Elsevier

Journal of Pediatric Surgery

Volume 25, Issue 11, November 1990, Pages 1196-1199
Journal of Pediatric Surgery

Aberrant cervical thymus in children: Three case reports and review of the literature

https://doi.org/10.1016/0022-3468(90)90764-ZGet rights and content

Abstract

Aberrant migration of thymic tissue occurs with ectopic thymus in the mediastinum, base of the skull, tracheal bifurcation, and cervical region. A recent review of the literature showed a total of 76 reported cases of aberrant thymus or thymic cysts in patients who presented with primary neck masses. We report three additional cases of ectopic cervical thymus. All three patients presented with asymptomatic cervical masses, and preoperative diagnosis included branchial cleft cyst, cervical lymphangioma, and cervical teratoma. All patients underwent complete surgical resection of the masses. Aberrant cervical thymus rarely produces symptoms because it does not invade contiguous stryctures. Despite its rarity, it should be considered in the differential diagnosis of asymptomatic neck masses in children.

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    This discrepancy between previous reports and the present study may be attributed to the different populations analyzed [3,19]. Most previous reports represent case presentations or reviews consisting of several cases [14,20], with almost all of the cases showing clinical symptoms, such as a neck mass, due to the anomaly [3]. In contrast, most of the ECTs in our study represented incidental findings identified in infants who died from unrelated causes.

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    The dorsal and ventral wings of the third pharyngeal pouch begin to form the primordia of the inferior parathyroid and thymic glands, respectively. Both glands separate from the pharyngeal wall and migrate caudally and medially, with the thymus “pulling” the inferior parathyroid gland along in a structure called the thymopharyngeal duct or tract.7 During its descent into the thorax, the upper end of the thymus becomes drawn out and eventually vanishes, and it is during this descent that primordial thymic tissue may become arrested in the neck to form a cervical mass.

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Presented at the 21st Annual Meeting of the Canadian Association of Paediatric Surgeons, Edmonton, Alberta, September 20–23, 1989.

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