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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.

WOS: 000387038500009, PubMed: 28824990, Introduction The aim of the study was to evaluate the results of surgery to remove huge mediastinal masses and their pathology. Surgical resection was chosen for accurate diagnosis and treatment of the huge mediastinal masses extending into the pleural cavity. Methods Records were reviewed for eight patients who had the diagnosis of huge benign mediastinal masses and who underwent operation; details of the patients and operations were recorded. Results Mean age was 34.5 (range 22 to 44) years, and male-to-female ratio was 2:6. Computed tomography and magnetic resonance imaging (MRI) were used to evaluate the location and extent of the abnormality and to characterize the tissue components of the mass. Most of the tumors were located in the posterior mediastinum. The most frequent presenting symptom was exertional dyspnea. The majority of cases underwent posterolateral thoracotomy, and complete resection was possible in seven patients. Partial resection could only be performed in one. The mean diameter of the resected masses was 15 x 10 cm. Histopathologic examination revealed 3 neurogenic tumors, 2 teratomas, 1 thymolipoma, and 1 ectopic thyroid, and 1 hemangioma. Minor complication was seen in two cases. Conclusion The presurgical thoracic MRI provided correct diagnosis along with radiologic characterization and topography. Surgery must be the preferred treatment in huge benign mediastinal masses.

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.

Thymolipomas are rare tumors of the anterior mediastinum containing both thymic stroma and an abundance of fat. We present a 40-year-old man with no underlying disease who presented with cough and progressive dyspnea. Clinical evaluation revealed a giant mass of lipid density filling almost the entire left hemithorax with mediastinal shift. Total excision of the 40×33×8 cm mass weighing 4 kg was performed via a left thoracotomy and the histopathologic diagnosis of the mass was reported as thymolipoma. The patient remains alive and disease-free, twelve months after the intervention.

A number of masses arise in relation to the thymus. The radiologist has an important role regarding the differential diagnosis 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 the thymoma is the most common tumor. Furthermore imaging is of great importance in the preoperative staging and oncological follow-up. To evaluate the thymus CT scan is used in the majority of the cases. MRI or PET-CT can have an added value in the differential diagnosis of various thymic pathologies in some cases. We present an overview of thymic masses with typically imaging features: thymic hyperplasia, thymomas, thymic carcinoma, thymic non-hodgkin lymphoma, thymolipoma and thymic carcinoid.

The patient was 35-year-old women with a six-month history of difficulty breathing and chest pain. An anterior-posterior chest radiograph revealed a widened mediastinum with small lung volumes. During his diagnostic evaluation, a computed tomographic scan was performed and with huge mass in the anterior mediastinum with extension to the left and right side of pleural space. With postero-lateral thoracotomy the huge mass was resected. The patient discharged with good condition., Journal of Cardiovascular and Thoracic Research; ISSN 2008-6830

Thymolipoma is a rare benign tumor of the anterior mediastinum with mean age of incidence of 20 to 30 years with rare occurrence in children. All clinicians are not aware of this entity and so the diagnosis is easily missed. It is defined as a mass forming lesion composed of circumscribed mature adipose tissue and unremarkable thymus. I present a case of 4-year-old child with history of breathlessness. USG chest of the child had revealed a space occupying mass in the anterior mediastinum of 5 x 6 x 4 cms. On resection, the 550 gm weight mass showed capsulated, soft to firm, yellowish-tan colored areas. Sections from the mass showed predominantly adipose tissue containing interconnecting cords of thymus. Although rare, thymolipoma must be considered in the differential diagnosis of anterior mediastinal tumors.

Thymolipomas are rare tumors, usually located in the anterior mediastinum and may extend into the chest cavity. But the thymolipomas presenting solely in the chest cavity without demonstrable mediastinal mass are extremely rare. They can be termed as extramediastinal thymolipomas and they present as diagnostic and technical challenge for surgeons. We conducted a retrospective review of the pathologically proven 5 cases of thymolipomas which presented as chest cavity mass without mediastinal connection who had undergone surgical resection during last 10 years (1999 to 2008). There were four women and one man with a mean age of 38.75 years. Four had unilateral and one had bilateral chest cavity tumors. Mediastinal connection of the chest cavity tumor was established in two cases by Computed Tomography (CT) scan while in one case by Magnetic Resonance Imaging (MRI). CT guided Fine Needle Aspiration Cytology was suggestive of lipoma in all five cases. In cases with established mediastinal connection, median sternotomy was done to evacuate chest cavity tumor and thymus. Mediastinal connection was noted during surgery in two cases approached through the posterolateral thoracotomy, in which complete excision of the thymus was achieved through the same incision. Median sternotomy approach is best in cases of biopsy proven thymolipoma irrespective of mediastinal extension demonstrated by imaging study and complete excision of the thymus should be ensured. If complete excision of thymus is not possible through thoracotomy approach on finding mediastinal extension intraoperatively, there should not be any hesitation for converting to the median sternotomy.

Thymolipomas are rare tumors of the anterior mediastinum accounting for up to 9% of all thymic tumors. These tumors are associated with autoimmune diseases in up to 50% of the patients, including myasthenia gravis, aplastic anemia, hypogammaglobulinemia, lichen planus, and Graves' disease. These tumors with a fatty appearance also can arise in older patients with autoimmune disease.This retrospective study evaluated the thymolipomas from nine patients at a single institution, which were resected between 2002 and 2007. The clinical data as well as radiologic findings were evaluated, together with the follow-up.Seven patients initially presented with myasthenia gravis, and therefore they underwent a resection of the thymus, even though imaging techniques did not reveal a tumor in any of the cases. Another patient showed no symptoms of autoimmune disease for 20 years, and though cardiomegaly was suspected, further investigation revealed a thymolipoma. The symptoms of myasthenia gravis improved following the surgery in one patient. During follow-up, one patient died due to esophageal cancer, and the remaining patients are alive without recurrence.Thymolipomas are benign tumors that show an excellent outcome. Patients with autoimmune disease symptoms occasionally show an improvement of the symptoms after a resection of the tumors.

Thymolipomas are uncommon tumors of the anterior mediastinum. They may extend into, but rarely stem from, the chest cavity. Furthermore, thymoma arising in a thymolipoma is extremely rare. We report a unique case of thymoma type B1 that originated form a giant thymolipoma located in the chest cavity, which was resected by a lateral thoracotomy in a 23-year-old woman. To our knowledge, this is the first reported case of thymoma type B1 arising within a giant thymolipoma.

The authors describe a rare case of thymolipoma in a 26-year-old, otherwise healthy woman presenting with general fatigue. Radiological examinations disclosed a large anterior mediastinal mass. Macroscopically, the resected tumor was approximately 5 × 10 cm2, with nodular configuration, and microscopically, 3 components were identified: a normal thymic rim, hyperplastic thymic tissue, and a typical thymolipomatous component at the periphery of the hyperplastic area. The predominant component of the tumor was hyperplastic thymic tissue. The tumor was diagnosed as thymolipoma at the initial stage of development. This case suggests the histogenesis of thymolipoma—fatty regression or infiltration of fatty tissue into a previously hyperplastic thymus.

症例は53歳，女性．2008年6月に手指振戦を主訴に当院を受診し甲状腺機能亢進症と診断，術前精査中に胸部異常陰影を指摘された．生化学検査ではFT3，FT4，TRAbの高値とTSHの低下を認めた．胸部CT検査では前縦隔から右側にかけて右胸腔の約1/3を圧排するφ15×13cmで脂肪濃度の腫瘤性病変を認めた．また腫瘤内部は造影MRI検査にてT1強調画像，T2強調画像のいずれでも高信号であった．以上より甲状腺機能亢進症および縦隔脂肪腫と診断し，薬剤投与による甲状腺機能の安定化を得た後に手術を行った．胸骨正中切開アプローチにて胸腺から有茎状に発育した児頭大の腫瘍を摘出した．同時に甲状腺亜全摘術も行った．切除標本は28×16cmで1,050gあり，大部分が成熟脂肪細胞から成る病変であったが，部分的に胸腺組織が含まれており胸腺脂肪腫と診断した．術後経過は良好で術後13病日に退院した．

Introduction: Thymolipoma is a rare benign neoplasm of the anterior mediastinum accounting for 2%-9% of thymic tumors. It mainly consists of adipose tissue comporting foci of thymic tissue. Neoplastic transformation of the epithelial component is extremely rare with four cases of thymoma and a case of thymic carcinoid previously reported. Aim: To report a case of thymolipoma associated with B3 thymoma. Case presentation: A 59 year-old woman treated for asthma presented with dyspnea. No mysthenia gravis was present. Imaging revealed a huge mediastinal tumor of fat density compressing the right lung. Surgical resection revealed a 2.8 kg and 39 cm tumor of mainly lipomatous aspect comporting a stellar solid focus of 3 cm. Microscopically, the tumor was a thymolipoma, with a focus (3 cm) of a B3 thymoma. No complementary treatment was applied and the patient is disease-free, two months after operation. Conclusion: This is the first case of a B3 thymoma arising inside a giant thymolipoma. Diagnosis of thymolipoma should be suspected in a fat-density tumor of the anterior mediastinum. Malignant transformation despite rare is possible and resection is mandatory.

Thymolipoma is an unusual benign tumor of the mediastinum, comprising 2%–9% of thymic neoplasms. Most presentations are atypical. Here we present the case of a 68-year-old man with effort intolerance and fatigue for 4 months. Computed tomography of the chest revealed a lipomatous mass in the anterior mediastinum and bilateral hemithoraces. There were atelectatic changes in both lungs. The tumor was resected via a midline sternotomy. The patient had to be ventilated for 3 days postoperatively. The histopathological diagnosis was pleomorphic thymolipoma.

Thymolipoma is a rare benign tumor of mediastinum. It comprises 2-9% of all thymic neoplasms. A 35-year-old man patient applied to our hospital with chest pain. In physical examination nothing characteristic was found and the routine laboratory findings were not remarkable. A chest radiograph showed no abnormalities however chest multislice computed tomography scans revealed an anterior mediastinal lesion in thymic area. No findings was found in respect of invasion in magnetic resonance imaging. Preoperatively radiological diagnosis was thymic hyperplasia but histopathological diagnosis was thymolipoma. We present the case of thymolipoma phenomenon which causes the chest pain., Timolipoma mediastenin nadir benign tümörüdür. Timolipoma tüm timik neoplazilerin 2-9%’ unu oluşturur. Otuzbeş yaşında erkek hasta, göğüs ağrısı ile hastanemize başvurdu. Fizik muayenede özellik yoktu. Laboratuar bulguları normal sınırlarda idi Göğüs radyografisinde anormallik görülmedi ancak göğüs bilgisayarlı tomografisinde timik bölgede anterior mediastinal lezyon tespit edildi. Magnetic resonance görüntülemesinde invazyon açısından bulgu saptanmadı. Operasyon öncesi radyolojik tanı timik hiperplaziydi ancak histopatolojik tanı timolipomaydı. Biz burada göğüs ağrısına sebep olan nadir bir timolipoma olgusunu sunuyoruz

A variety of reactive, developmental, inflammatory, and tumorlike conditions can occur in the mediastinum (Table 1.1). Congenital and developmental cysts can present as a mass lesion in the mediastinum and may occur in a variety of settings. Congenital cysts usually occur in younger patients and are unilocular and small; they can arise anywhere along the anatomic course of embryonic descent of the thymus, including the neck. Developmental cysts can arise from displaced or ectopic remnants, such as foregut cysts and enteric duplication cysts. Acquired cysts can arise as a result of underlying inflammatory processes and can grow to be quite large and multiloculated. Thymic hyperplasia is another reactive process that presents as enlargement of the thymus and clinically can simulate a malignancy. Inflammatory conditions affecting the mediastinum include acute and chronic inflammation (mediastinitis), granulomatous processes related to sarcoidosis (affecting primarily mediastinal lymph nodes) or fungal infection, and end-stage fibrosing inflammation resulting in idiopathic sclerosing mediastinitis. Other developmental abnormalities that occur with some frequency in the mediastinum are the presence of ectopic thyroid or parathyroid tissue, which may give rise to tumor growths secondary to hyperplasia, benign nodules, or development of malignancy. Finally, a variety of benign tumorlike conditions in this anatomic compartment can lead to tumor masses that may be confused with malignancy, including thymolipoma, thymofibrolipoma, and Castleman’s disease.

BACKGROUND: Thymolipomas are the most outstanding mesenchymal mediastinal tumors although they represent only a small percentage of thymic neoplasms. Their histogenesis remains unsolved, and they are usually benign. Fine needle aspiration biopsy (FNAB) has become the method of choice for the study of mediastinal tumors, including thymolipomas. Making the correct diagnosis depends on the availability of all thymic and lipomatous components as well as on the correct application of a differential diagnosis with other lipomatous tumors. CASE: A 24-year-old woman had a 3-month history of coughing with sputum, fever, asthenia, adynamia, headaches and anemia. Physical examination revealed a bilateral pulmonary condensation syndrome. Imaging studies showed a well-defined, large mass occupying both hemithoraxes and the mediastinum. FNAB revealed an admixture of atypical adipocytes, nonneoplasic lymphoid tissue and capillaries with prominent endothelium. An initial diagnosis of well-differentiated liposarcoma was made. A 2.8-kg, encapsulated, yellowish gray mediastinal tumor was surgically removed. Mature adipose tissue intermingled with abundant thymic tissue containing numerous Hassall's corpuscles were seen histologically. Immunohistochemical markers for thymic epithelium, lymphoid tissue and adipocytes were all positive. Thymolipoma was the final diagnosis. The anemia subsided with resection of the tumor, and the patient was disease free 2.5 years after surgery. CONCLUSION: To the best of our knowledge, this is the second report of a thymolipoma studied with FNAB. The criteria for the differential diagnosis between thymolipomas and other lipomatous tumors should be kept in mind.

Thymolipomas are benign neoplasms that usually occur in adults and are rarely described in children. They are usually detected incidentally but can be of massive size and lead to respiratory compromise. A 6-month-old boy presented with respiratory distress and an anterior mediastinal mass which proved to be a thymolipoma. He underwent surgical resection and remains well on follow-up. Although rare, thymolipomas should be considered in the differential diagnosis even in infants presenting with an anterior mediastinum mass.

Imaging of the thymus can prove challenging for the radiologist. The purpose of this chapter is to provide a broad overview of the thymus, its role in normal physiology and pathologic processes. After a brief discussion of the history of the thymus, the embryology, anatomy, and histology of the thymus are reviewed. The normal appearance of the thymus using the various imaging modalities available to the radiologist is then discussed, followed by an overview of congenital thymic variants and benign pathologies involving the thymus, including thymolipoma, thymoma, and thymic rebound. The chapter concludes with a summary of thymic malignancies, with a primary focus on leukemia and lymphoma.

OBJECTIVES: Although significant improvement in myasthenic symptoms has been reported following the removal of thymolipomas, information on surgical outcomes among patients with thymolipomatous myasthenia gravis (MG) is limited. METHODS: This was a retrospective review of patients who underwent extended thymectomy for treatment of MG. RESULTS: From 1995 to 2010, 267 patients with MG underwent extended thymectomy, including 104 with thymomatous MG, 151 with non-thymomatous MG and 12 (4.4%) with thymolipoma. The mean duration of myasthenic symptoms before surgery was greatest in the thymolipomatous group (P< 0.001). The lowest mean age (36.1 years old, P< 0.001) and the lowest preoperative serum anti-acetylcholine receptor antibody titre (P= 0.015) occurred in the non-thymomatous group. More thymic and adipose tissue was removed from the thymolipomatous group compared with the non-thymomatous group (P< 0.001). Regarding surgical outcomes, the rate of stable remission was higher in the non-thymomatous (42.3%) and thymolipomatous (41.7%) groups compared with the thymomatous group (28.8%, P= 0.029). No instances of postoperative exacerbation of MG or tumour recurrence were noted during the postoperative follow-up of patients treated for thymolipoma. CONCLUSIONS: Our results suggest that patients with myasthenia thymolipomatous have surgical outcomes similar to those of patients with non-thymomatous MG and have a mean age at the time of surgery similar to that of patients with thymomatous MG.

Thymolipoma is an uncommon benign neoplasm of the thymus composed of mature adipose and thymic tissue. The diagnosis of thymolipoma should be considered in the case of a mediastinal mass with fat density, especially if it is interspersed with strands of soft tissue attenuation on computed tomography scans. However, it is sometimes difficult to differentiate radiologically between a thymolipoma and other mediastinal fatty tumors. Here we present a patient with a huge mediastinal mass that proved to be a thymolipoma.

症例は75歳の女性.他院での胸部X線写真上異常陰影を指摘され来院した.胸部CT上, 前縦隔に内部不均一で低吸収域を伴う腫瘍を認めた.胸腺原発の奇形腫を疑い, 胸骨縦切開による腫瘍摘出術を施行した.腫瘍は12.0×7.5×2.5cmで被膜に覆われており, 割面は充実性で黄色部分と白色部分が混在していた.病理組織学的に胸腺脂肪腫と診断した.術後経過は良好で退院し, 4年経過した現在, 再発を認めない.胸腺脂肪腫は, 胸腺に原発する比較的まれな良性腫瘍であり, 本邦では59例の報告がある.自験例はCT画像上, 過去の報告例に比してCT値が高く, 術前診断に難渋したので, 文献的考察を加えて報告する.

Thymolipomas are rare, often asymptomatic benign tumors; their revelation by myasthenia is exceptional. A 49-year-old patient with a one-year history of fluctuant muscular fatigability developed ptosis. Electromyography revealed a myasthenic neuromuscular block. The CT scan disclosed a thymic mass especially important on the left side. Thoracotomy under left mammary was performed for thymectomy. Pathology examination of the surgical specimen provided the diagnosis of benign thymolipoma. At 37 months follow-up, the myasthenia has remained unchanged.