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J Thorac Cardiovasc Surg 1996;112:835-836
© 1996 Mosby, Inc.

BRIEF COMMUNICATIONS

HUGE THYMIC CYSTS

Uur Gönüllü, MD, Adem Güngör, MD, smail Sava, MD, Özlem Özdemir, MD, Gül Moulkoç, MD, Doanay Alper, MD, inasi Yavuzer, MD

Ankara, Turkey

Received for publication April 20, 1995 Accepted for publication Dec. 7, 1995. Address for reprints: Adem Güngör, MD, Özveren Sokak 26/1, Demirtepe Ankara, 06570 Turkey.

Thymic cysts are uncommon mediastinal lesions located in the anterior compartment in all age groups. They are usually asymptomatic and found incidentally on chest roentgenograms. ¹ Rarely the cysts cause symptoms, such as hoarseness or dyspnea, resulting from pressure on nearby organs. The cysts may be uniloculated or multiloculated, ranging in size from microscopic to enormous, almost filling an entire chest.

Five patients with thymic cyst were seen in our hospital and treated surgically (Table I).

View larger version (107K): [in this window] [in a new window]   Fig. 1. Posteroanterior chest x-ray film showing a well-circumscribed lesion filling the left hemithorax.

When a thymic cyst is located in the neck, a mass can be detected, which can cause dyspnea and hoarseness. Three of our patients had dyspnea or cough or both. The others were free of symptoms. These cysts may be uniloculated or multiloculated and of various sizes. To our knowledge, the largest thymic cyst previously reported was 18 cm in diameter and multiloculated. ² The cyst in our case 4 is the largest uniloculated cyst reported, measuring 17 cm, and that in our case 5 is the largest multiloculated cyst (30 cm) reported (Table I).

On chest roentgenograms, thymic cysts look like smoothly contoured anterior mediastinal masses. A number of authors also have drawn attention to the usefulness of computed tomographic scans in evaluation of the thymus gland. ³ We performed thoracic computed tomographic scans in most of our patients and the findings supported the diagnosis.

Reports of thymic cysts developing after radiotherapy have been reported. ⁴ Neither of our patients had received radiotherapy. Thymic cysts can also form after thoracic operations, but none of our patients had undergone such operations. The apparent association of thymic cysts with infection (e.g., syphilis or tuberculosis) has been reported ² but was not present in our cases. If hemorrhage occurs, fluid in the cyst becomes brownish and more viscid. In two of our patients, the cysts had such findings. Microscopic examination did not show a definite epithelium. The walls showed fibrocollagenous scar tissue formation. Malignant degeneration, although rare, has been reported ⁵ but was not seen in this review. Some malignant tumors, particularly thymoma, Hodgkin's disease, and seminoma, can show prominent cystic changes. We therefore made every effort to detect any malignant tissue on pathologic examination. A diffuse goiter was seen in three of five patients. However, this finding may be coincidental because goiter is endemic in Turkey. This relationship should be investigated further. Operative excision of thymic cysts seems both diagnostic and curative.

Except in case 1, the thymic cysts were not localized in the midline and all were large. Therefore we preferred thoracotomies to explore and excise the cysts rather than median sternotomies. The cysts were completely removed to prevent a recurrence and to eliminate the risk of malignant transformation. Thoracotomy in patients with large cysts allows for easy removal of the cysts. Neither aspiration nor decompression of the cysts was necessary.

Footnotes

From the Departments of Respiratory Diseases and Thoracic Surgery, Medical School of Ankara University, Ankara, Turkey.

J THORAC CARDIOVASC SURG 1996;112:835-6

References

1. Suster S, Rosai J. Multilocular thymic cyst: an acquired reactive process—study of 18 cases. Am J Surg Pathol 1991;15:388-98.[Medline]
   
2. Bieger RC, McAdams AJ. Thymic cysts. Arch Pathol 1966;82:535-41.[Medline]
   
3. Dunne MG, Weksberg AP. Thymic cyst: computed tomography and ultrasound correlation. J Comput Tomogr 1983;7:351-5.[Medline]
   
4. Shapiro J, Gallant A, Wechsler RJ, Steiner RM. Thymic cyst secondary to cervical irradiation: a complication of treated laryngeal cancer. Comp Med Imaging Graph 1991;5:319-22.
   
5. Leon AS-Y, Brown JH. Malign transformation in a thymic cyst. Am J Surg Pathol 1984;8:471.[Medline]
   

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This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sinasi Yavuzer Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gönüllü, U. Articles by Yavuzer, S. Search for Related Content PubMed PubMed Citation Articles by Gönüllü, U. Articles by Yavuzer, S.