldrum ◽  
Rooks Veronica ◽  
Augustah Poutre ◽  
Timothy Biega
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Incidental Finding ◽  
Case Series ◽  
Surgical Excision ◽  
Neck Mass ◽  
Thymic Tissue ◽  
Ectopic Thymus ◽  
Unusual Finding

Abstract:: Ectopic thymic tissue is an unusual finding that is generally asymptomatic. We present a case series of five pediatric patients with cervical ectopic thymuses. In two patients, the ectopic thymic tissue was symptomatic, and in three patients it was an incidental finding. We highlight the need to include this anomaly on the differential diagnosis for a pediatric neck mass. We also propose observation, rather than surgical excision, as the treatment of choice for asymptomatic cervical ectopic thymus.

scholarly journals 766. Everything Old is New Again-A Case Series of New World Leishmaniasis in African Children in Portland, Maine

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S428-S428
Author(s):  
Jennifer Jubulis ◽  
Amanda Goddard ◽  
Elizabeth Seiverling ◽  
Marc Kimball ◽  
Carol A McCarthy
Keyword(s):  
Latin America ◽  
Cutaneous Leishmaniasis ◽  
New World ◽  
Pediatric Patients ◽  
Data Extraction ◽  
Clinical Manifestations ◽  
Case Series ◽  
Surgical Excision ◽  
Skin Lesions ◽  
Travel History

Abstract Background Leishmaniasis has many clinical manifestations and treatment regimens, dependent on species and host. Old world leishmaniasis is found primarily in Africa and Asia, and is associated with visceral disease, while new world disease, seen primarily in Latin America, is more commonly mucocutaneous. We present a case series of pediatric African patients with New World cutaneous leishmaniasis (NWCL). Methods Data extraction was performed via chart review, analyzing travel history, clinical presentation, diagnosis, and management in children with cutaneous leishmaniasis presenting to the pediatric infectious diseases clinic in Portland, ME. Biopsy specimens were sent to the federal CDC for identification by PCR and culture. Results Five cases of NWCL were diagnosed in pediatric patients in Maine from November 2018 through February 2020. Median age of patients was 10 years (range 1.5-15 years). Four cases (80%) occurred in children from Angola or Democratic Republic of Congo, arriving in Maine via Central/South America, with one case in a child from Rwanda who arrived in Maine via Texas. Three patients had multiple skin lesions and two had isolated facial lesions. Leishmaniasis was not initially suspected resulting in median time to diagnosis of 5 months (range 1-7 months). Four patients were initially treated with antibacterials for cellulitis and one was treated with griseofulvin. After no improvement, patients underwent biopsy with 2 patients diagnosed with L panamensis, 1 with L braziliensis, 1 with mixed infection (L panamensis and L mexicana), and 1 with Leishmania species only. One patient was managed with surgical excision, 3 with ketoconazole, and 1 was observed off therapy. Four patients were referred to otolaryngology. All continue to be followed in infectious disease clinic. Conclusion We present five cases of new world cutaneous leishmaniasis in African pediatric patients arriving to Maine through Latin America or Texas. Patients were diagnosed with cellulitis, tinea corporis or atopic dermatitis initially, underscoring importance of high index of suspicion in migrant patients. Detailed travel history and epidemiologic knowledge is essential to diagnosis, as patients may present with illness not congruent with country of origin. Optimal therapy remains unclear. Disclosures All Authors: No reported disclosures

scholarly journals Extensive parapharyngeal and skull base neuroglial ectopia; a challenge for differential diagnosis and treatment: case report

2010 ◽  
Vol 128 (5) ◽  
pp. 302-305 ◽  
Author(s):  
Giulianno Molina de Melo ◽  
Gabrielle do Nascimento Holanda Gonçalves ◽  
Ricardo Antenor de Souza e Souza ◽  
Danilo Anunciatto Sguillar
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Skull Base ◽  
Infratemporal Fossa ◽  
Newborn Infants ◽  
Surgical Excision ◽  
Neck Mass ◽  
Oral Feeding ◽  
Feeding Difficulties ◽  
Complete Surgical Excision

CONTEXT: Neuroglial ectopia has been defined as a mass composed of differentiated neuroectodermal tissue isolated from the spinal canal or cranial cavity and remains rare. This lesion has to be considered in the differential diagnosis among newborn infants with classical symptoms of respiratory distress, neck mass and feeding difficulties. We present a rare case of extensive parapharyngeal and skull base neuroglial ectopia in 6-month-old girl who presented respiratory and feeding obstruction at birth. CASE REPORT: A six-month-old girl who presented upper respiratory and feeding obstruction at birth and was using tracheostomy and gastrostomy tubes was referred to our institution. Complete surgical excision of the mass consisted of a transcervical-transparotid approach with extension to the infratemporal fossa by means of a lateral transzygomatic incision, allowing preservation of all vital neurovascular structures. The anatomopathological examination showed a solid mass with nests of neural tissue, with some neurons embedded in poorly encapsulated fibrovascular stroma, without mitotic areas, and with presence of functioning choroid plexus in the immunohistochemistry assay. Neurovascular function was preserved, thus allowing postoperative decannulation and oral feeding. Despite the large size of the mass, the child has completed one year and six months of follow-up without complications or recurrence. Neuroglial ectopia needs to be considered in diagnosing airway obstruction among newborns. Surgical treatment is the best choice and should be performed on clinically stable patients. An algorithm to guide the differential diagnosis and improve the treatment was proposed.

scholarly journals Head and neck inflammatory pseudotumor: Case series and review of the literature

2016 ◽  
Vol 29 (6) ◽  
pp. 440-446 ◽  
Author(s):  
Sagar Kansara ◽  
Diana Bell ◽  
Jason Johnson ◽  
Mark Zafereo
Keyword(s):  
Head And Neck ◽  
Inflammatory Pseudotumor ◽  
Case Series ◽  
Surgical Excision ◽  
Excisional Biopsy ◽  
Disease Recurrence ◽  
Neck Mass ◽  
Level Ii ◽  
Oral Corticosteroids ◽  
Inflammatory Pseudotumors

Inflammatory pseudotumor (IP) is an uncommon idiopathic lesion that often imitates malignancy clinically and radiologically. Inflammatory pseudotumors have been found to occur in various sites but rarely in the head and neck. The histopathology, imaging, and treatment of three unique cases of head and neck inflammatory pseudotumors are described in this case series. Patients in Cases 1 and 2 presented with right level II neck mass and left parotid tail mass, respectively. The patient in Case 3 presented with otalgia, jaw pain and trismus, and a left parapharyngeal space mass. The tumors in Cases 1 and 3 significantly decreased in size with tapered courses of oral corticosteroids. The tumor in Case 2 was surgically excised without disease recurrence. Malignancy must be ruled out with incisional or excisional biopsy. Treatment includes surgical excision, oral corticosteroids, or both. The literature shows that radiotherapy and small-molecule inhibitors may be promising alternatives.

scholarly journals Cervical root schwannoma: a case series

2016 ◽  
Vol 2 (1) ◽  
pp. 43
Author(s):  
Harshad Nikte ◽  
Nitish Virmani ◽  
Jyoti Dabholkar
Keyword(s):  
Case Series ◽  
Surgical Excision ◽  
Needle Aspiration ◽  
Neck Mass ◽  
Malignant Degeneration ◽  
Spinal Root ◽  
Nerve Tumor ◽  
Complete Surgical Excision ◽  
Operative Findings ◽  
Cervical Root

Cervical root schwannoma is an infrequent benign peripheral nerve tumor though those arising from high cervical spinal root are common amongst the spinal schwannomas. This mass commonly presents as a slow growing, asymptomatic, solitary neck mass with rare potential of   malignant degeneration. Displacement of Internal jugular vein and carotids anteriorly is frequently seen though abutment of esophagus is uncommon. Pre operative diagnosis can be established with imaging and Fine needle aspiration cytology (FNAC). Complete Surgical excision is the treatment of choice. Horner’s syndrome is the most common post operative neurological manifestation. Here we have recorded clinical features intra-operative findings and surgical histopathology. We have described a case of 19 year old male with cellular schwannoma of cervical sympathetic chain with intraspinal extension and arising from C5-C8 level. Another case of cervical root schwannoma is described in a 5 year old girl arising at C4-C5 level. Complete surgical excision was done for both patients with no postoperative neurological affection. The clinico-pathological evaluation and management are described

Cervical Lymphangioma in the Adult

1985 ◽  
Vol 93 (1) ◽  
pp. 65-69 ◽  
Author(s):  
Robert P. Schefter ◽  
Kerry D. Olsen ◽  
Thomas A. Gaffey
Keyword(s):  
Differential Diagnosis ◽  
Adult Life ◽  
Surgical Excision ◽  
Neck Mass ◽  
Men And Women ◽  
Clinical Behavior ◽  
Posterior Triangle ◽  
Cystic Lymphangiomas ◽  
Recent Origin

Cervical lymphangioma is rare among adults. Thirty-two patients with cervical lymphangioma were treated at the Mayo Clinic between 1950 and 1982. The records of these patients were reviewed to investigate the clinical and pathologic behavior of this lesion in persons more than 16 years of age. The lesions were seen in all decades of adult life and equally in men and women. Most lesions presented as a rapidly enlarging, asymptomatic mass. The anterior triangle of the neck was involved nearly as often as the posterior triangle, and right-sided locations predominated (72%). Histopathologic differentiation of the lesions into simplex, cavernous, and cystic lymphangiomas was not helpful in predicting clinical behavior. Surgical excision is the treatment of choice. The lesions may intimately involve the carotid sheath or adjacent nerves. Recurrence in 21% of the 28 patients on whom follow-up data were available mostly represented incomplete excision. Lymphangioma should be included in the differential diagnosis of a large asymptomatic neck mass of recent origin in the adult.

Ectopic cervical thymus: case report and review of pathogenesis and management

2009 ◽  
Vol 124 (6) ◽  
pp. 694-697 ◽  
Author(s):  
F Ahsan ◽  
R Allison ◽  
J White
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Literature Review ◽  
Rare Condition ◽  
Surgical Excision ◽  
Neck Mass ◽  
Rare Anomaly ◽  
Neck Lump

AbstractObjective:Ectopic cervical thymus is a rare anomaly, and 50 per cent of cases occur in children. The aim of this report was to remind clinicians of this rare condition, which is part of the differential diagnosis of a paediatric neck lump.Method:Case report together with literature review of the pathogenesis and management of ectopic cervical thymus.Results:The ectopic cervical thymus is a rare cause of a benign neck mass, and is thus usually misdiagnosed as lymphadenopathy or neoplasia. We discuss its embryology, aetiology, presentation, histopathology, radiology and management, with reference to the reported case.Conclusion:Ectopic cervical thymus should always be considered in the differential diagnosis of a paediatric neck lump. The diagnosis can often be confirmed by cytology and radiology prior to surgical excision.

scholarly journals Surgical Experiences of Pediatric Cervical Bronchogenic Cysts: A Case Series of 6 Patients

2021 ◽  
pp. 014556132098219
Author(s):  
Yanzhen Li ◽  
Shengcai Wang ◽  
Jun Tai ◽  
Jie Zhang ◽  
Lejian He ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Bronchogenic Cyst ◽  
Case Series ◽  
Side Wall ◽  
Neck Region ◽  
Surgical Excision ◽  
Complete Resection ◽  
Congenital Disease ◽  
Surgical Experience ◽  
Bronchogenic Cysts

Objectives: Bronchogenic cyst is a rare congenital disease which occurs especially in the neck region. This report presents 6 cases of bronchogenic cysts and discusses the diagnosis and surgical experience of this anomaly. Methods: A retrospective study of 6 pediatric patients with cervical bronchogenic cysts treated in our hospital during 2016 to 2019 was performed. We recorded and analyzed the clinical data of the patients, including age, symptoms, imaging findings, surgical procedure, and complications. Results: All patients underwent surgical excision. The chondroid tissues were found at the base of cysts which clung to the trachea in 5 patients and completely removed by surgery without recurrence. One patient showed recurrence due to residual cartilage after the first surgery, and the second surgery was required to resect the remaining cartilage. During the surgery, the recurrent laryngeal nerve (RLN) detector was used, which confirmed that all the RLNs clung to the side wall of cysts. All cases were cured without complications. Conclusions: Although rare, bronchogenic cysts should be considered in the differential diagnosis of peritracheal masses in children. Complete resection of the bronchogenic cysts, including the cartilages at the base, is vital in preventing recurrence. The RLN must be protected during the surgery.

scholarly journals Giant paraovarian cyst in an adolescent: a challenge of accurate diagnostic

2021 ◽  
Author(s):  
Ioana Anca Stefanopol ◽  
Dumitru Marius Danila ◽  
Georgiana Bianca Constantin ◽  
Liliana Baroiu
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Pediatric Patients ◽  
Correct Diagnosis ◽  
Pelvic Mass ◽  
Surgical Excision ◽  
Histopathological Diagnosis ◽  
Female Patients ◽  
Abdominal Masses ◽  
Paraovarian Cyst

Abstract BackgroundParaovarian cysts (POCs) are rarely seen among pediatric female patients. The diagnosis still represents a challenge. Giant POCs are exceedingly rare and only few cases have been reported in the literature.Case presentationA 17-year-old girl from the rural area presented with abdominal pain, pollakiuria and a giant abdomino-pelvic mass. Ultrasound and computed tomography revealed a 14cm x 24cm x 30cm anechoic unilocular cyst which raised the suspicion of a mesenteric or ovarian cyst. The correct diagnosis of left POC was established intraoperatory. Cystectomy was performed. Histopathological diagnosis was serous cystadenoma.DiscussionsPOCs become symptomatic when reach large sizes or complicate, the most feared complication being ovary torsion. Imagistic investigations can establish the diagnosis of cyst, but the cyst’s origin often remains an intraoperatory discovery. Surgical excision is necessary to decrease the risk of complications, and adnexal preservation is essential in pediatric patients. Even for pediatric female patients POC should be considered in the differential diagnosis of cystic abdominal masses.

scholarly journals Application of Shear Wave Sonoelastography in the Differential Diagnosis of Extra- and Intra-Thyroidal Ectopic Thymic Tissue

2020 ◽  
Vol 9 (12) ◽  
pp. 3816 ◽  
Author(s):  
Magdalena Stasiak ◽  
Zbigniew Adamczewski ◽  
Renata Stawerska ◽  
Bartłomiej Stasiak ◽  
Andrzej Lewiński
Keyword(s):  
Differential Diagnosis ◽  
Shear Wave ◽  
Shear Wave Elastography ◽  
Normative Values ◽  
Invasive Procedures ◽  
Thymic Tissue ◽  
Monitoring Method ◽  
Ectopic Thymus ◽  
The Us ◽  
The Mean

The ultrasound (US) pattern of intrathyroidal ectopic thymus (IET) can resemble papillary thyroid carcinoma (PTC) while the extrathyroidal ectopic thymus (EET) can mimic pathological lymph nodes. Recently, the usefulness of strain elastography (SE) was demonstrated in the differential diagnosis, however this method has several limitations. The aim of the current study was to assess the usefulness of shear wave elastography (SWE) in this field. The US, SE, and SWE were performed in 31 children with 53 ectopic thymuses (ETs) and quantitative values of SWE parameters were calculated, so as to generate potential normative values of ET elasticity and of the shear wave ratio (SWR). The mean SWRIET was 0.89 ± 0.21 and the mean shear wave stiffness (SWS) was 7.47 ± 1.93 kPa. The mean SWREET was 0.84 ± 0.15 and the mean SWSEET was 11.28 ± 2.58 kPa. The results have proven that the stiffness of ETs is lower or equal to the thyroid’s. SWE was demonstrated to be a useful diagnostic method for ET evaluation. Therefore, the application of SWE in ET diagnosis allows more accurate evaluation of ET-like lesions and, in many cases, allows one to avoid invasive procedures, simultaneously providing a precise monitoring method based on combined US and SWE evaluation.

scholarly journals Epidermal Cysts Surgery: Case Series

2020 ◽  
Vol 7 (3) ◽  
pp. 1-6
Author(s):  
Teodor Angelov ◽  
Valeri Malev ◽  
Georgi Tchernev
Keyword(s):  
Differential Diagnosis ◽  
Benign Tumor ◽  
Case Series ◽  
Surgical Excision ◽  
Complete Removal ◽  
Vascular Lesion ◽  
The Body ◽  
Trichilemmal Cyst ◽  
The Face ◽  
Risk Of Malignancy

Epidermal cysts are the most common scalp cysts in clinical practice. They are most commonly located in the region of the face, neck, and trunk, and have been reported in many other topographic areas of the body. Clinically, they are present as free-moving nodules located below the skin, ranging in size from a few millimeters to a few centimeters in diameter. Histopathologically, they are defined as benign tumor formations with a very low risk of malignancy. The differential diagnosis includes: lipoma, neurofibroma, salivary gland adenoma, vascular lesion and fibroid, and Trichilemmal cyst. The most common treatment for epidermal cysts is surgical excision with removal of all contents without compromising the integrity of the capsule. In this publication, we present five clinical cases of patients with epidermal cysts in different topographic regions of the body. The patients were treated surgically by elliptical excision and complete removal of epidermal cysts without rupture. The defects were closed with single discontinued skin sutures and the sutures were removed on an 8- / 14-postoperative day. No recurrence was observed in the postoperative period.

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