대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 362 Date 2004-10-02

  • Courtesy of Yu-Jin Lee, M.D., Hyung June Noh, M.D., Yu-Whan Oh, M.D. / Korea University Anam Hospital, Seoul, Korea
  • Age/Sex 43 / F
  • Chief ComplaintIncidental abnormality on a chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Multilocular thymic cyst
Radiologic Findings
Chest PA shows smooth marginated bulging opacity around right hilar portion. Chest CT scans show lobulating contoured mass with low attenuation in anterior mediastinum. Within the mass, septum-like thin linear attenuations are seen.
Photograph of gross specimen shows many small cysts separated by thick fibrous septae. Within cysts, multiple lobulating contoured whitish keratin materials are seen. Photomicrograph shows several cysts containing pinkish keratin-like materials and acelluar thick fibrous wall. The lining epithelial cells in cysts showed various shape and type.
Brief Review
Benign thymic cysts are uncommon lesions that account for approximately 3% of all anterior mediastinal masses. Such cysts can be either congenital or acquired in origin. Congenital cysts are typically unilocular. In contrast, acquired thymic cysts result from an inflammatory process and they are usually multilocular, hence the commonly used term "multilocular thymic cyst." The cysts contain turbid fluid or gelatinous material, have walls that are thick and fibrous, and typically have evidence of significant inflammation and fibrosis on histopathologic examination.
They typically manifest on CT as unilocular or multilocular cystic masses. The cysts have well-defined walls, and the lesions frequently have prominent soft-tissue attenuation components.
Multilocular thymic cysts should be distinguished from congenital cysts for several reasons: they may recur after excision, they may be associated with thymic neoplasms such as thymoma or thymic carcinoma, and they may adhere to adjacent structures and simulate an invasive neoplasm at thoracotomy.
The radiologic differential diagnosis for such lesions of the anterior mediastinum includes cystic teratoma, lymphangioma, hemangioma, and, as noted earlier, cystic degeneration of seminoma, Hodgkin's disease, and thymoma.
References
1. Choi YW, McAdams HP, Jeon SC, Hong EK, Kim YH, Im JG, Lee SR. Idiopathic multilocular thymic cyst: CT features with clinical and histopathologic correlation. AJR 2001 Oct;177(4):881-5.

2. Davis RD Jr, Oldham HN Jr, Sabiston DC Jr. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management and results. Ann Thorac Surg 1987;44:229 -237

3. Suster S, Rosai J. Multilocular thymic cyst: an acquired reactive process뾱tudy of 18 cases. Am J Surg Pathol 1991;15:388 -398

4. Indeglia RA, Shea MA, Grage TB. Congenital cysts of the thymus gland. Arch Surg 1967;94:149 -152
Keywords
Mediastinum, Benign tumor,

No. of Applicants : 34

▶ Correct Answer : 17/34,  50.0%
  • - Aditya Imaging Centre, Baroda, India Vivek Patel
  • - Calmette, Lille France D. Delhaye
  • - Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
  • - Chonnam National University Hospital, Korea Yong-Ju Moon
  • - CHU Nancy-Brabois, France Denis Regent
  • - Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - Hanyang University Hospital, Seoul, Korea Yo Won Choi
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Korea Univ Ansan Hopspital, Korea Je Bo-Kyung
  • - Mallinckrodt Institute of Radiology, USA Jin Mo Goo
  • - Marien Hospital, Hamm, Germany Davis Chiramel
  • - National Taiwan University Hospital, Taiwan Tan Che Kim
  • - Ohio State University Medical Center, Ohio, USA Sumit Seth
  • - Pusan National University Hospital, Busan Hyun Wook Choi
  • - Stanley Medical college,Chennai S.Ezhilan
▶ Semi-Correct Answer : 13/34,  38.2%
  • - Annecy Hospital, France Gilles Genin
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Auxerre Hospital, France Sebastien Larive
  • - Bangalore Medical College, Bangalore, India Raghavendra
  • - CHU Grenoble, France Mathieu Rodiere
  • - CIM Saint Dizier, France JC Leclerc
  • - Hamyang Seongsim Hospital, Korea Hyunchul Kim
  • - Han-gang sacred heart hospital, Korea Young-Jae Kim
  • - Hospital de la Marina Baixa. Spain Carlos F. Munoz-Nunez
  • - Hospital Donostia, Spain Aguirre, Poch, Baste
  • - Jikei University of Medicine, Japan Shigeki Misumi
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
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