Palade Emanuel, Delaca George Bucur, Titu Ioana-Medeea, Ciulic Sergiu Adrian, Cismaru Gabriel, Stef Adrian, Manole Simona
Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania.
Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania.
Diagnostics (Basel). 2025 Jan 12;15(2):159. doi: 10.3390/diagnostics15020159.
Mediastinal tumors, regardless of their location, can grow to significant sizes, causing compression-related symptoms. The term "giant" mediastinal tumor is inconsistently defined in the literature. This study presents a new clinical-radiological classification (CRC) for mediastinal tumors and evaluates its applicability through a systematic review and a detailed case analysis of a giant thymolipoma. : A systematic review of the literature from the past decade was conducted using PubMed to identify relevant studies on "giant" mediastinal tumors. The inclusion criteria focused on studies involving adult patients with documented tumor size and symptomatology. The review identified 22 studies, with most anterior mediastinal tumors classified as CRC 3 (81%), indicating "giant" tumors. Thymolipomas accounted for 58% of these cases. Tumor volume and weight correlated with symptom severity, guiding surgical approaches. The proposed CRC effectively standardized the definition of "giant" tumors. The case analysis of a 6.84 kg thymolipoma highlighted the challenges of surgical resection, confirming the importance of tailored surgical strategies for large tumors. The review of the literature revealed a significant variation in tumor size and weight across the different mediastinal compartments. Symptomatic tumors (CRC stage 3) located in the anterior mediastinum exhibited the largest volumes and weights, with an average volume of 4949 mL (range: 2013-8840 mL) and an average weight of 4137 g (range: 1575-7500 g). In comparison, tumors in the posterior mediastinum ranked second in terms of size, with an average volume of 2128 mL (range: 1040-5460 mL) and an average weight of 2489 g (range: 1009-6000 g). Tumors located in the middle mediastinum were considerably smaller, with an average volume of 536 mL (range: 21-1092 mL). Among the largest symptomatic tumors in the anterior mediastinum, thymolipomas were the most frequently observed histologic type. These findings underscore a clear size gradient across the mediastinal compartments, with the anterior mediastinum harboring the largest symptomatic tumors, followed by the posterior mediastinum, and the smallest tumors in the middle mediastinum. : The novelty of the study lies mainly in the new clinical-radiological classification (CRC) of mediastinal tumors. This classification integrates clinical presentation and cross-sectional imaging findings, offering a standardized framework for tumor reporting. In addition, it provides a precise definition of "giant" mediastinal tumors. The findings emphasize the need for early surgical intervention to prevent severe symptoms and complications. This study also showcases the largest -resected thymolipoma reported in the recent literature, supporting the utility of the proposed classification in clinical practice.
纵隔肿瘤无论位于何处，都可能生长到很大的尺寸，从而引起与压迫相关的症状。文献中对“巨大”纵隔肿瘤的定义并不一致。本研究提出了一种新的纵隔肿瘤临床-放射学分类（CRC），并通过系统评价和对一例巨大胸腺脂肪瘤的详细病例分析来评估其适用性。：使用PubMed对过去十年的文献进行系统评价，以确定关于“巨大”纵隔肿瘤的相关研究。纳入标准侧重于涉及有记录肿瘤大小和症状的成年患者的研究。该评价确定了22项研究，大多数前纵隔肿瘤被分类为CRC 3（81%），表明为“巨大”肿瘤。这些病例中胸腺脂肪瘤占58%。肿瘤体积和重量与症状严重程度相关，为手术方法提供了指导。所提出的CRC有效地规范了“巨大”肿瘤的定义。对一例6.84 kg胸腺脂肪瘤的病例分析突出了手术切除的挑战，证实了针对大型肿瘤制定个性化手术策略的重要性。文献回顾显示，不同纵隔区域的肿瘤大小和重量存在显著差异。位于前纵隔的有症状肿瘤（CRC 3期）体积和重量最大，平均体积为4949 mL（范围：2013 - 8840 mL），平均重量为4137 g（范围：1575 - 7500 g）。相比之下，后纵隔肿瘤在大小方面排名第二，平均体积为2128 mL（范围：1040 - 5460 mL）平均重量为2489 g（范围：1009 - 6000 g）。位于中纵隔的肿瘤要小得多，平均体积为536 mL（范围：21 - 1092 mL）。在前纵隔最大的有症状肿瘤中，胸腺脂肪瘤是最常见的组织学类型。这些发现强调了整个纵隔区域存在明显的大小梯度，前纵隔有最大的有症状肿瘤，其次是后纵隔，中纵隔的肿瘤最小。：该研究的新颖之处主要在于新的纵隔肿瘤临床-放射学分类（CRC）。这种分类整合了临床表现和横断面影像学结果，为肿瘤报告提供了一个标准化框架。此外，它还为“巨大”纵隔肿瘤提供了精确的定义。研究结果强调了早期手术干预以预防严重症状和并发症的必要性。本研究还展示了近期文献中报道的最大切除胸腺脂肪瘤，支持了所提出分类在临床实践中的实用性。
