Adult Cervical Thymic Cysts: A Narrative Review.

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.

Parotid Gland Solitary Fibrous Tumor Presenting as a Long Duration Mass: A Case Report.

The solitary fibrous tumor (SFT) is a tumor of uncertain histogenesis, affecting deep soft tissues, particularly the pleura (pulmonary) and extrapulmonary sites including thighs, retroperitoneum, other serosal surfaces, and cranial and spinal meninges. SFT and hemangiopericytoma are now considered the same entity, with general agreement on referring to this group of tumors as "SFT." SFTs are generally benign tumors with small subsets of malignant ones. Moreover, they are well-circumscribed with a good prognosis after surgical resection. SFTs are uncommon in the head and neck and are quite rare in the parotid gland region. Here, we present a case of a 48-year-old female with SFT of the parotid gland region; the diagnosis was confirmed by positive immunohistochemical staining for Bcl-2, CD34, and STAT6. STAT6 immunohistochemistry is sensitive and specific for SFTs.

Rathke's cleft cyst presentation mimicking craniopharyngioma: Case report.

INTRODUCTION: Rathke's cleft cysts (RCCs) are benign cystic lesions from the remnant cells of the craniopharyngeal duct within Rathke's pouch. Anticipation of such condition will help planning the treatment course. PRESENTATION OF CASE: We present a case of a 46-year-old male, referred to our tertiary center with a history of seizures, confusion and agitation for the past two weeks. After thorough investigations, he was found to have hyponatremia with low serum cortisol and hypothyroidism. After being sedated, intubated and stabilized, Magnetic Resonance Imaging (MRI) brain showed relatively medium to large sellar lesion which was highly suspicious of a craniopharyngioma (CP). However, after performing an endoscopic transphenoidal surgical resection of the lesion, clinical diagnosis supported RCC. DISCUSSION: The best treatment approach for CP is a complete surgical resection via a transphenoidal approach. Considering the fluid component of RCC, it may be treated with a more conservative surgery and does not necessitate a surgery as invasive as that of CP. CONCLUSION: Given the mixed solid and cystic nature of CPs, it is possible to confuse it with RCC and vice versa. The presented case highlights that Rathke's cyst may be challenging in terms of pre-operative diagnosis, peri-surgical management and histopathological examination.

Chronic Invasive Fungal Rhinosinusitis in Immunocompetent Patients: A Retrospective Chart Review.

Objective: We report cases of Chronic Invasive Fungal Sinusitis (CIFS) in patients considered as immunocompetent at tertiary care center (King Faisal Specialist Hospital), to analyze their clinical, biological, radiological features, and management. Material and methods: A retrospective chart review of CIFS in immunocompetent patients. The inclusion criteria as the following: immunocompetent patients of any age with histopathological findings of CIFS. Immunocompromised patients, acute Invasive Fungal Sinusitis (IFS), non-invasive fungal rhinosinusitis, and no positive histological findings were excluded. Results: Seventeen (17) patients were included. The species isolated included: Aspergillus (most frequent) & Mucor. Surgical treatment approaches were described. Complications reported include CSF leak, blindness, recurrence, and death. Conclusions: Early diagnosis and management of CIFS improve clinical outcomes.

Inverted Sinonasal Papilloma Involving the Middle Ear with Evidence of Squamous Cell Carcinoma.

Inverted papilloma is an uncommon benign epithelial tumor that typically affects the nasal cavity and originates from the lateral sinonasal wall. Inverted papilloma occurring in the middle ear is an even more rare and aggressive condition. We describe a case of a 76-year-old man who was treated for isolated sinonasal inverted papilloma and after 20 months he was found to have a recurrence in the nasal cavity with middle ear involvement and malignant changes consistent with nonkeratinizing squamous cell carcinoma arising from inverted papilloma. Several surgical procedures were required to remove the tumor along with radiation therapy postoperatively.

Intraoperative monitoring of the facial nerve.

OBJECTIVE: Intraoperative facial nerve monitoring (FNM) was used to assess the anatomical and physiological integrity of the facial nerve during neurotological, otological, and parotid surgeries. Why monitor the facial nerve? There are several reasons to perform FNM. First of all, it alerts the surgeon when something potentially harmful was carried out to the nerve. When the regional anatomy is confusing, it allows positive identification of the nerve. Finally, the integrity of the facial nerve is assessed at the end of the procedure. METHODS: Eighty seven patients who underwent intraoperative monitoring of facial nerve between 1991 and 1996 at the King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia were studied. The device used was the nerve integrity monitor manufactured by Xomed. The device works when a physiologically intact facial nerve is stimulated, the muscles that are innervated by this nerve will contract. RESULTS: In otologic surgery, FNM signals the unintentional mechanical stimulation of the facial nerve during surgery, it predicts the dehiscence in the bony covering of the nerve and it allows mapping the nerve through soft tissue and bone. Facial nerve injury is the most devastating complication of otologic surgery particularly when anatomy is distorted by previous surgery, granulation tissue or cholesteatoma distorts anatomy, and in rare instances by an anolomous course. However, it is unlikely to be injured when it has been identified. The surgical treatment of recurrent parotid tumor can be challenging. The main aim of surgery is complete removal of tumor and preservation of facial nerve. CONCLUSION: Facial nerve monitoring assists early nerve identification and decreases the nerve trauma. However, as an adjunct, it has proved extremely beneficial. In this paper, the facial nerve was monitored intraoperatively in 87 cases with different pathologies. It is certainly helpful in revision mastoid surgery and in removal of recurrent parotid tumor. Intraoperative monitoring of the facial nerve plays an important role in identification and preservation of the facial nerve during otological and parotid surgeries.