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Giant mediastinal thymolipoma mimicking teratoma
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Transcript of Giant mediastinal thymolipoma mimicking teratoma
Giant mediastinal thymolipoma mimicking teratoma
Case Report
Giant mediastinal thymolipoma mimickingteratoma
Binit Sureka a,*, Yatish Agarwal b
a Senior Resident, Department of Radiodiagnosis, VM Medical College & Safdarjung Hospital, New Delhi, Indiab Professor, Department of Radiodiagnosis, VMMC & Safdarjung Hospital, New Delhi
a r t i c l e i n f o
Article history:
Received 8 November 2013
Accepted 27 January 2014
Available online 12 March 2014
Keywords:
Thymolipoma
Imaging
Mediastinal
a b s t r a c t
A young female presented to us with chest complaints of 10 months duration. Imaging was
done which revealed fat attenuation mass lesion in the mediastinum occupying both
hemithoraces. Provisional differential diagnosis of giant teratoma, mediastinal thymoli-
poma, large pleural lipoma or a pulmonary lesion with effusion was kept. Patient under-
went surgery, mass was resected and the patient discharged in good condition.
Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Thymolipomas are rare mediastinal tumors composed of
mature adipose tissue intermixed with benign thymic tissue
arising from thymus gland. This tumor accounts for only a
small percentage of mediastinal masses. It has a clinical
importance as early diagnosis and complete surgical excision
is curative.
2. Case report
A 30-year-old female presented with complaints of gradually
increasing dyspnea, cough and tightness in chest of 10
months duration. General and neurological examination was
normal. Hemograms and sputum examination were normal.
Pulmonary function tests revealed mixed obstructive and
restrictive type of pattern. Chest skiagram revealed
homogenous opacities in bilateral mid and lower zones pre-
dominantly in central regions silhouetting the cardiac borders
with blunting of bilateral costophrenic and cardiophrenic
angles [Fig. 1]. Based on the chest radiograph and clinical
history of the patient, possibilities of the lesion arising from
either mediastinum, pulmonary or pleura were kept in the list
of differentials. So a contrast-enhanced computed tomogra-
phy (CECT) of chest was performed. It revealed a relatively
well marginated fat attenuation mass measuring
19� 21� 18 cmwith thin strands of hyperdensities suggestive
of fibrous septa in both sides of hemithorax [Fig. 2]. No calci-
ficationwas seen. Superiorly themass had continuity with the
thymus, and inferiorly themasswas reaching upto the level of
bilateral hemi diaphragms causing mild flattening of both the
diaphragm [Fig. 3]. No cervical or intraabdominal extension of
themass lesion was seen. Nomass effect or thrombosis of the
mediastinal vessels was seen. Passive compressive atelectasis
of basal segments of bilateral lungs was noted. The patient
underwent surgery (left postero-lateral thoracotomy), which
* Corresponding author. Tel.: þ91 9013082292.E-mail address: [email protected] (B. Sureka).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier .com/locate/apme
a p o l l o m e d i c i n e 1 1 ( 2 0 1 4 ) 4 9e5 1
http://dx.doi.org/10.1016/j.apme.2014.01.0110976-0016/Copyright ª 2014, Indraprastha Medical Corporation Ltd. All rights reserved.
revealed a massive mediastinal fatty-attenuation mass with
scattered fibrous components within themass. No vascular or
pleural invasion was noted. Pathological examination of
resected specimen revealed that the tumor was predomi-
nantly composed of lobules of mature adipose tissue inter-
mixed with septa of thymic tissue containing abundant
Hassall’s corpuscles and was consistent with the diagnosis of
mediastinal thymolipoma. The mass weighed 2900 g.
3. Discussion
Mediastinal thymolipomas are rare, benign, slow-growing
tumors of the antero-superior mediastinum containing an
admixture of thymic parenchyma and mature adipose tissue.
The term “thymolipoma”was first used by Hall in 1949.1 These
tumors represent 2%e9% of all thymic neoplasms.2,3 Mean age
of presentation is 22 years without sex predilection.2 Most
Fig. 1 e Chest X-ray postero-anterior (PA) view showing
homogenous opacities in bilateral mid and lower zones
predominantly in central regions silhouetting the cardiac
borders with blunting of bilateral costophrenic,
cardiophrenic angles.
Fig. 3 e Coronal reformatted CT thorax showing continuity
of mass with the superior mediastinum and no
intraabdominal extension.
Fig. 2 e Axial CECT thorax showing a relatively well marginated fat attenuation mass containing thin strands of
hyperdensities suggestive of fibrous septa in mediastinum and both sides of hemithorax with passive segmental
atelectasis.
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patients are asymptomatic, and detected incidentally. Symp-
toms such as cough, dyspnea, arrhythmias, chest tightness
and chest pain may occur secondary to the displacement of
mediastinal structures. Associations with myasthenia gravis,
cystic lymphangioma, aplastic anemia and Graves disease are
known.2 These tumors may be mistaken for cardiomegaly,
diaphragmatic elevation, pleural or pericardial tumor, peri-
cardial effusion, consolidation, atelectasis, or sequestration
on chest radiographs.4 On CT, thymolipomas appear as pri-
marily fatty tissue mixed with linear whorls of soft-tissue
attenuation and have continuity with the superior medias-
tinum along the anatomical location of thymus. The sharp
borders of the lesion delineate a well-defined capsule, with no
invasion of surrounding structures. On T1-weighted Magnetic
Resonance (MR) imaging, mass follows fat signal.5
Differentials of fat containing lesions are lipoma, lip-
osarcoma, mediastinal lipomatosis, teratoma, diaphragmatic
hernias, extramedullary erythropoiesis, lipoid pneumonia,
lipoblastoma, cardiac liposarcomas.2,6 Demonstration of
continuity of mass with thymus on coronal images clinches
the diagnosis.7
In conclusion, mediastinal thymolipomas are rare thymic
neoplasms. Chest radiographs which do not conform to a
particular site of origin or lacking correlation with the clinical
and radiograph findings, should be evaluated by a contrast-
enhanced CT scan.
Conflicts of interest
The author has none to declare.
r e f e r e n c e s
1. Hall GF. A case of thymolipoma with observations on apossible relationship to intrathoracic lipomata. Br J Surg.1949;36:321e324.
2. Gaerte SC, Meyer CA, Winer-Muram HT, Tarver RD, Conces DJ.Fat-containing lesions of the chest. Radiographics.2002;22:S61eS78.
3. Takamori S, Hayashi A, Tayama K, Ohtsuka S, Hiraki H,Shirouzu K. Thymolipoma associated with myasthenia gravis.Scand Cardiovasc J. 1997;31:241e242.
4. U�gras‚ N, Akyıldız EU, Unal N, Bayram AS. An incidental uniquemediastinal mass in an asymptomatic young patient:thymolipoma. Tuberk Toraks. 2013;61:78e80.
5. Aghajanzadeh M, Alavi A, Pourrasouli Z, Aghajanzadeh G,Massahnia S. Giant mediastinal thymolipoma in 35-year-oldwomen. J Cardiovasc Thorac Res. 2011;3:67e70.
6. Molinari F, Bankier AA, Eisenberg RL. Fat-containing lesions inadult thoracic imaging. AJR. 2011;197:W795eW813.
7. Rosado-de-Christenson ML, Pugatch RD, Moran CA,Galobardes J. Thymolipoma: analysis of 27 cases. Radiology.1994;193:121e126.
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