Table of Contents  
CASE REPORT
Year : 2017  |  Volume : 11  |  Issue : 2  |  Page : 165-167

Enormous thymolipoma: A case report


1 Chest Department, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt
2 Cardiothoracic Department, Faculty of Medicine for Girls, Al Azhar University, Cairo, Egypt

Date of Submission13-Jun-2016
Date of Acceptance08-Jul-2016
Date of Web Publication25-Apr-2017

Correspondence Address:
Hoda A Eid
Chest Disease Department, Al-Zahraa University Hospital, Abbaseya 11517 Cairo
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1687-8426.203799

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  Abstract 

Thymolipoma is unusual benign mediastinal, slow-growing, encapsulated tumor of the anterior mediastinum with no tendency to recur after a complete surgical excision. Here, we report the case of an adult female who presented with progressive dyspnea of 2 months’ duration especially on lying down. Chest radiograph showed opacity occupying the entire left side. Computed tomography of the chest revealed a large mass on the left side with fat attenuation. Computed tomography-guided biopsy obtained was diagnosed as hyperplasic thymic tissue. The tumor was successfully removed surgically, and histopathological examination confirmed thymolipoma.

Keywords: mediastinum mass, thymic neoplasm, thymolipoma


How to cite this article:
Eid HA, Ali AE, Elsabry MA. Enormous thymolipoma: A case report. Egypt J Bronchol 2017;11:165-7

How to cite this URL:
Eid HA, Ali AE, Elsabry MA. Enormous thymolipoma: A case report. Egypt J Bronchol [serial online] 2017 [cited 2017 Jun 29];11:165-7. Available from: http://www.ejbronchology.eg.net/text.asp?2017/11/2/165/203799

The abstract was presented at the Al-Azhar Grand Round in February 2016, Cairo, Egypt.



  Introduction Top


Thymolipoma accounts for 2–9% of all thymic neoplasm, composed of mature adipose tissue and benign thymic tissue. The majority of these tumors are clinically quiescent; however, they may reach large dimensions and manifest themselves clinically with compression of adjacent structures. Complete surgical excision is curative [1].


  Case report Top


A 21-year-old female patient presented to the hospital with complains of gradually progressive dyspnea of 2 months’ duration associated with productive cough. The patient had no history of hemoptysis, loss of weight, loss of appetite, or other constitutional symptoms. Clinically, there was no abnormality detected on general examination. Local examination revealed limitation in chest movement with a decrease in Tactile vocal fremitus (TVF) on the entire left side. On percussion, there was dullness all over the left side, 2, 3, 4, 5 at right midclavicular line and bare area. Chest auscultation detected decreased breath sounds on the left side. Routine blood investigations were within normal limits. A chest radiograph revealed an opacity occupying the entire hemithorax and shifting mediastinum to opposite side ([Figure 1]a). A computed tomography scan of the thorax revealed a large mass occupying the entire left side with fat attenuation (−80 to −120 HU) compressing and shifting mediastinal structures to the opposite side ([Figure 1]b). Spirometry confirmed the presence of a restrictive defect. Chest ultrasound showed that the echoes in the mass were homogeneous but of higher intensity than those of liver parenchyma with no effusion. Ultrasound-guided tru-cut biopsy was performed, and pathological examination for core biopsy showed lymphoid infiltrate. Flexible bronchoscopy was performed and reported narrowing of the main, lobar, and segmental bronchi (slit like) with intact healthy mucosa. Computed tomography-guided biopsy detected hyperplastic thymic tissue. The patient was referred to the cardiothoracic department. Posterolateral thoracotomy incision (fifth intercostal space) was made. A very large (giant), soft, well-defined, encapsulated mass of about 5 kg, with smooth surface occupying the whole left hemithorax, originating from the thymus gland without any invasion to the adjacent structures, was noticed. Manipulation of the mass was very difficult and so we could not remove it as one structure. Its capsule was opened by means of diathermy and the mass was removed in pieces. Thereafter, we excised the thymus gland with the mass capsule; after mass removal the secondary hypoplastic lung was another problem. We tried to reduce cavity space with positive ventilation of the lung, sixth rib excision, and ablation of the left phrenic nerve. Physiotherapy was started on the first postoperative day with incentive spirometry and exercise training, with oxygen therapy, and applying low suction on chest drains, and follow-up with clinical examination and chest radiography daily was carried out. The diagnosis was confirmed by histopathological examination as thymolipoma. Ten-month postoperative, the lung filled the pleural cavity and the residual space improved ([Figure 2],[Figure 3],[Figure 4],[Figure 5]).
Figure 1: (a) Plain radiograph of the chest P–A view. (b) Computed tomography (lung window). (c) Computed tomography (mediastinal window).

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Figure 2: Mass capsule.

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Figure 3: Excised mass.

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Figure 4: Jar of excised mass.

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Figure 5: Cut of computed tomography (CT) of the chest (after 10 months).

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  Discussion Top


Thymolipoma is a rare condition with an incidence of about 0.12 cases per 100 000 per year. The first case of a thymolipoma was reported by Lange in 1916 [2]. It appears as a mass composed of mature adipose tissue and benign thymic tissue. The thymic tissue component in thymolipomas is separated by large amounts of mature fat, with no atypia and no mitotic activity. There is no recognized sex predilection. Reported age range is between 3 and 6 years, with a mean age of 22 years [1]. The radiologic features can mimic several conditions, including cardiomegaly, pleural tumors, pericardial effusion, pericardial tumors, basal atelectasis, and pulmonary sequestration. The majority of these tumors are clinically quiescent; however, they may reach large dimensions and manifest themselves clinically by compression of adjacent structures [3]. The pathogenesis of thymolipomas has not been elucidated. Some theories suggest that it is a variant of a thymoma, or hyperplasia of mediastinal fat, or neoplasm of mediastinal fat, which engulfs thymic tissue and thymic hamartoma; however, the most interesting theory is that a thymolipoma represents a benign tumor of specialized thymic stroma (fat), arising in relationship to the thymic epithelium. [4]. Thymolipomas can occasionally be associated with myasthenia gravis. Histopathological examination revealing admixture of mature adipose tissue and microscopically normal thymus tissue with Hassal’s corpuscles is diagnostic [5]. Surgically local resection is curative. There are no reports of recurrence, metastasis, or mortality.


  Conclusion Top


It is important to consider mediastinal tumors in the differential diagnosis of patients presenting with progressive dyspnea without any apparent cardiac illness but chest cardiograph showing enlarged cardiac silhouette [6].

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Ringe B, Dragojevic D, Frank G, Borst HG. Thymolipoma − a rare, benign tumor of the thymus gland, two case reports and review of the literature. Thorac Cardiovasc Surg 1979; 27:6.  Back to cited text no. 1
    
2.
Damadoglu E, Salturk C, Takir HB, Ertugrul M, Yilmaz A, Atasalihi A, Yilmaz A. Mediastinal thymolipoma: an analysis of 10 cases. Respirology 2007; 12:924–927.  Back to cited text no. 2
    
3.
Teplick JG, Nedwich A, Haskin ME. Roentgenographic features of thymolipoma. Am J Roentgenol Radium Ther Nucl Med 1973; 117:873–880.  Back to cited text no. 3
    
4.
Toyama T, Mizuno T, Masaoka A, Shibata K, Yamakawa Y, Niwa H, Torii K. Pathogenesis of thymolipoma: report of three cases. Surg Today 1995; 25:86–88.  Back to cited text no. 4
    
5.
Moran CA, Rosado-de-Christenson M, Suster S. Thymolipoma: clinicopathologic review of 33 cases. Mod Pathol 1995; 8:741–744.  Back to cited text no. 5
    
6.
Mohan Rao PS, Moorthy N, Shankarappa RK, Bhat P, Nanjappa MC. Giant mediastinal thymolipoma simulating cardiomegaly. J Cardiol 2009; 54:326–329.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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