Thornwaldt’s cyst – a case report and review of the literature

Целта на това съобщение е да се представи рядък случай на епифарингеална киста, произхождаща от джобчето на Rathke, и да се направи обзор на достъпната литература по този проблем. Касае се за пациента В. С. С на 29 г. от Варна. Насочен е от рентгенолог след МРИ-изследване към Отделението по УНГ на МБАЛ „Св. Анна“ – Варна АД на 18.III.2012 г. с оплаквания от теменно главоболие. Диагнозата „киста на Thornwaldt“ се поставя въз основа на назофарингоскопия, МРИ и КАТ. Тя се потвърждава чрез хистологично изследване. При назофарингоскопията се открива кистозна формация в епифаринкса. МРИ показва добре отграничена овална структура с размери до 17 mm в областта на епифаринкса. Тя е хипоинтензна на FLAIR и градиент-ехо Т2-образи, хиперинтензна на Т1-образи и изоинтензна на меките тъкани. Ексцизията на кистата се извършва под обща интубационна анестезия. Патохистологично се доказва киста, тапицирана с цилиндричен епител. Налице са гнойно-продуктивни възпалителни изменения. На тази рядка кистична малформация на епифаринкса, описана за първи път от Thornwaldt през 1885 г., до сега са посветени общо само 17 публикации, реферирани в базата-данни MEDLINE. Представеният клиничен случай е изключително рядък. Поради това той представлява определен диференциално-диагностичен интерес за рино-фарингологията.The purpose of this communication is to report a rare case of an epipharyngeal cyst originating from Rathke’s recess and to perform a survey of the literature on this topic available as well. It concerned V. S. S., a 29-year old patient from Varna. He was forwarded by roentgenologist after MRI examination to the Division of Otorhinolaryngology, St. Anna Hospital of Varna, on March 18, 2012 with complaints of occipital headache as well as of bad and smelly breath. The diagnosis of a Thornwaldt’s cyst was based on nasopharyngoscopy, MRI, and CAT. It was confirmed by a histological examination.By using of the nasopharyngoscopy, a cystic formation in the nasopharynx was detected. MRI demonstrated a well-outlined oval-shaped structure up to 17 mm on size in the nasopharynx. It was hypointense on FLAIR and gradient-echo T2-images, hyperintense on T1-images, and isointense towards the soft tissues. Cyst excision was performed under general intubation anesthesia. Pathohistologically, a cyst upholstered by a cylindrical epithelium was proved. Purulent-productive inflammatory alterations were present. To this rare cystic epipharyngeal malformation first described by Thornwaldt in 1885 up-to-date a total of only 17 publications abstracted in MEDLINE database were devoted. The clinical case reported is extraordinarily rare. That is why it represents a definite differential-diagnostic interest for rhinopharyngology

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