Kang Taekyung, Kang Mi-Jin
Department of Emergency Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea.
Department of Radiology, Inje University Sanggye Paik Hospital, Seoul, Korea.
Mediastinum. 2024 Jul 12;8:52. doi: 10.21037/med-24-13. eCollection 2024.
Thymic cysts can be classified as congenital or acquired. Most thymic cysts do not change in size over a short period of time. Although very rare, thymic cyst rupture is associated with serious complications, such as mediastinal hemorrhage and hemothorax. We experienced a case of partial rupture of a secondary thymic cyst, in an asymptomatic patient.
A 60-year-old woman visited Inje University Sanggye Paik Hospital with left hilar bulging detected on routine chest radiograph. A chest computed tomography (CT) scan revealed a 6 cm well-defined cystic mass with partial septation in the prevascular mediastinum. Thus, secondary thymic cyst was suggested. On the follow-up chest CT scan taken 3 months later, the size of the thymic cyst decreased, while the solid portion increased slightly, suggesting the potential presence of malignancy. Consequently, surgery was conducted. Adhesion to the lung and aorta was observed, but they were relatively well separated. The pathological findings revealed a partially ruptured thymic cyst with fat necrosis and multifocal granulomas.
There are controversies in the treatment of thymic cysts. Some clinicians prefer strict medical supervision to avoid unnecessary surgery, while others advocate immediate excision to avoid complication. However, if any changes are observed during the follow-up of the thymic cyst, it may indicate malignant transformation or rupture, necessitating prompt surgical excision.
胸腺囊肿可分为先天性或后天性。大多数胸腺囊肿在短时间内大小无变化。虽然非常罕见，但胸腺囊肿破裂会引发严重并发症，如纵隔出血和血胸。我们遇到一例无症状患者的继发性胸腺囊肿部分破裂病例。
一名60岁女性因常规胸部X线检查发现左肺门膨隆就诊于仁济大学桑格耶白医院。胸部计算机断层扫描（CT）显示前纵隔血管前有一个6厘米边界清晰的囊性肿块，有部分分隔。因此，考虑为继发性胸腺囊肿。在3个月后进行的胸部CT随访扫描中，胸腺囊肿大小减小，而实性部分略有增加，提示可能存在恶性病变。因此，进行了手术。观察到与肺和主动脉有粘连，但相对容易分离。病理结果显示为部分破裂的胸腺囊肿，伴有脂肪坏死和多灶性肉芽肿。
胸腺囊肿的治疗存在争议。一些临床医生倾向于严格的医学监测以避免不必要的手术，而另一些人则主张立即切除以避免并发症。然而，如果在胸腺囊肿随访期间观察到任何变化，可能提示恶性转化或破裂，需要及时手术切除。
