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Idiopathic Multilocular Thymic Cyst

CT Features with Clinical and Histopathologic Correlation

Yo Won Choi1, H. Page McAdams2, Seok Chol Jeon1, Eun Kyung Hong3, Yun-Hyeon Kim4, Jung-Gi Im5 and Seung Ro Lee1

1 Department of Radiology, Hanyang University Hospital, 17 Haengdang-dong, Sungdong-ku, Seoul 133-792, South Korea.
2 Department of Radiology, Duke University Medical Center, P.O. Box 3808, Durham, NC 27710.
3 Department of Pathology, Hanyang University Hospital, Seoul 133-792, South Korea.
4 Department of Diagnostic Radiology, Cheonnam University Hospital, 8 Hakdong Dongku, Kwangju 501-757, South Korea.
5 Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongro-gu, Seoul 110-744, South Korea.



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  		Fig. 1A. —Multilocular thymic cyst in 39-year-old woman with 6-year history of systemic lupus erythematosus. Contrast-enhanced CT scan shows well-defined cyst walls (closed arrow), multiple internal septa, and enhancing soft-tissue attenuation components (open arrows) more easily distinguished from cysts than on unenhanced CT.

 


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  		Fig. 1B. —Multilocular thymic cyst in 39-year-old woman with 6-year history of systemic lupus erythematosus. Photograph of gross specimen shows cystic mass involving both lobes of thymus. Cyst contents are variable. Note prominent soft-tissue component in cephalad aspect of right lobe of thymus (arrows), corresponding to enhancing portion of mass (open arrows, A) on enhanced CT.

 


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  		Fig. 1C. —Multilocular thymic cyst in 39-year-old woman with 6-year history of systemic lupus erythematosus. Photomicrograph shows multiple cysts containing eosinophilic fluid (F) and intervening hyperplastic thymic tissue (T). (H and E, x1)

 


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  		Fig. 2A. —Multilocular thymic cyst in 29-year-old woman with 8-month history of myasthenia gravis. Contrast-enhanced CT scan at level of aortic arch shows well-marginated multilocular cystic mass in anterior mediastinum. Note small nodular calcifications (arrowhead) in cyst wall (arrow) and soft-tissue attenuation.

 


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  		Fig. 2B. —Multilocular thymic cyst in 29-year-old woman with 8-month history of myasthenia gravis. Contrast-enhanced CT scan at level of carina shows multilocular cystic mass (arrows) with soft-tissue attenuation.

 


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  		Fig. 2C. —Multilocular thymic cyst in 29-year-old woman with 8-month history of myasthenia gravis. Photograph of gross specimen shows many small cysts separated by thick fibrous septa in right thymic lobe (R) and two large cysts in left thymic lobe (L). Note dark hemorrhagic fluid in left lobe cysts and yellow fluid in right lobe cysts. Number of right lobe cysts is greater than noted on CT (A and B). Also note nodular and linear calcifications in left lobe cyst wall (open arrows) corresponding to calcification (arrowhead, A) on CT. Aggregated small cysts (black arrowheads) in top of right thymic lobe and soft-tissue region (white arrowheads) in lower portion of left thymic lobe (arrows, in A and B) corresponded to soft-tissue attenuation components on CT.

 


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  		Fig. 3. —Multilocular thymic cyst associated with incidental thymoma in asymptomatic 25-year-old man. Contrast-enhanced CT scan shows smooth unilocular cystic mass in right anterior mediastinum. Note focal thickening of medial cyst wall (arrows) corresponding to thymoma in cyst wall of pathologic specimen (not shown).

 


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  		Fig. 4. —Multilocular thymic cyst in asymptomatic 58-year-old woman. Contrast-enhanced CT scan shows homogeneous, unilocular cystic mass (arrows) in anterior mediastinum. Only inferior portion of mass had perceptible cyst wall (not shown).

 

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