Ribet and colleagues followed up two patients with bronchogenic cysts who refused surgery for 15 years and found that one patient remained free of symptoms and the other died of a malignancy of unknown origin. As for thymic and mesothelial cysts, watchful observation data were not available in our experience. An accurate imaging diagnosis may allow these lesions to leave alone. Many patients with mediastinal cysts were initially asymptomatic, later with occasional severe outcomes. In our series, 60% of patients were actually asymptomatic but they accepted an offer of surgery. We believe that preventive resection should be preferred, even in asymptomatic patients because of the unpredictability of clinical behavior. VATS may be an acceptable surgical procedure for patients with mediastinal cysts, which are rarely malig-nant. Ribet et al analyzed the operative records and found that the VATS approach was hazardous in 11 to 30% patients with bronchogenic cysts because of pericystic adhesions or communication of the cysts with tracheobronchial or esophageal structures. The need for conversions should not be delayed. These technical difficulties were less frequently encountered in other types of cysts. in detail
In summary, we reviewed our experience with cysts of the mediastinum, emphasizing the clinical spectrum of the disease, diagnosis and treatment, and some case presentations with unusual clinical manifestations. Early recognition of these relatively rare lesions would lead to immediate and appropriate surgical intervention. Early surgical intervention is also important, because a definitive histologic diagnosis can only be established by means of surgical extirpation.