Giant thymoma successfully resected via median sternotomy and anterolateral thoracotomy: a case report

Surgical resection of a giant thymolipoma causing respiratory failure: A case report

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.

An asymptomatic giant AB thymoma in a patient with Down syndrome: a case report

Background

Mediastinal mass management may represent a real challenge for all the physicians who deal with it. Mediastinum, in fact, contains different vital structures which are often involved by growing neoplasms with increasing severity. Therefore, up to 60% of the patients with mediastinal mass are symptomatic, according to the structure involved. Different neoplasms may arise essentially from all mediastinal organs, whereas thymic epithelial tumors and lymphomas represent more than 90% of mediastinal tumors.

Case Description

We report the first case described of a giant asymptomatic mediastinal mass in a 43-year-old male affected by Down syndrome (DS), turned out to be a thymoma, treated exclusively and successfully with radical surgery. Despite the absence of any symptoms, the giant thymoma infiltrated the diaphragm, the pericardium, the upper lobe of the left lung together with the left phrenic nerve resulting in the compression of heart and great vessels.

Conclusions

To date, this is the first description of a thymic malignancy in a patient with DS, that usually is characterized by a low-incidence of solid tumor except for germ-cells ones. Surgery has been extremely challenging, due the clinical condition of the patient together with the tumor features; nevertheless, oncological radicality criteria were completely fulfilled. After four years from surgery, the patient is alive and still disease-free, highlighting the importance of radical surgery.

Giant thymoma presenting as a large bilateral intrathoracic mass: A case report and a comparison between median sternotomy and hemiclamshell approach

Introduction

Thymoma is an epithelial tumor that commonly lies in the anterior mediastinum. It rarely extends to the pleural cavities. There is no standard approach for resecting similar giant thymomas.

Case presentation

An eighteen-year-old woman presented with a six-month history of progressive exertional dyspnea, weight loss, and loss of appetite. Radiological imaging demonstrated a giant mediastinal mass extending to both pleural cavities, a transthoracic needle biopsy was then performed, which indicated thymic hyperplasia.

Clinical discussion

The tumor was completely resected using a two-step approach, starting with a median sternotomy then extending it to a hemiclamshell incision, which provided better exposure of the tumor and caused less morbidity.

The left part of the thymoma was resected using a median sternotomy, which took a relatively long time and caused significant blood loss. Then the incision was extended to a hemiclamshell incision through the pleural cavity to remove the right part of the tumor. This approach helped us to visualize the tumor better and did not cause any significant blood loss.

The removed mass measured 36 × 29 × 10 cm and weighed 4500 g. Pathologic diagnosis indicated a type B1 tumor with no capsular invasion according to the World Health Organization classification.

Conclusion

The hemiclamshell approach is superior to the median sternotomy incision in resecting giant thymomas extending to the pleural cavity, as it saves time and causes less morbidity.

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Giant Thymoma is an extremely rare clinical entity.

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It is very uncommon for a thymoma to reach both pleural cavities.

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Comparing the median sternotomy to the hemiclamshell approach in resecting giant thymomas extending to the mediastinum.

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The hemiclamshell approach caused less morbidity and no significant blood loss compared to the median sternotomy.