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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 encapsulated tumor of anterior mediastinum. Overall, thymic neoplasms comprise only 4% of all mediastinal tumors. Only 2–9% of these are reported to be thymolipomas. Less than 200 cases have been published in the world literature and its incidence in both genders is equal and usually develops at any age. The youngest case in the literature was described in 6-month-old child. Thymolipoma can be associated with chronic lymphocytic leukemia, myasthenia graves, aplastic anemia, hyperthyroidism and Hodgkin’s disease. Half of the patients are asymptomatic, the neoplasm incidentally is discovered radiologically. The other half mostly represents shortness of breath, cough, chest pain and upper respiratory tract infection. The clinical case, diagnosis and treatment of gigantic thymolipoma in 3-year-old child is described in this article. A clinical case of giant thymolipoma in a 3-year-old child is presented. The child had several respiratory symptoms: episodes of choking, dry cough, groaning breathing during physical exertion and anxiety, chest deformity (enlarging the right half) and signs of type II respiratory failure. Radiographically - subtotal darkening of the right hemithorax with mediastinal shift to the contralateral side with compression of the left lung; laboratory results - hyperleukocytosis(39х109/l). Computed tomography showed a large hypovascular mass formation with inhomogeneous structure and areas of lipomatosis. Most likely, this is the case of congenital nature of thymolipoma, which manifested itself at the age of 3. Correct pathomorphological diagnosis was made with the help of open biopsy, since when performing the puncture method, there is a possibility of verification error due to insufficient amount of histological material given the inhomogeneity of the mass of the formation, as well as taking into account the suspicion of a lymphoproliferative process. Considering the mediastinal and intrathoracic compression syndrome, as well as the benign nature of these tumor, which is characterized by the absence of infiltrative growth, the only correct treatment tactic is radical surgery. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors., Тимолипома является редкой, инкапсулированной, доброкачественной опухолью средостения. Новообразования тимуса составляют 4% всех опухолей средостения. Только 2-9% таких новообразований описаны как тимолипомы. В мировой литературе опубликованы меньше 200 таких случаев, частота возникновения среди женщин и мужчин одинаковая, может развиваться в любом возрасте. Самый ранний случай описан у ребенка в возрасте 6 месяцев. Тимолипома может ассоциироваться с хроническим миелолейкозом, миастенией, апластической анемией, гипертиреозом и болезнью Ходжкина. Клиническое течение у половины пациентов является бессимптомным, новообразование случайно диагностируется рентгенологически. Вторая половина в основном проявляет одышку, кашель, боль в груди и инфекции дыхательных путей. Представлен клинический случай гигантской тимолипомы у ребенка в возрасте 3 лет. У ребенка наблюдались респираторные симптомы: эпизоды удушья, сухого кашля, стонущего дыхания во время физической нагрузки и беспокойства, деформация грудной клетки посредством увеличения правой половины и признаки дыхательной недостаточности ІІ ст. Рентгенологически - субтотальное затемнение правого гемиторакса со смещением средостения в контрлатеральную сторону с компрессией левого легкого; лабораторно - гиперлейкоцитоз (39х109/л). На компьютерной томографии - гиповаскулярное образование больших размеров с негомогенной структурой и участками липоматоза. С наибольшей вероятностью имеет место врожденный характер тимолипомы, которая манифестировала в 3-летнем возрасте. Установить правильный патоморфологический диагноз удалось благодаря выполнению открытой биопсии, поскольку при выполнении пункционного метода возможна погрешность верификации вследствие недостаточного количества гистологического материала, принимая во внимание негомогенность массы образования, а также с учетом подозрения на лимфопролиферативный процесс. Учитывая синдром медиастинальной и интраторакальной компрессии, а также доброкачественный характер данных опухоли, характеризующихся отсутствием инфильтративного роста, единственной правильной тактикой лечения является радикальное хирургическое вмешательство. Исследование выполнено в соответствии с принципами Хельсинкской декларации. На проведение исследований получено информированное согласие родителей детей. Авторы заявляют об отсутствии конфликта интересов., Тимоліпома є рідкісною, інкапсульованою, доброякісною пухлиною переднього середостіння. Загалом новоутворення тимуса займають 4% усіх пухлин середостіння в дітей. Лише 2-9% цих новоутворень описані як тимоліпоми. У світовій літературі опубліковано менше 200 таких випадків, частота виникнення серед чоловіків і жінок однакова, може розвиватись у будь-якому віці. Наймолодший випадок описано в дитини віком 6 місяців. Тимоліпома може поєднуватися з хронічним лімфолейкозом, міастенією, апластичною анемією, гіпертиреозом і хворобою Ходжкіна. Клінічний перебіг у половини пацієнтів безсимптомний, новоутворення випадково діагностується рентгенологічно. Інша ж половина переважно репрезентує задишку, кашель, біль у грудях та інфекції дихальних шляхів. Наведено клінічний випадок гігантської тимоліпоми в дитини віком 3 роки. У дитини спостерігалися респіраторні симптоми: епізоди задухи, сухого кашлю, стогнучого дихання під час фізичного навантаження та неспокою, деформація грудної клітки у вигляді збільшення правої половини та ознаки дихальної недостатності ІІ ст. Рентгенологічно - субтотальне затемнення правого гемітораксу із зміщенням середостіння в контрлатеральний бік із компресією лівої легені; лабораторно - гіперлейкоцитоз (39х109/л). На комп’ютерній томографії - гіповаскулярне новоутворення великих розмірів із негомогенною структурою та ділянками ліпоматозу. З найбільшою ймовірністю має місце вроджений характер тимоліпоми, що набула своєї маніфестації у 3-річному віці. Встановити правильний патоморфологічний діагноз вдалося завдяки виконанню саме відкритої біопсії, оскільки при виконанні пункційного методу можлива похибка верифікації внаслідок недостатньої кількості гістологічного матеріалу, зважаючи на негомогенність маси утворення, а також з урахуванням підозри на лімфопроліферативний процес. З огляду на синдром медіастинальної та інтраторакальної компресії, а також на доброякісний характер даних пухлини, що характеризуються відсутністю інфільтративного росту, єдиною правильною тактикою лікування є радикальне хірургічне втручання. Дослідження виконано відповідно до принципів Гельсінської декларації. На проведення досліджень отримано інформовану згоду батьків дитини. Автори заявляють про відсутність конфлікту інтересів.

Thymomas are malignant, epithelial tumors of the thymus of diverse morphology that may metastasize or relapse after resection. The WHO histological classification includes five main subtypes A, AB, B1, B2 and B3. Types A and AB usually harbour a specific GTF2I gene mutation. Thymolipomas are very rare, benign tumors composed of thymic parenchyma and adipose tissue. We present the case of a 37-year-old male with an incidentally found mediastinal tumor that shared morphological features of a thymoma of unknown histological type and a thymolipoma-like tumor. Microscopically the tumor contained three components: (I) a highly organoid component that reproduced the thymic parenchyma with numerous Hassall corpuscles; (II) a lymphocyte-poor, epithelial component; (III) mature adipose tissue. A wide panel of immunohistochemical tests was used, but the results were not decisive for differential diagnosis. Genetic analysis of GTF2I, BRAF and NRAS genes revealed no mutations. The tumor was completely resected. The patient did not receive adjuvant radiotherapy. A 1.5 years after resection there was no evidence of tumor recurrence. Based on our case we carefully analyse and compare the microscopic features of thymoma vs. thymolipoma. The differentiation between these tumors is crucial due to their distinct clinical course and required therapeutic approach.

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.

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.

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.

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.

Thymoangiolipoma is a rare, slow-growing, benign thymic neoplasm that arises from the anterior mediastinum. A 61-year-old man with the chief complaint of right eye ptosis and high serum acetylcholine receptor antibody level is presented here. The spiral computed tomography of the chest revealed a hypodense mass in the anterior mediastinum. Microscopic examination showed admixture of adipose tissue, thymic tissue and blood vessels with the diagnosis of thymoangiolipoma. Thymoangiolipoma is a rare histologic variant of thymolipoma which can be associated with myasthenia gravis and must be considered as a differential diagnosis in anterior mediastinal mass with fat density in radiologic evaluation.

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.

Thymolipoma is a rare benign slow-growing encapsulated tumor of anterior mediastinum that accounts for 2–9% of all thymic neoplasms. About 30–50% of them are asymptomatic and found incidentally. Less than 200 cases have been published in the world literature so far. Here we report a case of thymolipoma of an adult female presented with progressive dyspnea, chest tightness and non-productive chough for 2-month duration. All blood investigations were normal. Radiological examinations suggested the presence of fat and soft tissue within the tumor without invading the neighboring structures. We concluded that the only curative treatment of thymolipoma is surgical excision. Unfortunately, the patient did not give consent despite telling her the outcomes if we do not do the surgical procedure, and a week later she passed away due to respiratory distress secondary to the mass effect of the tumor.

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.

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.

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.