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Giant Thymolipoma

India Institute of Medical Sciences
New Delhi 110029, India

We present a case of giant thymolipoma. A 14-year-old boy presented to the hospital with complaints of gradually increasing breathlessness of 2 months' duration. The patient had no history of cough, hemoptysis, loss of weight, loss of appetite, or other constitutional symptoms. A chest radiograph revealed a large mass obscuring the border of the heart and the diaphragm.

A CT scan of the chest revealed a large mass occupying the entire left hemithorax and extending anteriorly into the right hemithorax (Fig. 3A). The mass was of fat density with areas of soft-tissue density in-between. The mass was draping around the heart and great vessels (Fig. 3B). The biopsy specimen showed a lesion composed of an admixture of mature adipose tissue and microscopically normal thymus tissue showing lymphocytes and thymic corpuscles, features that are consistent with thymolipoma.

View larger version (139K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —14-year-old boy who presented with complaints of gradually increasing breathlessness of 2 months' duration. There was no history of cough, hemoptysis, loss of weight, loss of appetite, or other constitutional symptoms. Chest radiograph (not shown) revealed large mass obscuring border of heart and obscuring diaphragm. Coronal multiplanar reconstruction image shows large mass has fat density with areas of soft-tissue density in-between and that it occupies entire left hemithorax and extends into right hemithorax.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —14-year-old boy who presented with complaints of gradually increasing breathlessness of 2 months' duration. There was no history of cough, hemoptysis, loss of weight, loss of appetite, or other constitutional symptoms. Chest radiograph (not shown) revealed large mass obscuring border of heart and obscuring diaphragm. Axial contrast-enhanced CT image shows mass is draping around heart and great vessels.

Thymolipoma is a rare, benign, slowly growing tumor of the anterior mediastinum involving the thymus gland. Although first reported by Lange in 1916 [1], the term was coined by Hall in 1948 [2]. The highest incidence occurs in children and young adults with a mean age of 22 years. The tumors are usually large, most weighing more than 500 g with 25% weighing more than 2,000 g. On occasion, they can attain a huge size. The largest of these tumors that have been reported in the literature weighed 6,000 g [3].

Because of its large size and pliability, the mass usually drapes itself around the heart, conforming to its borders, and adheres to surrounding structures; invasion per se has never, to our knowledge, been documented. Most patients are asymptomatic, and the mass is detected on routine chest radiography. Symptoms, when present, are attributable to displacement of mediastinal structures. Approximately 25% of patients complain of cough, dyspnea, and chest pain.

Thymolipoma is associated with other diseases, such as myasthenia gravis [4], cystic lymphangioma [5], and Graves' disease [6].

The pathogenesis of these tumors is unknown. The involuting hyperplasia hypothesis, the more plausible of several hypotheses, supposes that the tumor represents an abnormal hyperplasia followed by partial or complete thymic involution with consequent fatty replacement [7].

The radiologic features of thymolipoma can mimic several conditions including cardiomegaly, pleural tumors, pericardial effusion, and pericardial tumors. On CT, the tumor appears almost entirely fatty with some areas of inhomogeneity of soft-tissue density that represent thymic tissue mimicking liposarcoma. Its sharp borders, its lack of compression of nearby vessels, and its location point to a benign lesion.

Surgery is the main treatment technique.

References

Top References

 

1. Lange I. Uber ein Lipom des Thymus [in German]. Zentralbl Allg Pathol Anat1916; 27:97 -100
2. Hall GFM. A case of thymolipoma. Br J Surg1948; 36:321 -324
3. Dunn BH, Frkovick G. Lipomas of the thymus gland. Am J Pathol 1956;32:41 -51
4. Retigen D, Fetter B, Roses A, et al. Thymolipoma in association with myasthenia gravis. Arch Pathol Lab Med1978; 102:463 -466[Medline]
5. Scully NM. Lipothymoma with cystic lymphangioma. Am Surg 1960;26:400 -404[Medline]
6. Benton C, Gerard P. Thymolipoma in a patient with Graves' disease. J Thorac Cardiovasc Surg1966; 51:428 -432[Medline]
7. Begilow NH, Ehler AA, Albany NY. Lipothymoma: an unusual benign tumor of the thymus gland. J Thorac Surg1952; 23:528 -538

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				S. Ceran, B. Tulek, G. Sunam, and M. Suerdem Respiratory Failure Caused by Giant Thymolipoma Ann. Thorac. Surg., August 1, 2008; 86(2): 661 - 663. [Abstract] [Full Text] [PDF]

This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gamanagatti, S. Articles by Arvind, S. Search for Related Content PubMed PubMed Citation Articles by Gamanagatti, S. Articles by Arvind, S. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?