Paediatric giant cervicomediastinal thymolipoma

Abstract

We report a case of a 11-year-old boy who presented with a massive soft tissue right cervical painless and progressive lesion displacing trachea to the left and extending into the anteriosuperior mediastinum which was diagnosed to be a lipomatous mass on chest CT scan. Subsequent biopsy and total excision proved it to be a giant cervicomediastinal thymolipoma. It was successfully excised with excellent prognosis and long-term results. A giant paediatric cervicomediastinal thymolipoma is a rare, benign, mediastinal mass of thymic origin. It may remain asymptomatic despite massive size and up to 50% in some series are associated with autoimmune disease. CT scan gives fat density and encapsulated benign nature and biopsy usually establishes the diagnosis. Preoperative tissue diagnosis is important as now the availability of thoracoscopic option is best suited to reduce morbidity. Treatment of choice is total excision using open surgical, minimal invasive techniques or robotic surgery and the prognosis is excellent.

Successful Thoracoscopic Excision of Left Middle Mediastinal Teratoma in a Girl

“…It is a very rare situation to have dual pathology of two varieties such as an incidental congenital mediastinal teratoma in a toddler girl presenting with acute abdomen secondary to an infective pathology. Sacrococcygeal teratoma is the most common teratoma in infants and children and is rare at other locations [3][4][5][6][7]. Extra-gonadal teratomas of the mediastinum are very rare tumors that occur most frequently in the anterior mescibasejournals.org Patel R diastinum.…”

“…The selection of surgical approach is based on site, size, adhesions and tumor characteristics such as mature/immature/malignant. Currently, the surgical approach has shifted from invasive approaches such as a sternotomy to minimally invasive ones utilizing lung isolation ventilation [7][8][9].…”

“…However, risk factors such as left sided tumor, large tumors, intra-operative tumor adhesion or bleeding, immature or malignant tumour, strong tumor cell adhesion with high grades of adhesion, non-availability of equipment and supportive devices, and less thoracoscopic experience of the surgical team may require conversion, mini-thoracotomy or open thoracotomy which would lead to safety procedures and complete removal of the teratoma. Pre-operative or intraoperative aspiration of fluid contents may be helpful for patients with large mature cystic teratomas to do cytopathological studies and to facilitate thoracoscopic surgery [7,8].…”

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“…Most patients diagnosed with thymolipoma are asymptomatic, being incidentally diagnosed during a routine thoracic X-ray [27,41,42] or even during autopsy [24].…”

Cervico-Thoracic Giant Lipoma in a Child

“…One of the lipoma cases that extended to the anterior mediastinum was reported by Sharma et al (3). The only pediatric case with a giant cervico-mediastinal thymolipoma was presented by Patel et al (6). The patient was an 11-year-old boy who presented with a cervical mass extending from behind the right side of the neck and plunging into the right side of the chest under the sternum.…”