Katsumata Yuki, Suzuki Shigeki, Ishiguro Yuki, Sakamaki Hiroyuki, Kazama Akio, Asakura Keisuke
Department of General Thoracic Surgery, Sagamihara Kyodo Hospital, Sagamihara, Kanagawa, Japan.
Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0152. Epub 2025 Jun 18.
Thymomas are associated with necrosis and hemorrhage in approximately 5% of cases; however, cases in which necrotic tissue constitutes the majority of tumors are rare.
A 30-year-old man was referred to our hospital with transient anterior chest pain and a mediastinal mass detected on a health check-up. Positron emission tomography/computed tomography showed no fluorodeoxyglucose uptake, and serum and biochemical analyses revealed no elevated inflammatory responses or tumor marker levels. Based on imaging findings, thymic cysts and thymomas were considered differential diagnoses, and thoracoscopic mediastinal tumor resection was performed. The encapsulated tumor, which was adherent to the lung via the thickened pleura, was successfully resected, and a rapid diagnosis of thymoma was made. Final pathological examination confirmed a type B2 thymoma, with necrosis comprising approximately 80% of the tumor. The patient has been followed up on an outpatient basis, with no recurrence at 1 year after surgery.
Extensive necrosis in thymic tumors often suggests high-grade malignancy, but may also occur in necrotic thymoma with a favorable prognosis. Recognizing this possibility is essential to avoid overtreatment and guide appropriate surgical management.
胸腺瘤约5%的病例伴有坏死和出血；然而，坏死组织占肿瘤大部分的病例很少见。
一名30岁男性因健康检查时发现短暂性胸痛和纵隔肿块被转诊至我院。正电子发射断层扫描/计算机断层扫描显示无氟脱氧葡萄糖摄取，血清和生化分析显示炎症反应或肿瘤标志物水平未升高。根据影像学检查结果，胸腺囊肿和胸腺瘤被列为鉴别诊断，遂行胸腔镜纵隔肿瘤切除术。通过增厚的胸膜与肺粘连的包膜肿瘤被成功切除，并快速诊断为胸腺瘤。最终病理检查证实为B2型胸腺瘤，坏死约占肿瘤的80%。患者一直在门诊随访，术后1年无复发。
胸腺肿瘤广泛坏死常提示高级别恶性，但也可能发生在预后良好的坏死性胸腺瘤中。认识到这种可能性对于避免过度治疗和指导适当的手术管理至关重要。
