Weis C-A, Märkl B, Schuster T, Vollert K, Ströbel P, Marx A
Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
Institut für Pathologie, Klinikum Augsburg, Augsburg, Deutschland.
Pathologe. 2017 Jul;38(4):286-293. doi: 10.1007/s00292-017-0283-z.
Reactive and neoplastic thymic pathologies are the main considerations in the case of masses in the anterior and middle part of the mediastinum, while neurogenic tumors are predominant in the posterior mediastinum (which are not dealt with here). In neonates and infants, the commonest pathologies in the anterior mediastinum comprise germ cell tumors (mainly teratomas), congenital thymic cysts and true thymic hyperplasia (TTH). In toddlers, teratomas, yolk sac tumors and cysts predominate. In children over 5 years of age, lymphomas are the commonest mass lesions whereas thymomas and thymic carcinomas are rare. In addition, inflammation-linked hyperplasia in myasthenia gravis and rebound thymic hyperplasia after chemotherapy must be considered. Although rare at all ages, sarcomas must be considered in the differential diagnosis from birth onwards and throughout adolescence. Based on the report of a rare case of recurrent TTH, the differential diagnosis of this benign but potentially life-threatening condition is discussed.
反应性和肿瘤性胸腺病变是纵隔前部和中部肿块的主要考虑因素，而神经源性肿瘤在纵隔后部占主导地位（本文不涉及）。在新生儿和婴儿中，前纵隔最常见的病变包括生殖细胞肿瘤（主要是畸胎瘤）、先天性胸腺囊肿和真性胸腺增生（TTH）。在幼儿中，畸胎瘤、卵黄囊瘤和囊肿占主导地位。在5岁以上的儿童中，淋巴瘤是最常见的肿块病变，而胸腺瘤和胸腺癌则很少见。此外，必须考虑重症肌无力中与炎症相关的增生以及化疗后胸腺反弹增生。尽管肉瘤在所有年龄段都很罕见，但从出生到整个青春期的鉴别诊断中都必须考虑到。基于一例罕见的复发性TTH病例报告，讨论了这种良性但可能危及生命的疾病的鉴别诊断。
