Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2023; 11(5): 1137-1143
Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1137
Surgical resection of a giant thymolipoma causing respiratory failure: A case report
Liang-Hui Gong, Wen-Xiang Wang, Yong Zhou, De-Song Yang, Bai-Hua Zhang, Jie Wu
Liang-Hui Gong, Wen-Xiang Wang, Yong Zhou, De-Song Yang, Bai-Hua Zhang, 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
Author contributions: Gong LH, Wang WX, Zhou Y, Yang DS, and Zhang BH contributed to manuscript writing and editing; Wu J contributed to conceptualization and supervision; and all authors have read and approved the final manuscript.
Supported by Hunan Provincial Natural Science Foundation of China, No. 2022JJ40246; and Hunan Cancer Hospital Climb Plan, No. 2021NSFC-B005.
Informed consent statement: Informed written consent was obtained from the patient for the publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jie Wu, MD, Doctor, Surgical Oncologist, The Second Department of Thoracic Surgery, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, No. 283 Tongzipo Road, Yuelu District, Changsha 410031, Hunan Province, China. wujie@hnca.org.cn
Received: October 23, 2022
Peer-review started: October 23, 2022
First decision: December 13, 2022
Revised: December 21, 2022
Accepted: January 16, 2023
Article in press: January 16, 2023
Published online: February 16, 2023
Processing time: 113 Days and 11.3 Hours
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.

Keywords: Thymolipomas; Thymus neoplasm; Respiratory insufficiency; Anterior mediastinal mass; Posterolateral thoracotomy; Case report

Core Tip: Thymolipoma is a rare benign tumor originating from the anterior mediastinal thymus that can occasionally grow to a massive size. Surgical resection is the only feasible and curative treatment modality. Here, we report a very rare case of thymolipoma that caused respiratory insufficiency by compressing most of the lungs. A right posterolateral thoracotomy was successfully performed, and the completely excised tumor weighed 7.5 kg, which made it the largest reported thymus neoplasm to our knowledge.