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Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A 45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected. Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in terms of difficult intubation, co-existing airway compression requiring reinforced tubes and fiberoptic guidance, the possibility of sudden airway collapse post-induction, risk of hypoxemia secondary to reduced functional residual capacity (FRC) and haemodynamic disturbances during and after removal of huge mass. Keywords: Anterior mediastinal mass, Mediastinal widening, Tumor of the thymus.

Thymolipoma is a rare benign neoplasm of the thymus containing both mature adipose tissue and thymic tissue. We report a case of a 34‐year‐οld man, presenting a mass of the anterior mediastinum, the radiology investigation and operatory piece diagnosed a thymolipoma. This study highlights the clinical diagnostic and therapeutic features as well as the evolutionary characteristics of this entity.

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.Investigate the significance of myasthenia gravis in thymolipoma patients.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.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.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.

Thyrolipoma and thymolipoma are rare neoplasms of the thyroid gland and thymus, respectively. Their simultaneous occurrence is exceptional. Up to now, only 2 cases have been reported in literature in 1966 and in 1997. For the first time, we report the occurrence of both neoplasms associated with myasthenia gravis in a 64-year-old woman. The value of this case report lies not only in the fact that it allows us to speculate on the presence of a syndrome but also because a complete radiological work-up (computed tomography scanner, magnetic resonance imaging, Positron emission tomography (PET) with fluorodeoxyglucose (FDG)) is reported.

Introduction Liposarcoma is the most common soft tissue tumor which is commonly found in the retroperitoneal region. This kind of tumor is usually well-differentiated with low to no potential to metastasize. Thymoliposarcomas are extremely rare tumors that are difficult to diagnose and differentiate from thymomas and other benign conditions. Presentation of a case:This report presents a case of a 46-year-old male patient with dyspnea, generalized fatigue and non-specific chest pain caused by a giant anterior mediastinal mass. Computed tomography scan revealed a large mass in the anterior mediastinum. CT guided biopsy was consistent with thymolipoma. The tumor was surgically resected. The histological analysis of the tumor revealed thymoliposarcoma. Discussion:Thymoliposarcoma usually presents with non-specific symptoms. The mean age of the diagnosis is 55.8 years old with a slight predominance in males. The corner stone of the treatment remains surgical excision of the tumor while the role of adjuvant therapy is not well documented., Highlights • Thymoliposarcoma is an extremely rare diagnosis. • The mean age of diagnosis is 55.8 years with a slight predominance in males. • The mainstay of treatment remains surgical resection of the tumor. • The role of adjuvant therapy is not well documented in the literature.

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.

A thymolipoma is a slow-growing, anterior mediastinal tumor, rare in childhood. The authors present a report of a 4-year-old girl with persistent right thoracic hypotransparency on the chest radiograph. Computed tomography and magnetic resonance imaging revealed an anterior, well-limited, mediastinal mass of heterogeneous density, with lipomatous and soft tissue density areas. The tumor was totally excised and the histopathologic findings revealed a thymolipoma. A year and a half after surgery, the child remains well. This report enhances the relevance of differential diagnosis in the presence of persistent radiologic thoracic hypotransparency.

The thymus is a primary lymphoid organ that plays a key role in the immune system development. Normally, it is located in the anterior mediastinum and it changes tissue composition with progressive fatty involution with age. The spectrum of pathological processes involving the thymus include enlargement, tumour development, and cystic change. In addition, other local pathology can mimic thymic disease. Differentiating these entities can be challenging; however, recognizing key features on imaging is essential to appropriately guide further investigation and therapy. The focus of this pictorial review will be to highlight the important distinguishing features of thymic hyperplasia, thymomas, thymic cysts, thymic neuroendocrine tumours (NETs), thymolipomas, mediastinal teratomas, and other mimics of thymic disease. Knowledge of the varying imaging findings on computed tomography and magnetic resonance imaging is valuable for radiologists to appropriately classify disease, avoid misdiagnosis, and expedite therapy.

Patient: Female, 56-year-old Final Diagnosis: Thymolipoma association with myasthenia gravis Symptoms: Acute congestive heart failure • asymptomatic thymolipoma Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare co-existance of disease or pathology Background: Thymolipoma, which was described initially by Hall in 1949, is an uncommon benign thymic tumor that represents around 9% of all thymic tumors. The incidence of thymolipoma is around 0.12 out of 100 000 cases per year, with a higher incidence in the younger age population. Thymolipoma incidence has been linked to different autoimmune diseases, including myasthenia gravis, in half of the reported cases. There are 34 reported cases in the literatures documenting such a relationship between thymolipoma and myasthenia gravis. The exact pathogenesis is unclear. However, some genetic findings revealed the presence of myoid cells, which might play a vital role in this association. Case Report: A 56-years-old female known to have myasthenia gravis presented to the Emergency Department with acute congestive heart failure, atrial fibrillation, and stroke secondary to infected vegetation from the mitral valve. The patient underwent a semi-urgent mitral valve replacement surgery treating her cardiac presentation along with an extended thymectomy to control her myasthenia gravis disease. The final histopathological assessment of the removed thymus revealed a thymolipoma pathology. Conclusions: The possibility of thymolipoma as an anterior mediastinal mass should be kept in mind when dealing with an older age group of myasthenia gravis patients on steroids. Concomitant heart surgery and thymectomy are feasible, and extended thymectomy is the treatment of choice for thymolipoma in myasthenia gravis patients with a better complete remission rate after resection. However, further comparative studies are needed for a more reliable conclusion of the postoperative myasthenia gravis response after resection.

Background Thymic tumors are unusual neoplasms, representing 0.2 to 1.5% of tumors in humans, but correspond to 20% of mediastinal tumors and 50% of those that occur in the anterior mediastinum. They tend to appear around the fourth and fifth decades of life without gender predilection. Up to 30% of patients are asymptomatic, therefore many are incidentally diagnosed. Radical thymectomy is the treatment of choice with high survival rates when detected in the early stages. Methods This was a retrospective descriptive study, including 18 adult patients’ diagnosis of thymic neoplasm, who were managed with surgical resection from 2011 to 2019. Information about demographics, clinical characteristics, imaging findings, surgical and medical management, plus histological findings was obtained and reported. Results 18 patients with thymic tumors were included, of which specific histologic studies reveled thymomas, carcinomas, neuroendocrine tumors, thymolipoma and thymic cyst. Mean age was 52.7 years, with a predominance of male population. The main symptom was dyspnea, followed by cough and chest pain. Paraneoplastic syndromes such as myasthenia gravis, aplastic anemia and Cushing syndrome were reported. 89% of cases were treated by radical thymectomy alone, while only 2 cases required chemotherapy and radiotherapy. There were no surgical complications. Mean hospital stay length was 11. 9 days, with only 1 mortality during hospital admission. 5-year survival rate was 81%. Conclusions The treatment of choice is radical thymectomy, which has been shown to positively impact patient mortality. Early detection is key to improve patient outcomes.

Knowledge of the range of non-neoplastic and benign mediastinal and thymic lesions is indispensable due to their morphological similarity to their neoplastic counterparts. Therefore, non-neoplastic lesions should always be included in the differential diagnosis during diagnostic workup of any mediastinal mass. Clinically and radiologically, these lesions often closely mimic mediastinal malignancies and tissue diagnosis is usually necessary for definitive diagnosis. Consideration of the age of the patient, symptomatology, laboratory results, as well as the exact topography of the lesion diagnosis or even resection of the entire lesion is often is usually necessary for definitive diagnosis. Important for correct diagnosis of thymic lesions is also Consideration of the age of the patient, symptomatology, laboratory results, as well as the exact topography of the lesion are other important factors in the evaluation of mediastinal lesions. Another crucial parameter in the assessment of thymic pathology is the size and weight of the thymus in relation to an age-specific reference range.

Thymolipoma is a rare disease among benign tumors. We herein report the case of a child who underwent thoracoscopic resection of a large thymolipoma. A 3-year-old boy was diagnosed with an anterior mediastinal solid tumor. Thoracic imaging revealed a fat density mass that was 8.0 × 5.0 × 3.5 cm in size. Given the MRI findings of the tumor, we suspected that the lesion was a teratoma. We decided to perform thoracoscopic exploration and, if possible, resection of the solid tumor sequentially. We successfully resected the tumor thoracoscopically. A histological examination revealed thymolipoma. For large mediastinal tumors in the intrathoracic space in children, the thoracoscopic approach is recommended when the tumor is preoperatively considered to be benign and resectable.

Thymolipoma is a rare tumor of the thymus. Classic radiologic findings of thymolipoma include fatty masses of the anterior mediastinum in conjunction with the thymus. Differential diagnosis with other more aggressive entities like liposarcoma and teratoma can be challenging. We report a case where chemical shift magnetic resonance imaging helped in the differential diagnosis.

A 66-year-old woman was referred to our institute for an enlarging tumor of the thyroid, and neck and chest computed tomography scan showed not only a thyroid tumor, but also an anterior mediastinal tumor and ground-glass nodules in the lung. Because of persisting symptoms, an enlarging thyroid mass, and the possibility of cancer, excision of the tumors was proposed. A 6-cm-long vertical skin incision was made in the right axilla, a mini-thoracotomy was made in the third intercostal space, and an additional port was placed in the fifth intercostal space. Thoracoscopic partial resection of the right upper lobe of the lung was performed first. Then, the da Vinci surgical system (da Vinci, Intuitive Surgical Inc., Sunnyvale, CA, USA) was introduced through the mini-thoracotomy. The mediastinal tumor was then excised circumferentially robotically. After resection of the lung and mediastinal tumors, the da Vinci was undocked, and a subcutaneous tunnel from the axillary incision to the thyroid was created using the flap dissection technique. The da Vinci was re-introduced through the axillary incision. A long camera port was used, and the skin and muscle flap was elevated to maintain adequate working space during the robot-assisted thyroidectomy. Total operating time was 277 min, and the patient's postoperative course was uneventful. The histopathological examinations of the lung, mediastinal, and thyroid tumors were adenocarcinoma, thymolipoma, and adenomatous goiter, respectively. In conclusion, single-incision robotic surgery for three lesions was achieved safely with good clinical results and excellent cosmetic results.

Leiomyomas are the most common benign esophageal neoplasm. About half of them were smaller than 5 cm and asymptomatic with a stable size for many years. Esophageal leiomyomas that excess than 5 cm in size may develop as a consequence of giant one at rapid growth rate. This case report specifically describes a mid-aged woman who experienced a missed diagnosis of an esophageal leiomyoma over three years, which was covered by mediastinal thymolipoma and it subsequently developed as a giant tumor occupying the entire esophagus that makes the simple enucleation impossible. A surgical intervention of esophagectomy had to be performed to manage this entity.

No abstract available. Article truncated after 150 words. A 20-year-old man presented with a continuous, mild, dull aching pain affecting the left chest pain for 15 days duration. There were no aggravating or relieving factors nor any history of fever, respiratory or cardiac symptoms. The patient’s vital signs were normal and examination of the respiratory and the cardiovascular systems revealed no abnormality. Electrocardiography and biochemical investigations, including cardiac enzymes, were normal. Chest radiography (Figure 1) revealed a subtle opacity causing fullness of the aorto-pulmonary window with subtle, smooth prominence of the left upper cardiac border; the left hilum was visualised discretely through the opacity (Figure 2). The patient underwent enhanced contrast chest CT (CECT, Figure 3) for further evaluation, revealing a large mass measuring 13 x 7.9 x 5 cm in the anterior mediastinum, extending from thoracic inlet to the left cardiophrenic angle. The mass consisted predominantly of fat density, with an average attenuation of - 84 Hounsfield …

Thymolipoma is a rarely seen benign pathological entity of anterior mediastinum and constitutes of around 2–7% of thymic tumors. They usually present as soft tissue mass composed of mature adipose tissue and thymic tissue, which are clinically silent most of the time, i.e., the reason they reach to a larger dimension before diagnosis. Preoperaative diagnosis is always challenging for the thymolipoma. We wish to report a case of the soft tissue mass of anterior mediastinum in a young male, which on surgical exploration and final histopathological examination was diagnosed as thymolipoma.

Introduction: Thymic Epithelial Tumours (TET) represent a group of rare primary tumours of the mediastinum, and include Thymomas and Thymic Carcinomas. Objectives: Describe demographics, clinical presentation, staging and survival of patients diagnosed with TET; compare our results with current ESMO guidelines for TET (2015). Methods: Retrospective analysis of medical records of patients diagnosed with thymic tumours, followed in our pneumology department, between 1999 and 2019. Results: We identified 30 patients, of which 3 were excluded for not meeting the definition of TET (two were neuroendocrine thymic tumours and one a thymolipoma). Of the remaining 27, 59.3% were males, mean age 64.4±2.28 years. Most patients (85.2%) had no smoking habits and 63% had no significant comorbidities. Previous malignancy was reported in only 11.1%. Auto-immune disorders were present in a third of the patients; of those, 77.7% presented with myasthenia gravis and 11.1% with one of the following: red cell aplasia, thyroiditis, Good syndrome, cerebellar degeneration. Nonspecific respiratory symptoms were present in 55.5%. The most frequent histopathological type, according to the World Health Organisation classification, was B1 (22.2%), followed by AB, B2 and C (18.5% each). Regarding the Masaoka-Koga classification, 29.6% patients were in stage I and another 29.6% in stage IVA. Eighteen patients underwent surgery. 5-year overall survival was 75%, and progression of the disease occurred in 6 cases. Discussion and Conclusions: In comparison to the guidelines, our sample had a higher proportion of males, higher mean age and higher incidence of advanced disease, which resulted in a lower 5-year survival.

Morgagni-Larrey hernia is an exceedingly rare presentation of congenital diaphragmatic hernia. Despite its rarity, it is associated with significant risk of morbidity and mortality. Herein, we describe a unique case report of an elderly woman who presented with left-sided chest pain, dyspnea, and chronic history of recurrent respiratory tract infections. On the basis of her medical history, general physical examination and imaging studies, she was operated for a presumptive diagnosis of thymolipoma. However, the intra-operative findings revealed that it was an unusual variant of a diaphragmatic hernia and the hernia sac appeared through the retrosternal foramen of Morgagni. Hence we concluded that it was a Morgagni-Larrey hernia compressing the lungs and heart. Consequently, the hernia was reduced and the defect was repaired. During the postoperative period, the patient had an uneventful recovery. To conclude, the possibility of a Morgagni-Larrey hernia should be strongly considered while evaluating a patient with recurrent chest infections, dyspnea, and vague chest pain.

Thymolipomas are rare benign tumors of the thymic gland. We describe a case of an eight-year-old boy who presented after a syncopal episode secondary to a large mediastinal mass found to be a thymolipoma on percutaneous biopsy. Successful thoracoscopic thymectomy was performed with complete resection of the tumor en-bloc with the thymus. Given the association with myasthenia gravis and other pathologic processes, we propose a thoracoscopic thymectomy be performed in conjunction with thymolipoma resections when feasible.

Objectives:Fine-needle aspiration cytology (FNAC), a well-accepted minimally invasive diagnostic technique utilized in adults, is gradually gaining ground for pediatric patients as well. However, there are very few comprehensive reports in the literature on utility of FNA in pre-operative diagnosis of pediatric tumors.Material and Methods:An observational study was conducted at a cancer research center and a pediatric tertiary care hospital over a 5-year period. A cytologic-histologic correlation was performed for FNACs performed in pediatric patients for a clinical diagnosis of neoplastic lesions at both the centers. Relevant clinical details and histopathology, wherever available, were retrieved. Sensitivity, specificity, and accuracy of FNAC in diagnosis of malignant lesion were calculated from the cases with available histologic correlation.Results:Of the 266 cases included, there was a slight male predominance with lymphadenopathy being the most common presentation and non-Hodgkin’s lymphoma as the most frequent diagnosis in cases clinically suspected to have a neoplasm. Histologic correlation was available in 112 cases with 100% concordance in liver and kidney tumors. Few rare cytologic diagnoses such as papillary renal cell carcinoma, mesenchymal hamartoma of the liver, and thymolipoma could be accurately rendered on FNAC smears in conjunction with the clinic-radiologic features. The sensitivity, specificity, and accuracy of FNA in diagnosing malignant pediatric tumors were found to be 100%, 92.6%, and 97.7%, respectively.Conclusion:The present study underscores the high sensitivity and accuracy of FNAC in diagnosis of pediatric tumors, both in superficial and deep-seated locations. Awareness of the cytomorphologic features and clinic-radiologic correlation may assist the cytopathologists in rendering a precise diagnosis of rare pediatric tumors as well.

Dr. Juan Rosai is one of the most prolific contributors to the literature on mediastinal pathology, and he has added steadily to that body of work over a 50-year period. Rosai has written several landmark articles in this topical area, including articles on thymic epithelial lesions, mediastinal neuroendocrine tumors, mediastinal lymphoma and other hematopoietic lesions, thymolipoma, thymoliposarcoma, mediastinal solitary fibrous tumor, intrathymic langerhans-cell histiocytosis, mediastinal germ cell neoplasms, and multilocular thymic cyst. This review recounts his role as one of the principal figures in the surgical pathology of mediastinal diseases.

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.

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Thymolipoma is a benign and rare tumor that could be found at any age. Thymolipoma associated with the myasthenia gravis, Graves disease, aplastic anemia, and hypogammaglobulinemia was reported previously, but in this case, thymolipoma is associated with lymphocytosis. A 6-year-old girl was brought to the hospital because of a chronic cough. Her evaluation revealed a 130 × 160× 160 mm fat-containing soft tissue mass arising from anterior mediastinum with complete left lung collapse and contralateral mediastinal shift. Her past medical history showed that she had been evaluated and treated unsuccessfully due to severe lymphocytosis two years earlier. Her peripheral blood and bone marrow cell morphology were normal; in contrast, blood cell count and CD flow cytometry showed severe lymphocytosis. The patient's tumor was excised entirely without any complications, and lymphocytosis resolved during the follow-up period. Because the T lymphocytes are developed in the thymus, and more than 80% of cells in CD flow cytometry were T lymphocytes, and the lymphocytosis resolved with tumor removal; therefore, the authors suggested that Thymolipoma could be associated with lymphocytosis.

The thymus is a primary lymphoid organ located in the upper prevascular mediastinum. A number of masses arise in relation to the thymus. Accurate knowledge of anatomy and imaging features is essential for the differentiation between non-tumoral thymic pathology and malignant thymic tumors. In general, a benign hyperplasia of the thymus occurs in children and young adults, while in adults thymoma is the most common tumor. Furthermore imaging is of great importance in the preoperative staging and (oncological) follow-up. Computed tomography (CT) is the imaging modality of choice to assess the mediastinal structures, including the thymus. Medical imaging is essential to further characterize those lesions that warrant further workup. Surgery is the gold standard for the treatment of thymoma with the aim of complete resection. We provide an overview of thymic masses with typically imaging features: thymic hyperplasia, thymic cyst, thymolipoma, thymoma, thymic carcinoma, and thymic carcinoid. Lymphoma will be discussed in Chapter 15: Imaging of Non-thymic Mediastinal Tumors.

Gardner's syndrome is a hereditary disorder inherited as an autosomal dominant with high penetrance and variable expression that is caused by a mutation of the adenomatous polyposis coli gene. It is characterized by gastrointestinal polyps associated with multiple osteomas, dental anomalies, and skin and soft tissue tumors. We present a case of 30-year-old female patient with Gardner's syndrome who presented with a giant mediastinal thymolipoma. The tumor was completely excised through a bilateral posterolateral thoracotomy. There was no recurrence after 20 months of follow-up. We therefore suggest that physicians who regularly treat patients with Gardner's syndrome carefully examine for thoracic manifestations.

Introduction: A causal relationship between the thymus gland and myasthenia gravis (MG) has been assumed for decades. However, this relationship is still a matter of conjecture and speculations and awaits definitive proof. Recently, myoid cells have been considered as effectors in the pathogenesis of MG as well as thymic enlargement (thymolipoma, true thymic hyperplasia). Material and methods: we report a retrospective study about 6 cases of thymic enlargement with 4 cases of true thymic hyperplasia (TTH) and 2 cases of thymolipoma (TL). Aim: Our objective is to discuss the role of myoid cells in the pathogenesis of MG associated with thymic enlargement. Results: The majority of our patients were men with a sex ratio of 4/2. Only 2 patients had a past medical history consistent for MG. Myoid cells were found in all cases. Conclusion: Through our small study, the implication of myoid cells in the pathogenesis of the association MG-TL or TTH remains unproved.

Thymolipomas are rare benign tumors composed of mature adipose tissue and benign thymic tissue and one of the differential diagnoses of an anterior mediastinal mass. These tumors may run an indolent, asymptomatic course, often achieving massive dimensions before presentation. We report a 17-year-old girl who presented with progressive dyspnea with nonproductive cough since 2 months’ duration. Clinical examination was unremarkable. Computed tomography of chest revealed a large lobulated anterior mediastinal mass protruding into the right hemithorax and to the diaphragm. A CT guided needle biopsy gave the diagnosis of thymolipoma. The tumor was successfully removed en bloc through a median sternotomy. Histopathological examination confirmed thymolipoma.

Introduction The association of myasthenia gravis (MG) and inflammatory myopathy is rare and often only one of the diseases is diagnosed. Thymus pathology may be in the origin of such disease association. Methods We described four patients with both MG and inflammatory myopathy. Results These cases correspond to 2.3% of our MG cohort. Case 1: MG, polymyositis and thymolipoma; case 2: MG and necrotizing myopathy without thymic pathology on a background of scleroderma, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia (CREST); case 3: MG and dermatomyositis without thymic pathology; case 4: MG and dermatomyositis with type C thymoma. Discussion The recognition of these neuromuscular co-morbidities contributes to (i) understanding their pathogenic mechanisms, (ii) developing better management approaches and (iii) further improving disease outcomes.

Myasthenia gravis (MG) is an autoantibody mediated autoimmune disease characterized by skeletal muscle fatigability and weakness through different types of immune attacks against various proteins of the postsynaptic membrane or in the neuromuscular cleft of the neuromuscular junction. In a subset of patients with autoantibodies against the muscle type acetylcholine receptors (AChRs) there is strong evidence that the thymus is involved in the pathogenesis of MG, while its role is questionable or unknown in MG due to autoantibodies against muscle specific kinase (MuSK), lipoprotein receptor like protein 4 and agrin. Here we describe the thymic alterations that have repeatedly been encountered in MG, i.e., thymic follicular hyperplasia (TFH) (thymitis), ‘thymic atrophy’, thymoma and thymolipoma. The potential link of non-thymic tumors [e.g., follicular dendritic cell (FDC) sarcoma] with MG will be discussed.

Thymolipoma is an uncommon benign neoplasm and its pathogenesis is unclear. The current study describes the case of an 82-year-old woman who presented with dyspnea and dysphagia and was discovered to have an anterior mediastinal thymolipoma enlarged to cranial part of the neck. We conclude that the only curative treatment of thymolipomas is surgical excision.

Objective: The mediastinum is the central portion of the thoracic cavity, housing numerous organs and harbouring a mixed bag of non-neoplastic and neoplastic lesions. Accurate diagnosis is essential owing to the widely variable therapeutic and prognostic implications. Material and Method: Cases of mediastinal masses were retrospectively reviewed from January 2011 till January 2016. Clinico-radiological records of these cases were retrieved. Fine needle aspiration cytology (FNAC) was performed wherever feasible. Histopathological and immunohistochemical evaluation of the excised specimens was undertaken. Results: Of the 60 cases included in our study, 22 were anterior, 20 were middle and 18 posterior mediastinal masses. The majority of the patients were symptomatic (96.8%). The most common pathology was thymoma (12 cases) followed by ten cases of lymphoma, eight cases each of tubercular lymphadenopathy and schwannoma, six cases of neurofibroma, four cases of extragonadal germ cell tumours, two cases each of thymic cyst, bronchogenic cyst, retrosternal goitre, ganglioneuroma and neuroblastoma, and one case each of lipoma and thymolipoma. FNAC was done in 54 cases of which 7 cases yielded inadequate material. Immunohistochemistry was required for classification of lymphoma cases and confirmation of a mixed component in germ cell tumours. Conclusion: Mediastinal masses create significant diagnostic dilemma for the clinicians, radiologists and histopathologists. While imaging studies help in narrowing the differential diagnosis, accurate categorisation is not always possible. FNAC is a useful and cost effective tool. However, sampling error and complexities in performing the technique are major hurdles in the usefulness of this diagnostic modality.