Moul J W, Fernandez E B, Bryan M G, Steuart P, Ho C K, McLeod D G
Department of Pathology, Walter Reed Army Medical Center, Washington, D.C.
J Urol. 1994 Nov;152(5 Pt 1):1480-3. doi: 10.1016/s0022-5347(17)32451-5.
Thymic hyperplasia has been reported as a rebound phenomenon in children and young people, most commonly following chemotherapy for cancer. Although thymic hyperplasia has been documented in testis cancer patients after chemotherapy, to our knowledge it has not previously been reported in newly diagnosed cases before systemic therapy. A retrospective review of 362 testicular germ cell tumor patients treated at a single tertiary care center between January 1, 1980 and August 1, 1993 was performed, with special review of 221 who underwent computerized tomography staging of the chest. Thymic hyperplasia was detected in 4 of the 221 patients (1.8%) including 3 of 100 (3.0%) with seminoma and 1 of 121 (0.8%) with nonseminoma. All 4 patients had low stage (I or IIa) disease with a delay in diagnosis (5 to 24 weeks) and thymic hyperplasia was discovered at staging evaluation 18 to 37 days after orchiectomy but before other cancer therapy was administered. Of the 4 patients 2 underwent thymectomy, revealing histological thymic rebound hyperplasia. All 4 patients had no evidence of recurrence at 1 to 54 months after treatment. In addition to the well known post-chemotherapy phenomenon, thymic hyperplasia may also occur in nonsystemically treated, newly diagnosed testicular cancer patients. An anterior mediastinal mass in an otherwise low stage newly diagnosed testicular cancer patient may represent thymic hyperplasia and not necessarily metastatic disease.
胸腺增生在儿童和年轻人中被报道为一种反弹现象，最常见于癌症化疗之后。虽然化疗后睾丸癌患者中已有胸腺增生的记录，但据我们所知，此前尚未有在全身治疗前的新诊断病例中出现胸腺增生的报道。我们对1980年1月1日至1993年8月1日在一家三级医疗中心接受治疗的362例睾丸生殖细胞肿瘤患者进行了回顾性研究，特别对其中221例接受胸部计算机断层扫描分期的患者进行了复查。在221例患者中有4例（1.8%）检测到胸腺增生，其中100例精原细胞瘤患者中有3例（3.0%），121例非精原细胞瘤患者中有1例（0.8%）。所有4例患者均为低分期（I期或IIa期）疾病，诊断有延迟（5至24周），胸腺增生在睾丸切除术后18至37天但在进行其他癌症治疗之前的分期评估时被发现。4例患者中有2例行胸腺切除术，显示组织学上的胸腺反弹增生。所有4例患者在治疗后1至54个月均无复发迹象。除了众所周知的化疗后现象外，胸腺增生也可能发生在未经全身治疗的新诊断睾丸癌患者中。在新诊断的低分期睾丸癌患者中，前纵隔肿块可能代表胸腺增生，而不一定是转移性疾病。
