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Case Reports
. 2025 Jul 2:13:1613764.
doi: 10.3389/fped.2025.1613764. eCollection 2025.

An anterior mediastinal cystic lesion pathologically confirmed as a mediastinal pancreatic pseudocyst after thoracoscopic resection: a rare case report and literature review

Kui Zhai #  1 , Xingpeng Miao #  1 , Guiling Xue  1 , Zhanyu Yuan  2 , Mao Jia  2 , Mingyan Chen  3 , Renzhong Zha  1
Affiliations
Case Reports

An anterior mediastinal cystic lesion pathologically confirmed as a mediastinal pancreatic pseudocyst after thoracoscopic resection: a rare case report and literature review

Kui Zhai et al. Front Pediatr. .

Abstract

Background: Mediastinal lesions have diverse etiologies, with thymoma, cystic teratoma, and lymphoma being relatively prevalent. In contrast, a pancreatic pseudocyst within the mediastinum is exceedingly rare and can often be mistaken for a thymic cyst or teratoma.

Case presentation: A 17-year-old female presented with a cough and sputum production. Chest CT revealed an anterior mediastinal mass, initially raising the suspicion of a thymic cyst. Thoracoscopic exploration and resection revealed a cystic lesion with a thick wall and brownish fluid. Both frozen section and final histopathological analysis confirmed a mediastinal cyst. Immunohistochemical markers (SYN positive, CK7 positive) led to a diagnosis of mediastinal pancreatic pseudocyst. The patient experienced significant recovery post-surgery, with a marked improvement in symptoms.

Conclusion: This case highlights the importance of including mediastinal pancreatic pseudocyst in the differential diagnosis of anterior mediastinal cystic lesions. A thorough clinical and radiological assessment, along with surgical pathology and immunohistochemical profiling, is essential for accurate diagnosis and appropriate management.

Keywords: CT; anterior mediastinal cystic mass; mediastinal pancreatic lesion; pancreatic pseudocyst; x-ray.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Preoperative imaging studies. (A) Preoperative chest x-ray; (B) sagittal view of contrast-enhanced chest CT; (C) coronal view of contrast-enhanced chest CT; (D) lung window of plain chest CT; (E) mediastinal window of plain chest CT; (F) axial view of contrast-enhanced chest CT. The arrows indicate the location of the lesion.
Figure 2
Figure 2
Intraoperative photographs. (A) Location of the lesion; (B) brown fluid aspirated from the cystic cavity; (C) complete resection of the lesion; (D) resected specimen, showing a cystic structure.
Figure 3
Figure 3
Immunohistochemical findings of the resected lesion. (A)SYN (Synaptophysin) positive; (B) CK7 (Cytokeratin 7) positive; (C) CK20 (Cytokeratin 20) negative; (D) MUC-5ac (Mucin 5AC) negative.
Figure 4
Figure 4
Postoperative follow-up chest x-ray, indicating complete removal of the lesion.
See this image and copyright information in PMC

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