Cervical thymic cyst in adults: Consideration in a neck mass algorithm

Objectives: 1) Review the epidemiology, clinical features, and histopathology of cervical thymic cysts; 2) Compare differences in presentation of cystic neck masses among disparate age populations; 3) Discuss proposed pathogenetic mechanisms for development of thymic cysts as well as the proper management; and 4) Understand a comprehensive algorithm for the workup of cystic neck masses. Methods: Retrospective case series and literature review. Results: Cervical thymic cysts are rare lesions that most often occur in the pediatric age group; there are few published reports of thymic cysts in the adult population. In reviewing our records over a ten year period, we have found 5 incidences of thymic cysts. We present one example in detail, and a comparison of the 5 cases. In addition to a discussion of proposed pathogenetic mechanisms and characteristic pathologic features of thymic cysts, we propose an algorithm for workup of cystic lateral neck masses. Conclusions: Despite its rare occurrence, thymic cyst can present in adult patients as a unilateral cystic cervical neck mass. Surgical management is an essential component for both diagnosis and treatment of cystic neck masses.