Diagnosis and management of ectopic cervical thymus in children: Systematic review of the literature.

Biopsy, Fine-Needle Child Child, Preschool Choristoma / diagnostic imaging Diagnosis, Differential Humans Neck Thymus Gland Ultrasonography
Cervical thymic cyst Cervical thymus Children

Journal

Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631

Informations de publication

Date de publication:
Nov 2021
Historique:
received: 26 09 2020
revised: 19 02 2021
accepted: 08 03 2021
pubmed: 2 4 2021
medline: 30 10 2021
entrez: 1 4 2021
Statut: ppublish

Résumé

Ectopic cervical thymus (ECT) is a rare cause of neck swelling in children. Our aim was to evaluate the diagnostic and management challenges of this condition. Systematic review of the literature (1997-2020) using PRISMA guidelines. A total of 192 cases of ECT were identified. Forty-two cases (4 studies) were excluded because of insufficient data resulting in 150 cases (7 bilateral) in a total of 143 patients. ECT presented as a solid mass in 71 cases (10 incidentally found at autopsy, 33 conservatively managed and 28 excised) and as a cystic mass in 79 cases (all excised). A total of 165 imaging studies in 123 patients were performed (65 ultrasound scans (USS), 51 magnetic resonance imaging (MRI) scans and 49 computer tomography (CT) scans). ECT was diagnosed by imaging in 18.7% (23/123) of patients. Fine needle aspiration cytology or incisional/needle biopsy were performed in 16% (23/140) cases; a correct diagnosis of ECT was obtained in 52% (12/23) of those cases. There were no reports of malignancy in 143 specimens analysed. A normal mediastinal thymus was absent in 2.5% (1/40) of patients investigated. ECT is a benign and relatively rare condition in children that is seldom diagnosed on imaging before tissue sampling or surgical excision. ECT might be the only active thymus in 2.5% of cases and careful consideration should be taken prior to its excision in young children. We recommend that ECT should be considered in the differential diagnosis of neck masses in children. Conservative management might be appropriate in selected cases and the presence of a normal mediastinal thymus in the thorax should be investigated before planning surgical excision.

Sections du résumé

BACKGROUND/PURPOSE OBJECTIVE
Ectopic cervical thymus (ECT) is a rare cause of neck swelling in children. Our aim was to evaluate the diagnostic and management challenges of this condition.
METHODS METHODS
Systematic review of the literature (1997-2020) using PRISMA guidelines.
RESULTS RESULTS
A total of 192 cases of ECT were identified. Forty-two cases (4 studies) were excluded because of insufficient data resulting in 150 cases (7 bilateral) in a total of 143 patients. ECT presented as a solid mass in 71 cases (10 incidentally found at autopsy, 33 conservatively managed and 28 excised) and as a cystic mass in 79 cases (all excised). A total of 165 imaging studies in 123 patients were performed (65 ultrasound scans (USS), 51 magnetic resonance imaging (MRI) scans and 49 computer tomography (CT) scans). ECT was diagnosed by imaging in 18.7% (23/123) of patients. Fine needle aspiration cytology or incisional/needle biopsy were performed in 16% (23/140) cases; a correct diagnosis of ECT was obtained in 52% (12/23) of those cases. There were no reports of malignancy in 143 specimens analysed. A normal mediastinal thymus was absent in 2.5% (1/40) of patients investigated.
CONCLUSIONS CONCLUSIONS
ECT is a benign and relatively rare condition in children that is seldom diagnosed on imaging before tissue sampling or surgical excision. ECT might be the only active thymus in 2.5% of cases and careful consideration should be taken prior to its excision in young children. We recommend that ECT should be considered in the differential diagnosis of neck masses in children. Conservative management might be appropriate in selected cases and the presence of a normal mediastinal thymus in the thorax should be investigated before planning surgical excision.

Identifiants

DOI: 10.1016/j.jpedsurg.2021.03.003 PMID: 33789804
pubmed: 33789804
pii: S0022-3468(21)00203-7
doi: 10.1016/j.jpedsurg.2021.03.003
pii:
doi:

Types de publication

Journal Article Review Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

2062-2068

Informations de copyright

Copyright © 2021. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None.

Auteurs

Anette Chang (A)

Department of Paediatric Surgery, Monash Children's Hospital, Clayton, Melbourne, Australia.

Ramesh M Nataraja (RM)

Department of Paediatric Surgery, Monash Children's Hospital, Clayton, Melbourne, Australia; Department of Paediatrics, Monash University, Clayton, Melbourne, Australia; Department of Surgery, Monash University, Clayton, Melbourne, Australia.

Eduard Pudel (E)

Department of Ear, Nose and Throat/Head and Neck Surgery, Monash Medical Centre, Clayton, Melbourne, Australia.

Robert Stunden (R)

Department of Paediatric Surgery, Monash Children's Hospital, Clayton, Melbourne, Australia.

Stephen Baré (S)

Department of Pathology, Monash Medical Centre, Melbourne, Australia.

Maurizio Pacilli (M)

Department of Paediatric Surgery, Monash Children's Hospital, Clayton, Melbourne, Australia; Department of Paediatrics, Monash University, Clayton, Melbourne, Australia; Department of Surgery, Monash University, Clayton, Melbourne, Australia. Electronic address: maurizio.pacilli@monash.edu.

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Classifications MeSH

questionsmedicales.fr › Techniques d'investigation › Techniques cytologiques › Cytodiagnostic › Biopsie › Ponction-biopsie à l'aiguille › Cytoponction › Diagnosis and management of ectopic cervical...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Diagnosis and management of ectopic cervical...
questionsmedicales.fr › Personnes › Tranches d'âge › Enfant › Enfant d'âge préscolaire › Diagnosis and management of ectopic cervical...
questionsmedicales.fr › États, signes et symptômes pathologiques › États anatomopathologiques › Choristome › Diagnosis and management of ectopic cervical...
questionsmedicales.fr › Diagnostic › Diagnostic différentiel › Diagnosis and management of ectopic cervical...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Diagnosis and management of ectopic cervical...
questionsmedicales.fr › Régions du corps › Cou › Diagnosis and management of ectopic cervical...
questionsmedicales.fr › Systèmes sanguin et immunitaire › Système immunitaire › Système lymphatique › Tissu lymphoïde › Thymus (glande) › Diagnosis and management of ectopic cervical...
questionsmedicales.fr › Diagnostic › Techniques et procédures diagnostiques › Imagerie diagnostique › Échographie › Diagnosis and management of ectopic cervical...