Cysts Originating from Cervical Lymphatic Ducts

Česká verzia

Authors: Z. Pokorná ¹; I. Stárek ¹; Richard Salzman ¹ ; D. Skanderová ² ; P. Flodr ²
Authors place of work: Klinika otorinolaryngologie a chirurgie hlavy a krku FN Olomouc ¹; Ústav klinické a molekulární patologie LF UP a FN Olomouc ²
Published in the journal: Otorinolaryngol Foniatr, 67, 2018, No. 2, pp. 71-76.
Category: Přehledový článek

Summary

Cysts originating from cervical lymphatic ducts are very seldom affections. However, they play an important role in the differential diagnosis of supraclavicular masses. The etiology remains unclear. Practically all cases arise from the thoracic duct, those affecting the right lymphatic duct are encountered exceptionally rarely. The cysts manifest themselves clinically as an otherwise asymptomatic swelling in the supraclavicular area. The diagnostics is based on imaging methods. However, both the CT and MRI scans lack any specific feature. In some cases, a direct communication between the cyst and relevant duct can be demonstrated using a lymphangiography. In a lab analysis, high content of T lymphocytes and triglyceride level is pathognomonic. In the differential diagnosis of these cyst the main problem is posed by so called unilocular lymphatic cysts, which share practically identical histomorphology, but they lack communication with a lymphatic duct. There is not a uniform opinion on the therapy. Because of absolute benign nature and possibility of spontaneous regression of these cysts, wait and see strategy is an option. A successful sclerotization was reported. The majority of authors prefer surgical exstirpation. At the operation, lymphatic vessels entering the cyst must be ligated to prevent the chyle leakage. In the presented overview, etiological, pathomorphological and clinical aspects of the cervical lymphatic duct cysts are described in detail.

Keywords:

thoracic duct, right cervical duct, cyst, differential diagnosis

Zdroje

1. Brauchle, R. W., Risin, S. A. Ghorbani, R. P., Pereira, K. D.: Cervical thoracic duct cyst: A case report and review of the literature. Arch. Otolaryngol. Head Neck Surg., 129, 2003, 5, s. 581-583.

2. Correia, M.: Le canal thoracique chez l´homme. Folia Anatomica Universitatis Cambrigensis, 1, 1926, s. 1-20.

3. Dool, J. J., de Bree, R., van den Berg, R., Leemans, C. R.: Thoracic duct cyst: sclerotherapy as alternative for surgical treatment. Head Neck, 29, 2007, 3, s. 292-295.

4. Dortch, J. D., Eck, D. L., Hakaim, A. G., Casler, J. D.: Management of cervical duct cyst with cyst-venous anastomosis. Int. J. Surg. Case Reports, 5, 2014, s.1028-1030.

5. Duci,c Y., Gallaher, T. T.: Thoracic duct cysts of the neck. J. Otolaryngol., 28, 1999, s. 344-346.

6. El Zawahry, M. D., Sayed, N. M., El-Awady, H. M., Abdel-Latif, A., El-Gind, M.: A study of the gross, microscopic and functional anatomy of the thoracic duct and lymph-venous junction. Int. Surg., 68, 1983, s. 135-138.

7. Gill, M. T., Lian, T. S., Thibodeaux, J. D., Nathan, C. A.: Cervical thoracic duct cyst: Importance of preoperative suspicion for appropriate management of left-sided necj mass. Ear. Nose Throat. J., 91, 2012, 12, E13-5.

8. Gottwald, F., Iro, H., Finke, C., Zenk, J.: Thoracic duct cysts: A rare differential diagnosis. Otolaryngol. Head Neck Surg., 132, 2005, 2, s. 330-333.

9. Graham, R. M., Thomson, E. F., Woodwards, R. T. M.: A chylous cyst at the right base of the neck. J. Oral Maxillofac. Surg.,46, 2008, s. 154-156.

10. Greenfield, J., Gottlieb, M. I.: Variations in the terminal portion of the human thoracic duct. AMA Arch. Surg., 73, 1956, s. 955-959.

11. Gupta, M., Lovelace, T. D., Sukumar, M., Gosselin, M. V.: Cervical thoracic duct cyst. J. Thorac. Imaging, 20, 2005, 2, s. 107-108.

12. Hamilton, B. E., Nesbit, G. M., Gross, N., Andersen, P., Sauer, D., Harnsberger, R.: Characteristic imaging findings in lymphoceles of the head and neck. Amer. J. Roentgenol., 197, 2011, 6, s. 1431-1435.

13. Hekiert, A., Newman, J., Sargent, R., Weinstein G.: Spontaneous cervical lymphocele. Head Neck, 29, 2007, s. 77-80.

14. Chapman, K. R., Ratnatunga, P. C.: Thoracic duct cyst presenting as a left supraclavicular mass. Ceylon Med. J., 46, 2001, s. 28-29.

15. Kadkhodayan, Y., Yano, M., Cross, D. T.: Direct puncture sclerotherapy of a thoracic duct cyst presenting as an enlarging left supraclavicular mass. BMJ Case Rep., 30, 2013.

16. Kausel, H. W., Reeve, T. S., Stein, A. A., Alleny, R. D., Stranahan, A.: Anatomic and pathologic studies of the thoracic duct. J.Thor. Surg., 34, 1957, s. 631-642.

17. Kinmonth, J. B.: The lymphatics. 2nd ed. London, Edward Arnold; 1982. s. 229-263.

18. Kinnaert, P.: Anatomical variations of the cervical portion of the thoracic duct in man. J. Anat., 115, 1973, 1, s. 45-52.

19. Kohnoe, S., Emi, Y., Hattori, T., Sugimachi, K.: Chylous cyst of the neck in adult. Otolaryngo. Head Neck Surg., 108, 1993, s. 190-191.

20. Kumar, A., Ramakrishnan, T. S., Sahu, S.: Primary cervical thoracic duct cyst: a case report a review of the literature. Ear Nose Throat., 93, 2014, 7, s. 17-21.

21. Langford, R. J., Daudia, A. T., Malins, T. J.: A morphological study of the thoracic duct at the jugulo-subclavian junction. J. Craniomaxillofac. Surg., 27, 1999, 2, s. 100-104.

22. Lecanu, J. B., Gallas, D., Biacabe, B. et al.: Lymphocele of the thoracic duct presenting as a left supraclavicular mass: A case report and review of the literature. Auris Nasus Larynx, 28, 2001, 3, s. 275-277.

23. Luosto, R., Koikkalainen, K., Jyrala, A., Makinen J.: Thoracic duct cysts of the mediastinum. Scan. J. Thor. Cardiovasc. Surg., 12, 1978, s. 261-263.

24. Matilla, P. S., Tarkkanen, J., Matilla. S.: Thoracic duct cyst: a case report and rewiew of 29 cases. The Annals of Otology, Rhinology & Laryngology; 108, 1999, s. 505-508.

25. Maruyama. M., Kobayashi, S., Kašuba, Y. et al.: Thoracic duct cyst in supraclavicular region. Ulster Med. J., 66, 1997, s. 140-143.

26. Miwa, T., Tatsuomi S., Tsukatani T., Ito, M., Furukawa, M.: OK-432 therapy for a cervical thoracic duct cyst. Otolaryngol. Head Neck Surg., 136, 2007, č. 5, s. 852-853.

27. Moesgaard, L., Baerentzen, S., Mirz, S.: Cervical thoracic duct cyst: a differential diagnosis of left supraclavicular swelling. Head Neck, 264, 2007, 7, s. 797-799.

28. Muramatsu, M., Tamura, N., Doi Y., Dambara T., Uekusa T., Mazura, S., Nukiwa, T., Kira, S.: A case of mediastinal lymphatic cyst pošibly originating from the right thoracic duct. Nihon Kyobu Shikkan Gakkai Zasshi, 30, 1992, 6, s. 1136-1140.

29. Myers, L. L., Pena, M. T., Sudech, R., Toledo, R., Wax, M. K.: Unilocular cervical lymphatic cyst in an adult. Amer. J. Otolaryngol., 21, 2000, 6, s. 412-415.

30. Phang, K., Bowman, M., Phillips, A., Windsor, J.: Review of thoracic duct anatomical variations and clinical implications. Clin. Anat., 27, 2013, 4, s. 637-644.

31. Podbielski, F. J., Rodriguez, H. E., Djohan, R. S., Conolly, M. M., Conlan, A. A.: Spontaneous right cervicothoracic lymphocele. J. Thorac. Cardiovasc. Surg., 125, 2003, s. 736-737.

32. Roge, V., Babin, E., Hitler, M., Capovilla, M., Blanchard, D.: Spontaneous cyst of the cervical segment of the thoracic duct: Literature review, Ann. Otolaryngol. Rhinol., 2, 2015, s. 1034.

33. Ross, J. K.: A review of the surgery of the thoracic duct. Thorax, 16, 1961, s. 12-21.

34. Sakamoto, H., Uda, H., Tanaka, S., Kuwabara, H., Miyauchi, A.: Thoracic duct cyst of the neck: A case report. Lymphology, 24, 1991,s. 130-134.

35. Shimada, K., Sato, I.: Morphological and histological analysis of the thoracic duct at the jugulo-subclavian junction in Japanese cadavers. Clin. Anat., 10, 1997, 3, s.163-172.

36. Schefte, R. P., Olsen, K. D., Gaffey, T. A.: Cervical lymphangioma in the adult. Otolaryngo. Head and Neck Surg., 93, 1985, s. 65-69.

37. Spiro, D. J., Spiro, R. H., Strong, E. W.: The management of chyle fistula. Laryngoskope, 100, 1990, s. 771-774.

38. Steinberg, I., Watson, R. C.: Lymphangiographic and angiographic diagnosis of persistent jugular lymph sac. Report of a case. N. Engl. J. Med., 275, 1966, s. 1471-1474.

39. Van Sonneberg, E., Wittich, G. R.,Casola, G., Wing, V. W., Halasz, N. A., Lee, A. S., Withera, C.: Lymphoceles: imaging characteristics and percutaneous management. Radiology, 161, 1986, 3, s. 593-596.

40. Wang, Y. A., Zhang, Z. Y., Zheng, J. W., Wei, M. Y., Wang, L. Z., Zhu, H. G.: Spontaneous thoracic duct cyst presenting as a left supraclavicular mass – report of a case and review of the literature. Phlebology, 24, 2009, s. 82-84.

41. Wax, M. K., Treolar, M. E.: Thoracic duct cyst: an anusual supraclavicular mass. Head Neck, 14, 1992, s. 502-505.

42. Zadvinski, D. P., Benson, M. T., Kerr, H. H., Mancuso, A. A., Cacciarelli, A. A., Mandrazo, B., Mafee, M. F., Dalen, K.: Congenital malformations of the cervicothoracic lymfatic system: embryology and pathogenesis. Radiographics, 12, 1992, s. 1175-1189.

43. Zorzetto, N. L., Ripan, W., De Freitas, V., Seullner, G.: Anatomical obsevations on the ending of the human thoracic duct. J. Morphol., 153, 1977, 3, s. 363-369.