Cervical thymic cysts are rare lesions, and in adults, they are extremely rare. We are reporting a case of a 58-year-old female with an asymptomatic anterior cystic neck mass, clinically diagnosed as a lymph cyst that was surgically excised. She was diagnosed as having an ectopic cervical thymic cyst based on histopathological findings. To the best of our knowledge, our patient is the oldest reported case of cervical thymic cyst to date.As malignant change has been reported in adult cervical thymic cysts, it should be considered in the differential diagnosis of cystic masses in the neck of adults, followed by complete surgical removal and histopathological confirmation for definitive diagnosis.A case report with a review of the literature along with relevant embryogenesis and pathogenesis has been presented in this article. Introduction Ectopic cervical thymic cysts in adults are rare(1,2). Most of the cases have been reported in the paediatric age group. Their prevalence is less than 1% of all cervical masses, and they are usually noted in childhood(1). Being uncommon, they are rarely included in the clinical diagnosis of cervical cystic masses and are misdiagnosed by surgeons as branchial cysts, lymphatic malformations, epidermoid cysts, dermoid cysts or thyroglossal cysts, lymphadenitis or neoplastic masses(3). Malignancy in thymic cysts, though rare, has been mentioned in literature (4,5). Therefore the surgeon should be aware of this possibility, and complete surgical removal is the treatment of choice, followed by thorough histological examination to ensure that a possible malignant change is not overlooked.Histopathologically, thymic cysts are diagnosed by the presence of remnants of thymic tissue, represented by Hassall’s corpuscles, in the cyst wall.The purpose of publishing this case is to acknowledge the rarity of an ectopic thymic cyst in the cervical region in an elderly female of 58 years old, this being older than any patients currently reported in the literature, and to discuss the embryology and pathological features of this rare entity . Case report A 58-year-old female with history of slowly growing painless cystic mass, first noticed 3 years ago on the left side of the anterior triangle of neck in the cervical region, was admitted to our outpatient department of Surgery. A clinical diagnosis of a lymph cyst was considered. Intraoperatively, the cystic mass was found to be anterior to the sternocleidomastoid muscle and did not extend to mediastinum. Patient underwent excision biopsy. We received an ovoid cystic specimen measuring 3x2 cm. Upon cutting it open, the cyst was found to be unilocular with clear serous fluid and smooth luminal surface.Histopathological examination showed a cyst wall lined by flat to cuboidal lining [fig.1]. The wall was composed of fat and fibro-collagenous tissue showing focal aggregation of lymphoid cells with Hassall’s corpuscles inside [fig.2]. Based on these classical findings, the diagnosis of ectopic thymic cyst of the cervical region was given.
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