SESSION TITLE: Surgery Case Report Posters I
SESSION TYPE: Case Report Poster
PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM
INTRODUCTION: Bronchogenic cysts are developmental anomalies of the ventral foregut arising from abnormal budding of the primitive tracheobronchial tree. Usually they acquire an intra-thoracic location primarily mediastinal or intraparenchymal, though atypical locations including cervical, intradiaphragmatic, interatrial septum and retroperitoneal have been reported. We present an extremely rare, aberrant location of a bronchogenic cyst within the thymic tissue that was minimally resected with robotic assistance.
CASE PRESENTATION: A 45 year old previously healthy male presented with shortness of breath, wheezing, productive cough and hypoxia on initial examination. Chest X-ray was normal and was followed by a CT angiogram to rule out a pulmonary embolism. The scan revealed an anterior mediastinal mass measuring 3.3x1.8x2.1cm consistent with a thymic neoplasm. Surgical resection was planned and the patient underwent a right-sided robotic-assisted thymectomy and lymphadenectomy. Pathological examination revealed an intra-thymic bronchogenic cyst present in the right side of the thymus filled with serous fluid. Histologically, the lining wall of the cyst was composed of respiratory type epithelium with focal squamous metaplasia.
DISCUSSION: Bronchogenic cysts developing within the thymus are extremely rare entities with less than five reported cases in the English literature . The mechanism is not completely understood. Bronchogenic cysts are usually fluid filled and the variability of the cyst content results in soft tissue attenuation on computed tomography  leading to a misdiagnosis of thymoma. We advocate minimally invasive surgical excision when identified due to their potential for malignant transformation  regardless of the presenting symptoms.
CONCLUSIONS: Intra-thymic bronchogenic cysts are very rare and should be considered in the differential of an anterior mediastinal mass. Minimally invasive resection is ideal for these benign lesions.
Reference #1: Suen HC, Mathisen DJ, Grillo HC, LeBlanc J, McLoud TC, Moncure AC, Hilgenberg AD. Surgical management and radiological characteristics of bronchogenic cysts. Ann Thorac Surg. 1993;55:476-481
Reference #2: McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, Matsumoto S. Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology. 2000; 217:441-6.
Reference #3: Tsai JH, Lee JM, Lin MC, Liau JY. Carcinoid tumor arising in a thymic bronchogenic cyst associated with thymic follicular hyperplasia. Pathol Int. 2012; 62 :49-54.
DISCLOSURE: The following authors have nothing to disclose: Maria Siddiqui, Adnan Al-Ayoubi, Sadiq Rehmani, Faiz Bhora
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