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Gerber TS, Porubsky S. Benign lesions of the mediastinum. Histopathology 2024; 84:183-195. [PMID: 37988262 DOI: 10.1111/his.15088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 11/23/2023]
Abstract
Mediastinal tumours represent a heterogeneous group of entities derived from the manifold structures located in or adjacent to the mediastinum. Due to the occurrence of some of these tumours in characteristic mediastinal compartments, an anatomical subdivision of the mediastinum in the prevascular (anterior), visceral (middle), and paravertebral (posterior) is helpful for the differential diagnosis. Benign anterior mediastinal tumours linked to an enlargement of the thymic gland mainly consist of thymic cysts and several types of thymic hyperplasia: true thymic hyperplasia, rebound hyperplasia, lymphofollicular hyperplasia, and so-called thymic hyperplasia with lymphoepithelial sialadenitis (LESA)-like features. Mature teratomas, ectopic (para)thyroid tissue, and benign thymic tumours such as thymolipoma or thymofibrolipoma represent further typical tumours of the anterior mediastinum. Pericardial, bronchogenic, or oesophageal duplication cysts predominate in the middle mediastinum, whereas neurogenic tumours and myelolipomas are characteristic findings in the posterior compartment. Vascular tumours, lipomas, adenomatoid tumours, Castleman disease, or mediastinitis are further examples of less frequent tumours or tumorous lesions affecting the mediastinum. This review focuses on benign mediastinal lesions with an emphasis on benign tumours of the thymus. Besides histology, characteristic epidemiological and clinical aspects prerequisite for the correct diagnosis and patient management are discussed.
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Affiliation(s)
- Tiemo Sven Gerber
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Stefan Porubsky
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Xu W, Wang L, Tang H, Luo L, Xu Y, Guo D. Thymic hyperplasia with lymphoepithelial sialadenitis (LESA)-like features: a case report and literature review. Diagn Pathol 2023; 18:102. [PMID: 37697376 PMCID: PMC10494424 DOI: 10.1186/s13000-023-01391-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Thymic hyperplasia with lymphoepithelial sialadenitis-like features (LESA-like TH) is a rare form of thymic hyperplasia, characterized by a prominent expansion of the thymic medulla containing hyperplastic lymphoid follicles with germinal centers, while an almost total absence of thymic cortex. Since the first report in 2012, only a few cases of LESA-like TH have been reported in the literature to date. Due to the rarity of LESA-like TH and the tumor-like morphology, it is easy to be misdiagnosed as other common diseases of the thymus in routine practice, such as thymoma and lymphoma. CASE PRESENTATION Herein, we present a case report of a 52-year-old Chinese female patient with LESA-like TH, without any discomforting symptoms. Computer-tomography imaging revealed a cystic solid mass in the anterior mediastinum, with well-defined boundaries and multiple internal septa. Histologically, prominent features were florid lymphoid follicles containing germinal centers, as well as hyperplasia of thymic epithelial cells and proliferation of Hassall bodies. However, the thymic cortex rich in immature T cells was almost completely absent. Furthermore, mature plasma cells, lymphoepithelial lesions, and cholesterol clefts were frequently seen. CONCLUSION We made a diagnosis of LESA-like TH and performed a literature review to better understand the clinicopathological features of LESA-like TH and reduce misdiagnosis.
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Affiliation(s)
- Wenfeng Xu
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Long Wang
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Hao Tang
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Ling Luo
- Department of Radiology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Yujuan Xu
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China
| | - Deyu Guo
- Department of Pathology, Guiqian International General Hospital, Guiyang City, Guizhou Province, China.
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Ren J, Fu Z, Zhao Y. Case report: Imaging findings of true thymic hyperplasia at 18F-FDG PET/CT in an infant. Front Oncol 2023; 12:1077777. [PMID: 36686837 PMCID: PMC9853067 DOI: 10.3389/fonc.2022.1077777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023] Open
Abstract
True thymic hyperplasia (TTH) in children is rare and difficult to distinguish from other thymic tumors such as thymoma and thymic carcinoma. A 3-year-old girl underwent an 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) scan (18F-FDG PET/CT) and a chest CT scan to evaluate an anterior mediastinal mass. 18F-FDG PET/CT revealed a mediastinal mass showing heterogeneously increased FDG uptake with a maximum standardized uptake value (SUVmax) of 7.1. Eventually, postoperative pathological diagnosis demonstrated TTH. So far, there are no reports of 18F-FDG PET/CT imaging of this disease.
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Affiliation(s)
- Jiazhong Ren
- Department of Medical Imaging, PET-CT Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zheng Fu
- Department of Medical Imaging, PET-CT Center, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Yaqing Zhao
- Department of General Affairs Section, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China,*Correspondence: Yaqing Zhao,
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Jiao J, Yu J, Chen C, Chen T, Zheng T, He L, Zeng Q. Thoracoscopic approach for massive thymic hyperplasia in an infant: Case report and literature review. Front Pediatr 2023; 11:1144384. [PMID: 36937950 PMCID: PMC10014623 DOI: 10.3389/fped.2023.1144384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/13/2023] [Indexed: 03/05/2023] Open
Abstract
Introduction Massive thymic hyperplasia (MTH) is a very rare entity, with fewer than 20 cases reported in the literature in infancy. Most patients have respiratory symptoms and the enlarged thymus gland occupies one side of the thoracic cavity. Posterolateral thoracotomy or median sternotomy is the main treatment for MTH in infants. We report a case of an infant with MTH in which the enlarged thymus occupied his bilateral thoracic cavity and he underwent video-assisted thoracoscopic surgery (VATS). In addition, we reviewed and summarized the relevant literature. Case Report A 4-month-old boy was admitted to the hospital with no apparent cause of dyspnea for 18 days, with cough and sputum. On examination, the patient was found to have cyanotic lips, diminished breath sounds in both lungs, and a positive three concave sign. There was no fever or ptosis. Preoperative imaging showed large soft tissue shadows in the bilateral thoracic cavity, with basic symmetry between the right and left sides. Tumor markers were within the normal range. Ultrasound-guided fine needle biopsy showed normal thymic structures with no evidence of malignancy. As his symptoms worsened, he eventually underwent unilateral thoracic approach video-assisted thoracoscopic exploratory surgery, during which a large mass occupying the bilateral thoracic cavity was removed in a separate block and part of the thymus in the left lobe was preserved. Pathological examination confirmed true thymic hyperplasia (TTH). No relevant complications occurred at the 2-month postoperative follow-up. Conclusion In infants, MTH occupying the bilateral thoracic cavity can produce severe respiratory and circulatory symptoms due to occupying effects. Although a definitive preoperative diagnosis is sometimes difficult, after combining computed tomography (CT) and fine needle biopsy to exclude evidence of other malignancies, the enlarged thymus occupying the bilateral thoracic cavity can be resected via VATS. Whether the enlarged thymus occupies the bilateral thoracic cavity and the size of the thymus are not absolute contraindications to thoracoscopic surgery. The method is safe, feasible, and minimally invasive to the patient.
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Affiliation(s)
- Jinghua Jiao
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Jie Yu
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Chenghao Chen
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Tian Chen
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Tiehua Zheng
- Department of Anesthesiology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Lejian He
- Department of Pathology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Qi Zeng
- Department of Thoracic Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
- Correspondence: Qi Zeng
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Tadiotto E, Clemente M, Pecoraro L, Piacentini G, Degani D, Pietrobelli A. Massive thymic hyperplasia in a 15-month-old boy: Case report and literature review. Clin Case Rep 2019; 7:27-31. [PMID: 30656002 PMCID: PMC6333069 DOI: 10.1002/ccr3.1896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/09/2018] [Accepted: 10/15/2018] [Indexed: 11/06/2022] Open
Abstract
A surgical approach is the choice in young infants with MTH, who are furthest from the time of physiological involution of the thymus, and when the thymus achieves the largest relative size, a surgical approach is the choice. Steroid therapy has been shown to be ineffective (4, 9, 16, 18-20). No surgical complications have been reported, and the outcome is excellent. Recurrence has been seen in only one case.
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Affiliation(s)
- Elisa Tadiotto
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Maria Clemente
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Luca Pecoraro
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Giorgio Piacentini
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Daniela Degani
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
| | - Angelo Pietrobelli
- Paediatric Clinic, Department of Life and Reproduction SciencesAzienda Ospedaliera Universitaria IntegrataVeronaItaly
- Pennington Biomedical Research CenterBaton RougeLouisiana
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Hamza A, Vouyoukas E, Anderson IJ, Higgins MJ. Thymic teratoma presenting as non-immune hydrops fetalis. AUTOPSY AND CASE REPORTS 2018. [PMID: 29515979 PMCID: PMC5828286 DOI: 10.4322/acr.2018.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Teratomas are one of the most frequent tumors in the pediatric population. They occur anywhere along the midline of the body, following the course of the embryonic germ cell ridge. In the mediastinal location, they exert space occupying effects, leading to a myriad of complications, including non-immune hydrops fetalis. We describe a fatal case of an immature thymic teratoma in a neonate presenting with hydrops fetalis. This case emphasizes the importance of early diagnosis and surgical intervention in such cases.
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Affiliation(s)
- Ameer Hamza
- St. John Hospital and Medical Center, Department of Pathology. Detroit, Michigan, USA
| | - Eleftherios Vouyoukas
- St. John Hospital and Medical Center, Department of Pathology. Detroit, Michigan, USA
| | - Ian Jacob Anderson
- St. John Hospital and Medical Center, Department of Pathology. Detroit, Michigan, USA
| | - Martha Jaye Higgins
- St. John Hospital and Medical Center, Department of Pathology. Detroit, Michigan, USA
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