Tuberculosis of the thymus

Tumors of the anterior mediastinum include several entities with different radiological and clinical manifestations, constituting a heterogeneous group of congenital, inflammatory, and neoplastic conditions. Among these lesions, the most common primary tumor of the mediastinum is thymoma, nearly followed by germ cell tumors and lymphomas. Tuberculosis of the thymus, an extremely rare condition, typically involves the mediastinal lymph nodes. We present, in this study, pathological, radiological, and clinical findings of one case of tuberculosis of the thymus in an 18-year-old patient who presented thoracic pain, dyspnea upon minimal effort, and progressive worsening of the symptoms in one week. The chest X-ray showed a large mass in the mediastinum, and computed tomography scans indicated that it was located anteriorly. The patient was submitted to surgery in order to excise the mass. Microscopy revealed a massive inflammatory response and granulomas in the thymic tissue. Ziehl-Neelsen staining for acid-fast bacilli yielded positive results, and a diagnosis of tuberculosis was made. Surgeons and pathologists should remain alert for this condition and should include it in the differential diagnosis of mediastinal masses.