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Policardo F, Tralongo P, Vegni F, Feraco A, De Stefano I, Carlino A, Ferraro G, Navarra E, Mulè A, Rossi ED. Some uncommon cystic lesions in the anterior head and neck region: Pitfalls to be avoided on cytology. Cytopathology 2024; 35:23-29. [PMID: 37522315 DOI: 10.1111/cyt.13272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/10/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
Abstract
Cystic lesions of the anterior head and neck region are a challenging and frequent finding on cytological smears. The scant amount of cellular material in cystic slides poses the greatest difficulty to interpretation, so that frequently they are diagnosed as inadequate or with minimal cellular component. Despite the majority of cystic lesions being benign, a minor portion consist of malignant cystic entities. In these latter cases, the evidence of very scant malignant cells can be misdiagnosed and/or underestimated, leading to a false negative diagnosis. Many papers have already described and detailed the range of possible benign and malignant cystic lesions in head and neck. In the current review we have focused on the less common entities that often lead to serious misinterpretation.
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Affiliation(s)
- Federica Policardo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Pietro Tralongo
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Federica Vegni
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Angela Feraco
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Ilenia De Stefano
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Angela Carlino
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Giulia Ferraro
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Elena Navarra
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Antonino Mulè
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
| | - Esther Diana Rossi
- Division of Anatomic Pathology and Histology, Fondazione Policlinico Universitario "Agostino Gemelli", IRCCS, Rome, Italy
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Awny S, Alashram M, Eladl A, Awad A, Taysir Y, ElKhasef W, Abdelrahman A, Abdelshaheed M, Fetoh FA, Elshabrawy M, Elshehawi ME, Hamdy O. A Cervical Thymic Cyst in an Adult Female; A Case Report and Comprehensive Literature Review. Indian J Otolaryngol Head Neck Surg 2023; 75:924-933. [PMID: 37275018 PMCID: PMC10234974 DOI: 10.1007/s12070-022-03159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction: Cervical thymic cyst accounts for (0.3-1) % of cervical cysts in children and are usually present during the first decade of life with few reported cases in adults. Herein, we present a 34-year-old female with a cervical thymic cyst. We conducted a review of all the previously reported cases as well. Case presentation: The patient complained of an anterolateral neck swelling that was noticed one year ago. It was a soft, fluctuant, mobile, non-tender swelling in the midline and the right side of the lower neck. Neck ultrasonography revealed a large thin-walled cyst, with no internal septa, echoes, or solid parts. Post-contrast MRI of the neck showed a well-defined, oblong-shaped, lobulated cystic lesion just beneath the strap muscle. The cyst extended caudally to the superior border of the anterior mediastinum at the level of the upper border of the manubrium sterni. The patient underwent excision of the swelling under general anesthesia via Kocher's collar neck incision. Connection with the thymus gland was detected behind the manubrium sterni which was separated. Pathological examination showed prominent thymic tissue confirming the diagnosis of a cervical thymic cyst. Conclusion: Adult cervical thymic cyst is very rare with a few cases reported in the literature. Surgical excision in symptomatic patients is the treatment of choice. Paper's main novel aspects: • A rare presentation of a cervical thymic cyst in an adult. • A comprehensive literature review including all the previously reported cases in one table.
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Affiliation(s)
- Shadi Awny
- Surgical oncology unit, Mansoura University Oncology centre, Mansoura, Egypt
| | - Marwa Alashram
- Medical intern, Mansoura University Hospitals, Mansoura, Egypt
| | - Aya Eladl
- Medical intern, Mansoura University Hospitals, Mansoura, Egypt
| | - Amira Awad
- Medical intern, Mansoura University Hospitals, Mansoura, Egypt
| | - Yara Taysir
- Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Wagdi ElKhasef
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Fetoh Alaaeldin Fetoh
- Cardiothoracic surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elshabrawy
- Cardiothoracic surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Eslam Elshehawi
- Anasthesia and intensive care Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Omar Hamdy
- Surgical oncology unit, Mansoura University Oncology centre, Mansoura, Egypt
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Almofada HS, Almedemgh NI, Othman EO. Adult Cervical Thymic Cysts: A Narrative Review. Ear Nose Throat J 2022:1455613221111490. [PMID: 35763329 DOI: 10.1177/01455613221111490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Thymic cysts are rare benign neck masses, accounting for less than 1% of all cervical masses. This study aims to discern different presentations, investigations, and treatment options of thymic cysts in adults by reviewing prior published studies from January 2010 to October 2021 to bridge the knowledge gap since the last review by Michalopoulos in 2011. Moreover, we present a case of a 28-year-old male with a left cervical thymic cyst. DATA SOURCES Data were obtained from a literature search using the ScienceDirect, PubMed, ResearchGate, and Google Scholar databases. METHODS AND RESULTS This study retrospectively analyzes reported cases of adult cervical thymic cysts by collecting demographic data, patient presentation, duration, location, size, type of imaging, fine-needle aspiration, and surgical approach. Eighteen patients were included. Cysts were seen on the left (n = 9), right (n = 5), and midline (n = 4). The age of the patients ranged from 19 to 64 years. Most patients present with painless left-sided neck swelling. Computed tomography (CT) was the preferred imaging modality in most cases. Moreover, surgical excision was essential for therapeutic and diagnostic purposes. This study did not require institutional review board approval. CONCLUSION Adult cervical thymic cyst is a rare etiology. Nevertheless, a painless left-sided neck mass with no clear lower border should uphold thymic cyst as a differential diagnosis. MRI and CT scans are the preferred imaging modalities for preoperative planning. Surgical excision is mandatory for treatment and histological confirmation. As of October 2021, around 54 cases of adult thymus cysts had been reported to the best of our knowledge and review.
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Affiliation(s)
- Hesham Saleh Almofada
- Otorhinolaryngology Head and Neck Surgery and Communicatons Sciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Alfaisal Unviersity, College of Medicine, Riyadh, Saudi Arabia
| | - Norah Ibrahim Almedemgh
- College of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Eyas Osama Othman
- Otorhinolaryngology Head and Neck Surgery and Communicatons Sciences Department, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
- Alfaisal Unviersity, College of Medicine, Riyadh, Saudi Arabia
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Abstract
Cervical thymic cysts (CTCs) represent 1% of all cervical cystic masses. A review of the literature found that CTCs are typically asymptomatic, with a propensity to be left sided. CTCs often require histological evaluation for diagnosis. A 27-year-old male patient presented to an outpatient otolaryngology clinic with worsening bilateral jaw and neck pain and an incidental right-sided neck mass found on cervical MRI. Preoperative differential diagnosis included venolymphatic malformation versus branchial cleft cyst. Histological examination of the excised specimen provided diagnosis of a CTC. Postoperatively, the patient reported improvement in cervical pain. CTCs are a rare cause of lateral neck mass in young adults. Typical presentation included neck enlargement with no symptoms or in some cases compressive symptoms. It is important to consider CTCs when formulating a differential for a lateral neck mass.
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Affiliation(s)
- Zachary J Cromar
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Viraj N Shah
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Brandon Kamrava
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kenneth R Nissim
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jaylou M Velez-Torres
- Department of Pathology - Head and Neck Cytopathology, University of Miami Miller School of Medicine, Miami, FL, USA
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Abstract
Retained thymic tissue may occur anywhere along the path of descent of the thymus. Cervical thymic cysts are a rare cause of benign neck masses. Thymopharyngeal duct cysts are thymic cysts that span the length of the neck and extend towards the mediastinum. These lesions are rare and classically have been described in paediatric patients. Here, we present the case of a 23-year-old woman with a left-sided neck mass, which was found to be a thymopharyngeal duct cyst. Multiple analytic modalities including the clinical presentation, imaging, operative findings and histology were required to confirm the diagnosis and are discussed below.
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Affiliation(s)
- Jessica Emilia Wahi
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Ruben Delgado
- Department of Pathology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Ana Maria Medina
- Department of Pathology, Mount Sinai Medical Center, Miami Beach, Florida, USA,Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | - Thomas Mesko
- Department of Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
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Smith BD, Schild MH, Jiang XS, Kahmke RR. A Rare Case of a Cervical Thymic Cyst Presenting in Adulthood. Case Rep Otolaryngol 2020; 2020:4059530. [PMID: 32832180 DOI: 10.1155/2020/4059530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/10/2020] [Accepted: 07/31/2020] [Indexed: 11/24/2022] Open
Abstract
The cervical thymic cyst (CTC) is a rare, benign neck mass that most commonly presents in the pediatric population. These entities can occur anywhere along the normal path of descent of the thymus from the mandible to the sternal notch, and extension into the mediastinum has been observed. The presentation of these masses is often characterized by a painless, enlarging neck mass in a child during the first decade of life. Although most patients are asymptomatic, abutment of the cyst against local structures has led to a variety of presentations including respiratory distress. These rare lesions are noted to have a male predominance and most commonly present on the left side of the neck. We present the rare case of a 19-year-old male who presented with a left-sided painless, cystic neck mass. He underwent a computed tomography scan of the neck which showed a large cystic mass in the left neck deep to the sternocleidomastoid muscle. Preoperatively, the diagnosis of an infected third branchial cyst was favored. The lesion was completely excised in the operating room. Final pathology was consistent with a CTC. The CTC is an uncommon benign process that often presents as an asymptomatic cystic neck mass. Knowledge of the clinical presentation, diagnostic process, and treatment of these rare lesions is essential for the Otolaryngologist.
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Queralt Martín R, Ibáñez Belenguer M, Martínez Hernández A, Menor Durán PD, Laguna Sastre JM. Thymic Cysts: A Rare Entity in Adults. Cir Esp 2020; 99:71-73. [PMID: 32444134 DOI: 10.1016/j.ciresp.2020.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Raquel Queralt Martín
- Servicio de Cirugía General y Digestiva, Hospital General Universitario de Castellón, Castellón, España.
| | - Miguel Ibáñez Belenguer
- Servicio de Cirugía General y Digestiva, Hospital General Universitario de Castellón, Castellón, España
| | - Andreu Martínez Hernández
- Servicio de Cirugía General y Digestiva, Hospital General Universitario de Castellón, Castellón, España
| | - Pedro Daniel Menor Durán
- Servicio de Cirugía General y Digestiva, Hospital General Universitario de Castellón, Castellón, España
| | - Jose Manuel Laguna Sastre
- Servicio de Cirugía General y Digestiva, Hospital General Universitario de Castellón, Castellón, España
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Abstract
Cervical thymic cyst is rare lesions leading to cervical mass. As it is a rare entity, it might be confused with other congenital neck masses or neoplastic lesions. Preoperative diagnosis is almost impossible. In the present study, a patient who was operated with prediagnosis of branchial cyst and diagnosed with thymic cyst according to the histopathologic examination was presented. A 16-month-old girl was admitted to our clinic with the complaint of growing right neck mass that was realized about 4 months ago. Magnetic resonance imaging (MRI) of the neck demonstrated a rim-enhanced hypointense cystic lesion in the posterior aspect of the submandibular gland, without tracheal right lateral and mid plane on MRI, curving common carotid artery to the medial. Patients underwent surgery under general anesthesia in company with existing findings. Hypoglossal nerve was surrounded by the mass, and the mass was totally resected. The final pathology result was reported as thymic cyst. Cervical thymic masses might be unnoticed in the differential diagnosis of the cervical mass as they are rarely seen entities. Histopathologic examination of the thymus tissue was performed for diagnosis. Surgical excision is the ideal treatment approach and no postoperative recurrence has been reported.
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Chen AL, Renshaw AA, Faquin WC, Alexander EK, Heller HT, Cibas ES. Thyroid FNA biopsies comprised of abundant, mature squamous cells can be reported as benign: A cytologic study of 18 patients with clinical correlation. Cancer Cytopathol 2018; 126:336-341. [PMID: 29634853 DOI: 10.1002/cncy.21976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 01/07/2018] [Accepted: 01/11/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND A thyroid nodule comprised almost exclusively of mature, benign-appearing squamous cells is an uncommon finding in fine-needle aspiration (FNA) biopsies of thyroid nodules. Reporting such specimens was not originally addressed by The Bethesda System for Reporting Thyroid Cytopathology. The authors correlated the biologic behavior of the specimens with their benign cytologic appearance through clinical, radiographic, and surgical follow-up. METHODS The pathology archives of 3 tertiary hospitals were searched for thyroid FNA specimens consisting of mature squamous cells without atypia. The authors reviewed all available slides and included only cases that were moderately to highly cellular; nucleated or anucleate squamous cells without atypia comprised the vast majority of the cellularity. Available clinical information and/or thyroid ultrasound examination(s) were reviewed by an endocrinologist or radiologist, respectively. RESULTS A total of 18 patients (7 men and 11 women; age range, 19-76 years) with 20 nodules met the prespecified inclusion criteria. The average nodule size was 2.1 cm. Common sonographic characteristics included a well-defined appearance, the lack of internal vascularity, a thin outer wall, general hypoechogenicity with low-intermediate internal echoes, and posterior acoustic enhancement. Clinical and radiographic follow-up (mean, 3.8 years; range, <1 to 9 years) was available for 9 patients, and all nodules were stable. All 4 cases with histologic follow-up were benign squamous-lined cysts. CONCLUSIONS The findings of the current study suggest that thyroid FNA specimens comprised almost exclusively of mature squamous cells can be reported as benign. Cancer Cytopathol 2018;126:336-41. © 2018 American Cancer Society.
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Affiliation(s)
- Athena L Chen
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew A Renshaw
- Department of Pathology, Baptist Hospital of Miami, Miami, Florida.,Department of Pathology, Miami Cancer Institute, Miami, Florida
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Erik K Alexander
- Endocrinology Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Howard T Heller
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Edmund S Cibas
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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10
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Abstract
Ectopic thymic tissue in neck is not uncommon; however, ectopic thymic cysts in neck are rare and intrathyroidal thymic cyst is still rarer. Multilocular proliferating thymic cyst is a rare entity and very few cases are described in mediastinum. We present the first case of a 73-year-old male with an intrathyroidal multilocular proliferating thymic cyst mimicking thyroid malignancy radiologically.
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Affiliation(s)
- Jayashri Chaudhari
- Department of Pathology, Seth G. S. Medical College & KEM Hospital, Parel, Mumbai, India,
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Wang J, Fang J. Ectopic thyroid mass in the left lateral neck and anterior mediastinum: a case report. J Med Case Rep 2014; 8:351. [PMID: 25335650 PMCID: PMC4217105 DOI: 10.1186/1752-1947-8-351] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Ectopic thyroid is characterized by the presence of thyroid tissue in a site other than in its usual pretracheal region. It is a rare condition among the thyroid diseases. Dural ectopic thyroid present in the cervical and anterior mediastinal has not been reported. Case presentation A 45-year-old Chinese woman presented with a nonfunctional ectopic thyroid located both in the cervical and anterior mediastinum. The ectopic thyroid was removed under video-assisted thoracoscopic surgery using a transverse neck incision and her postoperative period has been uneventful thus far. Conclusions Ectopic thyroid is a rare condition among the thyroid diseases, and its location in the anterior mediastinum is even more uncommon. Less than 15 cases have been reported in the last four decades. This is the first case of ectopic thyroid to appear in both the cervical and anterior mediastinum at same time. Masses in the anterior mediastinal are usually thymoma, lymphoma, pheochromocytoma and germ cell tumors. Ectopic thyroid in this area is quite rare so this case enhances our understanding of the diagnosis of mediastinal masses.
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Affiliation(s)
- Jiangling Wang
- Department of Anesthesiology, Cancer Hospital of Zhejiang Province, No, 38, Guangji Road, Hangzhou, Zhejiang Province, PR China.
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Alzahrani HA, Iqbal JM, Abu Shaheen AK, Al Harthi BN. Cervical thymic cyst in an adult. Case Rep Surg 2014; 2014:801745. [PMID: 24876986 DOI: 10.1155/2014/801745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 04/17/2014] [Indexed: 11/25/2022] Open
Abstract
Cervical thymic cysts (CTCs) are unusual lesions, representing only 1% of cystic cervical masses. Diagnosis of this condition in adults is even rarer.
We report a 34-year-old female who presented with asymptomatic progressively growing left-sided neck swelling. Neck ultrasound (US) showed a large cystic lesion with septation, compressing the ipsilateral vessels. Magnetic resonance imaging (MRI) confirmed the US findings. Surgical excision was performed which subsequently showed findings consistent with CTC. CTC in adult is extremely rare, with few reported cases identified in the literature. Thymic gland anomalies in the neck are the consequences of an arrest in the descent of the gland, sequestration of the thymic tissue, or failure of involution. The diagnosis of this condition is rarely done prior to surgical excision. The clinical presentation, radiologic imaging, surgical findings, and histologic appearance are all essential components to make the correct diagnosis of this very rare differential diagnosis of cystic lateral neck swelling.
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Mahmodlou R, Gheibi S, Aghajani Nargesi A, Mahmoodzadeh R, Salabati M. Symptomatic Cervical Thymic Cyst: A Case Report and Literature Review. ACTA ACUST UNITED AC 2013. [DOI: 10.17795/compreped-9379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Vijayasekaran A, Maegawa F, Guerrero M. A Rare Finding of an Ectopic Parathyroid Gland within a Cervical Thymic Cyst Presenting as a Lateral Neck Mass. Am Surg 2012. [DOI: 10.1177/000313481207800321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Felipe Maegawa
- Department of Surgery University of Arizona Tucson, Arizona
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