Thoracoscopic Thymectomy for Large Thymic Cyst: Myasthenia Gravis With Thymoma Concealed by Thymic Cyst

Yano, Motoki; Numanami, Hiroki; Akiyama, Takashi; Taguchi, Rumiko; Furuta, Chihiro; Iwakoshi, Akari; Haniuda, Masayuki

doi:10.1097/sle.0000000000000641

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…The authors do not describe any of the other characteristic features of MTC (lymphoid hyperplasia, cholesterol clefts), raising the question of whether this represents a true MTC. Yano et al 13 reported a MTC in which the authors documented a type A thymoma and a MNT. The authors did not go into detail describing the histologic appearance of the lesion.…”

Section: Discussionmentioning

confidence: 99%

Micronodular Thymomas With Prominent Cystic Changes: A Clinicopathological and Immunohistochemical Study of 25 Cases

Oramas

Moran

2020

Int J Surg Pathol

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Twenty-five cases of micronodular thymomas with prominent cystic changes are presented. The patients are 13 men and 12 women between the ages of 38 and 69 years. Clinically, the majority of patients presented with nonspecific symptoms of cough, chest pain, and dyspnea. Four patients were asymptomatic. Diagnostic imaging showed the presence of an anterior mediastinal mass and surgical resection of the tumor mass was performed in all the patients. Histologically, all the tumors were characterized by the presence of cystic structures of varying sizes lined by different types of epithelium. In addition, the tumors were characterized by nodules of epithelial cells embedded in a lymphocyte-rich stroma with germinal centers. Twenty-one tumors were encapsulated while 4 tumors were minimally invasive. Immunohistochemical stains were positive for keratin in the nodular epithelial component while CD45 and CD20 were positive in the lymphoid component. Clinical follow-up ranging from 12 to 24 months was obtained in 19 patients. All the patients were alive and well without disease. No clinical follow-up was available in 6 patients. The cases presented in this article highlight the existence of cystic micronodular thymomas, which can be easily misdiagnosed as a multilocular thymic cyst.

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Section: Discussionmentioning

confidence: 99%

Micronodular Thymomas With Prominent Cystic Changes: A Clinicopathological and Immunohistochemical Study of 25 Cases

Oramas

Moran

2020

Int J Surg Pathol

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“…A variety of inflammatory processes have been associated with development of these cysts, including: lupus ( 13 ), Sjogrens ( 18 ), Human immunodeficiency virus or HIV ( 19 - 21 ), surgery ( 22 ), immunoglobulin-G4 disease ( 23 ), and bacterial infection ( 24 ). Additionally, neoplastic processes associated with development of multilocular cysts are broad, and have included: Thymic carcinoma ( 12 , 15 , 25 ), Hodgkin’s lymphoma ( 26 , 27 ), Non-Hodgkin’s lymphoma ( 28 ), Langerhans histiocytosis ( 29 ), thymoma ( 15 , 30 , 31 ), papillary adenocarcinoma ( 32 ), seminoma ( 33 ) and, mature teratomas ( 34 ).…”

Section: Pathophysiologymentioning

confidence: 99%

“…Robotic resection, although rare, has been utilized ( 65 ). Subxiphoid and transcervical approaches seem to be effective in selected patients with anterior midline location cysts with sufficient operator familiarity ( 9 , 23 , 31 , 66 ). Clamshell approaches have also been utilized ( 20 ) however are morbid and should be cautiously undertaken.…”

Section: Treatmentmentioning

confidence: 99%

Mediastinal thymic cysts: a narrative review

Cooley-Rieders

Haren

2022

Mediastinum

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Background and Objective Mediastinal thymic cysts are a relatively rare pathology. With the expansion of eligible individuals screened with cross-sectional imaging for lung cancer, it is likely that there will be an increase in the number of individuals presenting with these cysts. Understanding this rare pathology will become more important when this incidental pathology is encountered. Methods Search of PubMed was undertaken using keywords “mediastinal”, “mediastinum”, “thymic”, “thymus”, “cyst”. Relevant literature was reviewed and selected for this comprehensive narrative review, including case reports, case series, and retrospective reviews. Key Content and Findings Thymic cysts in the mediastinum can be classified into two broad categories, congenital and inflammatory. Accurate diagnosis by imaging is challenging and the majority of patients are asymptomatic. Literature suggests that the majority of cysts are benign, however an unknown percentage may harbor neoplastic processes and over time can cause significant compressive symptoms. Definitive treatment and diagnosis is surgical, with overall excellent outcomes. The decision to pursue surgical treatment versus surveillance requires a shared decision making approach with patients. Conclusions Given the scarcity of available high quality evidence regarding the management of mediastinal thymic cysts, this review provides practitioners a broad knowledge base to guide patients to make informed decisions.

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“…The patient was able to be discharged home on postoperative day 3. Authors cite the improved visibility of bilateral phrenic nerves with this approach, particularly with the flexibility in moving the camera ( 37 , 38 ). Transcervical approach to thymectomy is largely discussed in the otolaryngology literature and has been successful for thymectomies as well as excision of parathyroid adenomas.…”

Section: Additional Approachesmentioning

confidence: 99%

Surgical approaches to mediastinal cysts: clinical practice review

Hsu¹,

Banks²,

Velotta³

2022

Mediastinum

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The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience—decreased length of stay (LOS) and pain—without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice review.

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Thoracoscopic Thymectomy for Large Thymic Cyst: Myasthenia Gravis With Thymoma Concealed by Thymic Cyst

Cited by 6 publications

References 10 publications

Micronodular Thymomas With Prominent Cystic Changes: A Clinicopathological and Immunohistochemical Study of 25 Cases

Micronodular Thymomas With Prominent Cystic Changes: A Clinicopathological and Immunohistochemical Study of 25 Cases

Mediastinal thymic cysts: a narrative review

Surgical approaches to mediastinal cysts: clinical practice review

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