{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:11:57Z","timestamp":1753891917494,"version":"3.41.2"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Report<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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 <jats:italic>via<\/jats:italic> 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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1144384","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T05:37:29Z","timestamp":1677649049000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Thoracoscopic approach for massive thymic hyperplasia in an infant: Case report and literature review"],"prefix":"10.3389","volume":"11","author":[{"given":"Jinghua","family":"Jiao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenghao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tian","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiehua","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lejian","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,3,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1016\/s0046-8177(78)80131-2","article-title":"Thymic hyperplasia and neoplasia: a review of current concepts","volume":"9","author":"Levine","year":"1978","journal-title":"Hum Pathol"},{"key":"B2","first-page":"1587","article-title":"Gigantic enlargement of the thymus gland","volume":"28","author":"Regal","year":"2007","journal-title":"Saudi Med J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1053\/j.semdp.2020.04.006","article-title":"Fine needle aspiration of thymic epithelial neoplasms and non-neoplastic lesions","volume":"37","author":"Illei","year":"2020","journal-title":"Semin Diagn Pathol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"743","DOI":"10.1159\/000328555","article-title":"Mediastinal masses diagnosed as Thymus hyperplasia by fine needle aspiration cytology","volume":"44","author":"Bangerter","year":"2000","journal-title":"Acta Cytol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1016\/0003-4975(93)90033-e","article-title":"Massive thymic hyperplasia","volume":"55","author":"Linegar","year":"1993","journal-title":"Ann Thorac Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"431","DOI":"10.3760\/cma.j.issn.1001-4497.2019.07.012","article-title":"Massive thymic hyperplasia:one case report","volume":"35","author":"Shao","year":"2019","journal-title":"Chin J Thorac Cardiovasc Surg"},{"key":"B7","first-page":"288","article-title":"Hyperplasia of thymic gland","volume":"37","author":"Lee","year":"1996","journal-title":"Singap Med J"},{"key":"B8","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1002\/path.1700340211","article-title":"An analysis of the data collected by the Status lymphaticus investigation committee","volume":"34","author":"Young","year":"1931","journal-title":"J Pathol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1007\/BF01745472","article-title":"Thymic hyperplasia","volume":"65","author":"Hofmann","year":"1987","journal-title":"Klin Wochenschr"},{"key":"B10","doi-asserted-by":"publisher","first-page":"640","DOI":"10.1111\/j.1365-2559.1989.tb01631.x","article-title":"True thymic hyperplasia: a histological and immunohistochemical study","volume":"15","author":"Ruco","year":"1989","journal-title":"Histopathology"},{"key":"B11","first-page":"177","article-title":"Tumor-like massive thymic hyperplasia in childhood: a possible defect of T-cell maturation, histological and cytoenzymatic studies of three cases","volume":"8","author":"Nezelof","year":"1986","journal-title":"Thymus"},{"key":"B12","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1016\/0003-4975(89)90131-8","article-title":"True thymic hyperplasia: a clinicopathological study","volume":"47","author":"Ricci","year":"1989","journal-title":"Ann Thorac Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"786","DOI":"10.1093\/ajcp\/68.6.786","article-title":"Report of a case of gross thymic hyperplasia in a child","volume":"68","author":"Katz","year":"1977","journal-title":"Am J Clin Pathol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1002\/ccr3.1896","article-title":"Massive thymic hyperplasia in a 15-month-old boy: case report and literature review","volume":"7","author":"Tadiotto","year":"2019","journal-title":"Clin Case Rep"},{"key":"B15","doi-asserted-by":"publisher","first-page":"721","DOI":"10.24953\/turkjped.2021.04.022","article-title":"Massive true thymic hyperplasia in a 3-month-old infant: case report and literature review","volume":"63","author":"Yang","year":"2021","journal-title":"Turk J Pediatr"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1016\/s0046-8177(87)80388-x","article-title":"Massive thymic hyperplasia with myoid cell differentiation","volume":"18","author":"Judd","year":"1987","journal-title":"Hum Pathol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1177\/000313480306900814","article-title":"Massive benign thymic hyperplasia in a six-month-old girl: case report","volume":"69","author":"Gow","year":"2003","journal-title":"Am Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1111\/jpc.12970","article-title":"Massive thymic hyperplasia in a neonate with Beckwith-Wiedemann syndrome","volume":"52","author":"Sayed","year":"2016","journal-title":"J Paediatr Child H"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1711","DOI":"10.1016\/j.jpedsurg.2010.05.001","article-title":"True thymic hyperplasia in an infant","volume":"45","author":"Tan","year":"2010","journal-title":"J Pediatr Surg"},{"key":"B20","doi-asserted-by":"publisher","first-page":"373","DOI":"10.12117\/jccmi.2021.05.017","article-title":"Giant thymic hyperplasia misdiagnosed as teratoma in children: report of one case","volume":"32","author":"Dai","year":"2021","journal-title":"J Chin Clin Med Imaging"},{"key":"B21","doi-asserted-by":"publisher","first-page":"471","DOI":"10.2214\/AJR.13.11210","article-title":"Imaging characteristics of pathologically proven thymic hyperplasia: identifying features that can differentiate true from lymphoid hyperplasia","volume":"202","author":"Araki","year":"2014","journal-title":"Am J Roentgenol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s11604-020-01031-2","article-title":"Anterior mediastinal lesions: cT and MRI features and differential diagnosis","volume":"39","author":"Nakazono","year":"2021","journal-title":"Jpn J Radiol"},{"key":"B23","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1007\/s00292-017-0283-z","article-title":"Echte thymushyperplasie","volume":"38","author":"Weis","year":"2017","journal-title":"Pathologe"},{"key":"B24","first-page":"599","article-title":"Focal proliferative IgA nephropathy with massive thymic hyperplasia in adolescent: report of one case","volume":"33","author":"Huang","year":"2022","journal-title":"J Chin Clin Med Imaging"},{"key":"B25","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1055\/s-2008-1059932","article-title":"Massive thymic hyperplasia in infants","volume":"38","author":"Lamesch","year":"1983","journal-title":"Eur J Pediatr Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/S0009-9260(96)80222-4","article-title":"Case report: true massive thymic hyperplasia","volume":"51","author":"Obaro","year":"1996","journal-title":"Clin Radiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1016\/s0003-4975(10)63315-2","article-title":"Massive hyperplastic Thymus in a 22-month-old infant","volume":"27","author":"Lee","year":"1979","journal-title":"Ann Thorac Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1136\/thx.2009.123125","article-title":"Massive thymic hyperplasia presenting with respiratory insufficiency in a 2-year-old child","volume":"65","author":"Szarf","year":"2010","journal-title":"Thorax"},{"key":"B29","doi-asserted-by":"publisher","first-page":"37","DOI":"10.5146\/tjpath.2016.01371","article-title":"Clinicopathological analysis of mediastinal masses: a mixed bag of non-neoplastic and neoplastic etiologies","volume":"33","author":"Sharma","year":"2016","journal-title":"Turk J Pathol"},{"year":"","key":"B30"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1144384\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T05:37:34Z","timestamp":1677649054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1144384\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,1]]},"references-count":30,"alternative-id":["10.3389\/fped.2023.1144384"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1144384","relation":{},"ISSN":["2296-2360"],"issn-type":[{"type":"electronic","value":"2296-2360"}],"subject":[],"published":{"date-parts":[[2023,3,1]]},"article-number":"1144384"}}