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Bessrour H, Messaoudi H, Lajmi M, Ragmoun W, Tlili K, Hachicha S. Giant anterior mediastinal thymolipoma: A rare case of thoracoscopic resection and surgical management challenges. Int J Surg Case Rep 2025; 130:111299. [PMID: 40233644 PMCID: PMC12019025 DOI: 10.1016/j.ijscr.2025.111299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Revised: 03/28/2025] [Accepted: 04/12/2025] [Indexed: 04/17/2025] Open
Abstract
INTRODUCTION Thymolipoma is a rare benign anterior mediastinal tumor composed of thymic and adipose tissues. Early diagnosis and accurate surgical management are crucial to prevent misdiagnosis and optimize patient outcomes. CASE PRESENTATION A 17-year-old male with no significant medical history presented to our thoracic surgery department with exertional dyspnea and a sensation of chest tightness. Given the worsening symptoms, a chest computed tomography (CT) scan was performed, revealing a well-circumscribed anterior mediastinal mass in the right paracardiac region, predominantly composed of fatty tissue. The patient underwent right thoracoscopic surgery, during which the tumor was successfully resected. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis of a thymolipoma. DISCUSSION Thymolipomas are rare benign tumors composed of mature adipose tissue and thymic tissue, typically located in the anterior mediastinum. They account for less than 9 % of all thymic tumors and are often discovered incidentally. Patients with thymolipomas may present with nonspecific symptoms, such as dyspnea, chest pain, or recurrent respiratory infections, depending on the size and compressive effects of the tumor. Imaging plays a crucial role in identifying thymolipomas, with CT scan often showing a well-encapsulated mass with fat and soft tissue components. Complete surgical resection remains the cornerstone of treatment, ensuring both accurate diagnosis and symptomatic relief. CONCLUSION This case underlines the exceptional presentation of a thymolipoma, emphasizing its rarity and the critical role of surgical management in achieving optimal outcomes. Early recognition and intervention are crucial, especially for large or symptomatic lesions.
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Affiliation(s)
- Habib Bessrour
- Department of Cardiac and Thoracic Surgery, The Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.
| | - Houssem Messaoudi
- Department of Cardiac and Thoracic Surgery, The Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Mokhles Lajmi
- Department of Cardiac and Thoracic Surgery, The Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Wafa Ragmoun
- Department of Cardiac and Thoracic Surgery, The Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Karima Tlili
- Department of Pathology, The Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
| | - Saber Hachicha
- Department of Cardiac and Thoracic Surgery, The Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia
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Gong LH, Wang WX, Zhou Y, Yang DS, Zhang BH, Wu J. Surgical resection of a giant thymolipoma causing respiratory failure: A case report. World J Clin Cases 2023; 11:1137-1143. [PMID: 36874437 PMCID: PMC9979298 DOI: 10.12998/wjcc.v11.i5.1137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Thymolipoma is a rare benign tumor arising from the anterior mediastinal thymus and is composed of mature fatty tissue and interspersed nonneoplastic thymic tissue. This tumor accounts for only a small percentage of mediastinal masses, and the majority of them are asymptomatic and found incidentally. To date, fewer than 200 cases have been published in the world literature, of which most excised tumors weighed less than 0.5 kg and the largest weighed 6 kg.
CASE SUMMARY A 23-year-old man presented with a complaint of progressive breathlessness for 6 mo. His forced vital capacity was only 23.6% of the predicted capacity, and his arterial partial pressure of oxygen and carbon dioxide were 51 and 60 mmHg, respectively, without oxygen inhalation. Chest computed tomography revealed a large fat-containing mass in the anterior mediastinum that measured 26 cm × 20 cm × 30 cm in size and occupied most of the thoracic cavity. Percutaneous mass biopsy revealed only thymic tissue without signs of malignancy. A right posterolateral thoracotomy was successfully performed to remove the tumor along with the capsule, and the excised tumor weighed 7.5 kg, which to our knowledge, was the largest surgically removed tumor of thymic origin. Postoperatively, the patient’s shortness of breath was resolved, and the histopathological diagnosis was thymolipoma. No signs of recurrence were observed at the 6-mo follow-up.
CONCLUSION Giant thymolipoma causing respiratory failure is rare and dangerous. Despite the high risks, surgical resection is feasible and effective.
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Affiliation(s)
- Liang-Hui Gong
- The Second Department of Thoracic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410031, Hunan Province, China
| | - Wen-Xiang Wang
- The Second Department of Thoracic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410031, Hunan Province, China
| | - Yong Zhou
- The Second Department of Thoracic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410031, Hunan Province, China
| | - De-Song Yang
- The Second Department of Thoracic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410031, Hunan Province, China
| | - Bai-Hua Zhang
- The Second Department of Thoracic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410031, Hunan Province, China
| | - Jie Wu
- The Second Department of Thoracic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha 410031, Hunan Province, China
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Hamouri S, Syaj S, Al-Kraimeen L, Al-Smady M, Alhadidi H, Barakat F. Thymolipoma and its Association with Myasthenia Gravis: a Multi-center Experience. Med Arch 2022; 75:375-381. [PMID: 35169361 PMCID: PMC8740664 DOI: 10.5455/medarh.2021.75.375-381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/21/2021] [Indexed: 11/03/2022] Open
Abstract
Background Thymolipoma is a rare benign thymic tumor that arises in the anterior mediastinum. It presents with non-specific symptoms such as chest pain and dyspnea due to compression of the tumor on surrounding structures. In addition, this tumor is associated with paraneoplastic syndromes, including myasthenia gravis. Such a relationship is still not understood and requires investigation. Objective Investigate the significance of myasthenia gravis in thymolipoma patients. Methods We present a series of 16 thymolipoma cases from multiple medical centers. Data extraction included demographic, diagnostic, radiological and laboratory, and clinical outcome variables. We also used the modified Osserman score to assess the severity of myasthenia gravis. Results Ten patients were males, and six were females; the sample mean age was 39.9 years (SD = 16.7). Upon presentation, 7/16 patients were asymptomatic, 4/16 patients had chest pain, and 2/16 had dyspnea. Seven patients were having myasthenia gravis; they experience generalized weakness (3/7), diplopia (2/7), ptosis (1/7), and bulbar weakness (1/7). Serum acetylcholine receptor antibody (AChRAb) was positive in 4 patients. All patients underwent thymectomy either via sternotomy or thoracotomy. After proper follow-up, only 2/7 of myasthenic patients had a complete remission of symptoms, no tumor recurrence was observed. Conclusion Although the effect of using steroids in myasthenic patients on thymolipomic transformation still needs confirmation, diagnosis of thymolipoma should be kept in mind in myasthenic patients presenting with relevant symptoms and taking steroids. Furthermore, complete remission of myasthenic symptoms after removal of thymolipoma needs further investigation.
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Affiliation(s)
- Shadi Hamouri
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sebawe Syaj
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Leen Al-Kraimeen
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Moaath Al-Smady
- Department of General Surgery, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hani Alhadidi
- King Hussein Medical Centre, Royal Medical Services, Amman, Jordan
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Campion T, Maity A, Ali S, Richards P, Adams A. Concurrent thyrolipomatosis and thymolipoma in a patient with myasthenia gravis: a case report and review of the literature. Ann R Coll Surg Engl 2021; 103:e212-e215. [PMID: 34192501 PMCID: PMC10752004 DOI: 10.1308/rcsann.2020.7089] [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] [Accepted: 09/07/2020] [Indexed: 11/22/2022] Open
Abstract
We present a case of a man with a background of myasthenia gravis who presented with a neck lump, which was diagnosed as thyrolipomatosis in continuity with a very large thymolipoma. Following removal of these lesions, the patient's myaesthenic symptoms improved. While thymolipomas are often seen in the context of myasthenia gravis, thyrolipomatosis is a rare entity and to our knowledge the concurrent finding of both lesions with myasthenia gravis has never been reported. We highlight the important imaging features of both entities and the clinical importance of recognising them.
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Affiliation(s)
| | - A Maity
- Royal London Hospital,
London, UK
| | - S Ali
- Royal London Hospital,
London, UK
| | | | - A Adams
- Royal London Hospital,
London, UK
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Surgical treatment of giant mediastinal tumors. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:52-60. [PMID: 33768981 PMCID: PMC7970080 DOI: 10.5606/tgkdc.dergisi.2021.19586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/11/2020] [Indexed: 11/21/2022]
Abstract
Background This study aims to evaluate the surgical treatment outcomes of giant mediastinal tumors. Methods Between July 2013 and July 2018, medical data of a total of 31 patients (26 males, 5 females; mean age 27.7±8.2 years; range, 18 to 56 years) who underwent radical surgery for a giant mediastinal tumor in our center and 47 cases (26 males, 21 females; mean age 45.4±16.7 years; range, 19 to 62 years) of giant mediastinal tumors retrieved from the National Center for Biotechnology Information database were retrospectively reviewed. Two-year overall survival and disease-free survival rates of the patients were evaluated. Results All patients underwent radical surgery (R0 resection). Symptoms caused by giant mediastinal tumors were relieved after radical surgery during follow-up. The two-year overall survival and disease-free survival rates were 100% and 86.7%, respectively, indicating a good prognosis. The surgical procedures for malignancies were more difficult than those for benign pathologies. Conclusion Radical surgery is the mainstay for treatment of giant mediastinal tumors to relieve symptoms in a short period of time and to achieve a good prognosis for up to two years, regardless of adjuvant therapy. The surgical route should be cautiously planned before radical surgery to reduce complications.
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Furlan K, Miller I, Rohra P, Mir F, Ocampo Gonzalez FA, Gattuso P. Well-differentiated liposarcoma primary from thymic stroma: Case report and literature review. Exp Mol Pathol 2020; 116:104517. [PMID: 32791064 DOI: 10.1016/j.yexmp.2020.104517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/30/2020] [Accepted: 08/07/2020] [Indexed: 11/16/2022]
Abstract
Primary liposarcoma of thymic stroma is an exceptionally rare tumor. Histological findings are often definitive for diagnosis, however due to the variability of nuclear atypia and the overlapping with other adipocytic tumors, ancillary techniques are helpful as confirmatory tools. Currently, Fluorescent in situ hybridization for MDM2 is the gold standard for diagnosis of well-differentiated and dedifferentiated liposarcomas, however a panel of immunohistochemical stainings, including MDM2, CDK4 and p16 is available as alternative method, helping to distinguish liposarcoma from its benign counterpart lipoma, especially in borderline cases. We describe the case of a young female diagnosed with a well-differentiated lipomatous tumor primary of thymic stroma with near cut-off result for MDM2-FISHand positive immunohistochemical staining for the panel described above. We discuss the challenges in the diagnosis of this rare entity andpresent an updated literature review.
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Affiliation(s)
- Karina Furlan
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America.
| | - Ira Miller
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Prih Rohra
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Fatima Mir
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Fernando A Ocampo Gonzalez
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, 1750 W Harrison St, 5th floor, Chicago, IL, Zip code: 60612, United States of America
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Yusuf Mohamud MF, Ahmed MA, Ali IH. Extensive mediastinal thymolipoma mimicking pulmonary edema. J Surg Case Rep 2020; 2020:rjaa080. [PMID: 32368336 PMCID: PMC7190029 DOI: 10.1093/jscr/rjaa080] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/09/2020] [Accepted: 03/16/2020] [Indexed: 11/14/2022] Open
Abstract
Thymolipoma is a rare benign slow-growing encapsulated tumor of anterior mediastinum that accounts for 2–9% of all thymic neoplasms. About 30–50% of them are asymptomatic and found incidentally. Less than 200 cases have been published in the world literature so far. Here we report a case of thymolipoma of an adult female presented with progressive dyspnea, chest tightness and non-productive chough for 2-month duration. All blood investigations were normal. Radiological examinations suggested the presence of fat and soft tissue within the tumor without invading the neighboring structures. We concluded that the only curative treatment of thymolipoma is surgical excision. Unfortunately, the patient did not give consent despite telling her the outcomes if we do not do the surgical procedure, and a week later she passed away due to respiratory distress secondary to the mass effect of the tumor.
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Affiliation(s)
| | - Mohamed Abdi Ahmed
- Emergency Medicine Department, Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, Somalia
| | - Ibrahim Hussein Ali
- Emergency Medicine Department, Mogadishu Somali-Turkish Training and Research Hospital, Mogadishu, Somalia
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Aghajanzadeh M, Asgary MR, Mesbah A, Hemmati H, Delshad MSE, Samidoust P, Hemmati G. Giant thymolipoma of mediastinum and neck - initially misdiagnosed as liposarcoma by core needle biopsy. J Family Med Prim Care 2019; 7:1079-1082. [PMID: 30598961 PMCID: PMC6259522 DOI: 10.4103/jfmpc.jfmpc_228_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thymolipomas are rare benign tumors, constituting one of the differential diagnoses of an anterior mediastinal mass. These tumors may have an indolent, asymptomatic course, often achieving massive dimensions before presentation. When it is symptomatic, respiratory symptoms predominate. We report a case of thymolipoma in a 30-year-old male complaining of heaviness and constricting type of chest pain and neck swelling of 1-year duration. Computed tomography scan finding revealed a space-occupying lesion in the anterior mediastinum and extend to the right side of the mediastinum, neck, and left hemithorax. A sono-guided core needle biopsy was carried out which identified an atypical cell and was suspicious to liposarcoma. The tumor was completely excised through “posterolateral thoracotomy.” Postoperative histopathological examination confirmed the diagnosis of thymolipoma. This is the second case we have reported from our institution.
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Affiliation(s)
- Manouchehr Aghajanzadeh
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Mohammad Reza Asgary
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Alireza Mesbah
- Department of Pathology, Guilan University of Medical Sciences, Rasht, Iran
| | - Hosein Hemmati
- Vascular Surgery and Dialysis Research Center, Razi Clinical Research and Development Center, Guilan University Medical Science, Rasht, Iran
| | - Mohammad Sadegh Esmaili Delshad
- Vascular Surgery and Dialysis Research Center, Razi Clinical Research and Development Center, Guilan University Medical Science, Rasht, Iran
| | - Pirouz Samidoust
- Respiratory Diseases and TB Research Center, Razi Hospital, Guilan University of Medical Science, Rasht, Iran
| | - Ghazaleh Hemmati
- Vascular Surgery and Dialysis Research Center, Razi Clinical Research and Development Center, Guilan University Medical Science, Rasht, Iran
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Progressive Dyspnea in a 40-Year-Old Man Caused by Giant Mediastinal Thymolipoma. Case Rep Surg 2016; 2016:3469395. [PMID: 27293949 PMCID: PMC4886086 DOI: 10.1155/2016/3469395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/24/2016] [Indexed: 11/23/2022] Open
Abstract
Thymolipomas are rare tumors of the anterior mediastinum containing both thymic stroma and an abundance of fat. We present a 40-year-old man with no underlying disease who presented with cough and progressive dyspnea. Clinical evaluation revealed a giant mass of lipid density filling almost the entire left hemithorax with mediastinal shift. Total excision of the 40 × 33 × 8 cm mass weighing 4 kg was performed via a left thoracotomy and the histopathologic diagnosis of the mass was reported as thymolipoma. The patient remains alive and disease-free, twelve months after the intervention.
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