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• W2417754964 abstract "Letters to the EditorEctopic Thymus Presenting as a Neck Swelling in a Newborn Akhter Nawaz, FRCSI Alic Jacobsz, and FRCS Ahmed Al-SalemFRCSI Akhter Nawaz Division of Pediatric Surgery, Department of Surgery, Tawam Hospital, Al Ain Abu Dhabi, United Arab Emirates Search for more papers by this author , Alic Jacobsz Division of Pediatric Surgery, Department of Surgery, Tawam Hospital, Al Ain Abu Dhabi, United Arab Emirates Search for more papers by this author , and Ahmed Al-Salem Division of Pediatric Surgery, Department of Surgery, Tawam Hospital, Al Ain Abu Dhabi, United Arab Emirates Search for more papers by this author Published Online::1 Mar 1998https://doi.org/10.5144/0256-4947.1998.192aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionA Nawaz, A Jacobsz, A Al-Salem, Ectopic Thymus Presenting as a Neck Swelling in a Newborn. 1998; 18(2): 192-193To the Editor. The differential diagnosis of a neck swelling in a child commonly includes cervical lymphadenopathy, branchial cyst, thyroglossal cyst and cystic hygroma. The thymus gland is usually located in the superior mediastinum, but because of its embryological origin it can be found ectopically in any location along a line extending from the embryological position in the neck to the final position in the superior mediastinum.1 Although ectopic cervical tissue is not an uncommon finding during autopsy studies,2,3 very few enlarge to present clinically. Ectopic cervical thymus should be considered in the differential diagnosis of cervical masses in children. This is a report of an ectopic cervical thymus presenting as a cervical mass in a newborn.A three-month-old baby, a product of full-term normal vaginal delivery to a gravida 2 para 2 mother, was admitted to our hospital because of a right-sided neck swelling. The mother noticed the swelling immediately after birth, and reported it to be increasing in size. Physical examination revealed a healthy-looking baby with no other abnormalities apart from a soft spongy irregular swelling on the right side of the neck. The swelling measured 3x4 cm in size and extended from just behind the ear above to the angle of the mandible below. The blood CBC, chemistry and chest x-ray were normal. Ultrasound and CT scan of the neck revealed a mass which was deep to the lower part of the parotid gland and under the sternocleidomastoid muscle laterally and the carotid sheath posteromedially. The mass measured 3 cm sagittally and 2.5 cm anteroposteriorly and was most likely lymphatic in origin (Figure 1). A normally placed thymus was seen on CT scan. Fine-needle aspiration biopsy was performed but the report was inconclusive. The patient was operated on and the mass was excised totally, together with an adjacent enlarged lymph node. Histology of the lymph node revealed reactive lymphadenitis, while that of the mass showed it to be thymus. This was identified by the medullary region containing multiple Hassal's concentric corpuscles of epithelial cells. There was no evidence of malignancy and no thyroid tissue was seen. Postoperatively, the patient did well and was discharged home on the third postoperative day.Figure 1. CT scan of the neck showing a mass on the right side of the neck.Download FigureEmbryologically, the thymus gland starts to develop at about the sixth week of intrauterine life as a paired primordia from a ventral sacculation of the third pharyngeal pouch. These elongate caudally as the tubular structures known as thymopharyngeal tracts. At about seven weeks of intrauterine life, the two tracts after separation and proliferation incompletely fuse in the midline, forming the thymus gland which (because of its attachment to the pericardium) descends into the superior mediastinum to lie anterior to the pericardium and great vessels.4 As a result of this, thymic tissue is sometimes seen along the descent line of the thymus from the original position in the neck to the final position in the superior mediastinum.1 Noback in an autopsy study of 65 random infants reported an 80% incidence of ectopic cervical thymus tissue,2 but the incidence of clinically apparent ectopic thymic tissue is rare.3 This is because only a few of these enlarge to become visible or cause symptoms. Whereas ectopic thymic tissue can be found commonly along the line of descent of the thymopharyngeal tracts, it is less often found in other sites, including the base of the skull, pharynx, neck and posterior mediastinum.5 The presence of ectopic thymic tissue at these sites was explained by the loss and sequestration of a part of the developing thymus, leading to its migration with local tissues.5 Of all these sites, ectopic cervical thymus is reported to be the most common. It is usually apparent clinically, while asymptomatic ectopic thymic tissue at other sites is difficult to diagnose and may produce symptoms in the form of dysphagia or airway compression.3,6Although ectopic cervical thymus is the most common of all types of ectopic thymus, the diagnosis in all is not suspected preoperatively, and is confirmed only after excision and histological examination. Ultrasound and CT scan in our case were not helpful. Fine-needle aspiration was tried in our patient but the result was inconclusive. Intraoperatively, these masses classically lie along the carotid sheath deep to the sternocleidomastoid muscle.Ectopic cervical thymus, although rare, should be borne in mind when considering the differential diagnosis of cervical masses in infants and children. To obviate the risk of possible malignant transformation which has been reported in aberrant cervical thymus and to confirm the diagnosis, excision of these lesions is mandatory.ARTICLE REFERENCES:1. Gilmour JR. Some developmental abnormalities of the thymus and parathyroids . J Path Bact. 1946; 52: 213–8. Google Scholar2. Noback GJ. Contribution to topographic anatomy of thymus gland with particular reference to its changes at birth and in period of newborn . Am J Dis Child. 1921; 22: 120–44. Google Scholar3. Spigland N, Bensoussan AL, Blanchard H, Russo P. Aberrant cervical thymus in children: three case reports and review of the literature . J Pediatr Surg. 1990; 25: 1196–9. Google Scholar4. Tovi F, Mares AJ. The aberrant cervical thymus: embryology, pathology and clinical implcations . Am J Surg. 1978; 136: 631–7. Google Scholar5. Al-Salem AH. Ectopic thymic tissue stimulating a posterior mediastinal mass . Eur J Pediatr Surg. 1992; 2: 106–7. Google Scholar6. McLead DM, Karandy EJ. Aberrant cervical thymus: a rare cause of acute respiratory distress . Arch Otolaryngol. 1981; 107: 179–80. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 18, Issue 2March 1998 Metrics History Published online1 March 1998 InformationCopyright © 1998, Annals of Saudi MedicinePDF download" @default.
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