Cysts of Hattori, also known as posterior mediastinal paravertebral Müllerian cysts, are mediastinal cysts of Mullerian origin, lined by ciliated non-stratified cuboidal to columnar epithelium, that occur in the posterior mediastinum.
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Epidemiology
Of all mediastinal masses, ~20% (range 10–30%) are cysts - of those, perhaps 5% represent cysts of Hattori 2 although they are rare with only ~40 reported in the literature (c. 2022) 1.
All cases of Hattori cyst reported to date have been in females, aged between 40–60 years 1,2.
Clinical presentation
Patients are asymptomatic or present with cough and chest pain/tightness, and sometimes shortness of breath and transient numbness 1,2.
Pathology
Considering it is rare for Mullerian-origin cysts to occur outside of the pelvis and the mediastinum is not included in the secondary Mullerian system, it is thought that cysts of Hattori are congenital choristomas (a form of heterotopia) 1.
Markers
The immunohistochemical characteristic of the cyst is positivity for estrogen and progesterone receptors 1,2.
Differential diagnosis
Radiographic features
Ultrasound
Endoscopic ultrasound will show a fluid-type anechoic cyst with regular thin walls 1.
CT
Well-defined soft tissue mass without calcifications in the paravertebral location. There is no bone destruction, no spiculation and no infiltration of adjacent structures.
MRI
T1: low signal
T2: high signal fluid type
T1 C+ (Gd): no significant enhancement
Nuclear medicine
No uptake FDG PET.
History and etymology
Cysts of Hattori were first reported by Hideo Hattori in 2005 1,2.
Treatment and prognosis
Surgical resection is generally recommended 2. There is a risk albeit unknown of malignant transformation 2.
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