Ectopic cervical thymus: is empiric surgical excision necessary?

Ectopic cervical thymus (ECT) is an uncommon cause of pediatric neck masses. We present the first algorithm for conservative management of this benign disease. The natural history of ECT is unclear since most cases in the literature have undergone surgical excision. This is due to concern for malignant transformation, however, no convincing evidence was found in the literature to support this. With accurate diagnosis, clinically asymptomatic patients can be conservatively managed, as the thymus is expected to involute naturally.