Belcadi Abassi Khadija, Laaraje Azzeddine, Abdelilah Radi, Abilkassem Rachid
Pediatrics, Mohammed V Military Hospital, Rabat, MAR.
Cureus. 2025 Jul 23;17(7):e88620. doi: 10.7759/cureus.88620. eCollection 2025 Jul.
Mediastinal masses in children often raise concern for malignant conditions, particularly lymphoma. The thymus, which is normally prominent in infants and young children, begins its physiological involution around the age of six to seven years; however, this process is gradual and can extend into adolescence. Thymic hyperplasia beyond this age is uncommon, and it can mimic a mediastinal tumor on imaging. We report a case of benign thymic hyperplasia in a 10-year-old asymptomatic patient who was initially suspected of having lymphoma based on an anterior-superior mediastinal mass seen on an external CT scan. Imaging showed a homogeneous mass occupying the thymic lodge, associated with bilateral cervical lymphadenopathy. Although the clinical and imaging findings were suggestive of benign thymic hyperplasia, the presence of a large anterior mediastinal mass with bilateral cervical lymphadenopathy warranted exclusion of T-lymphoblastic lymphoma. Therefore, a mediastinal biopsy was performed, confirming the benign nature of the lesion. This report underscores the importance of considering malignancy in the differential diagnosis and using biopsy judiciously to achieve diagnostic certainty when imaging alone cannot fully exclude aggressive pathology.
儿童纵隔肿块常引发对恶性疾病的担忧，尤其是淋巴瘤。胸腺在婴幼儿期通常较为突出，大约在6至7岁开始生理性萎缩；然而，这个过程是渐进的，可持续到青春期。超过这个年龄的胸腺增生并不常见，在影像学上可能类似纵隔肿瘤。我们报告一例10岁无症状患者的良性胸腺增生病例，该患者最初因外部CT扫描发现前上纵隔肿块而被怀疑患有淋巴瘤。影像学显示一个均匀的肿块占据胸腺区域，并伴有双侧颈部淋巴结肿大。尽管临床和影像学表现提示为良性胸腺增生，但存在一个大的前纵隔肿块并伴有双侧颈部淋巴结肿大仍需排除T淋巴母细胞淋巴瘤。因此，进行了纵隔活检，证实了病变的良性性质。本报告强调了在鉴别诊断中考虑恶性肿瘤的重要性，以及在仅靠影像学不能完全排除侵袭性病变时明智地使用活检以实现明确诊断的重要性。
