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巨大前纵隔胸腺脂肪瘤:一例罕见的胸腔镜切除术及手术管理挑战病例

Giant anterior mediastinal thymolipoma: A rare case of thoracoscopic resection and surgical management challenges.

作者信息

Bessrour Habib, Messaoudi Houssem, Lajmi Mokhles, Ragmoun Wafa, Tlili Karima, Hachicha Saber

机构信息

Department of Cardiac and Thoracic Surgery, The Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.

Department of Cardiac and Thoracic Surgery, The Military Hospital of Instruction of Tunis, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunisia.

出版信息

Int J Surg Case Rep. 2025 May;130:111299. doi: 10.1016/j.ijscr.2025.111299. Epub 2025 Apr 14.

Abstract

INTRODUCTION

Thymolipoma is a rare benign anterior mediastinal tumor composed of thymic and adipose tissues. Early diagnosis and accurate surgical management are crucial to prevent misdiagnosis and optimize patient outcomes.

CASE PRESENTATION

A 17-year-old male with no significant medical history presented to our thoracic surgery department with exertional dyspnea and a sensation of chest tightness. Given the worsening symptoms, a chest computed tomography (CT) scan was performed, revealing a well-circumscribed anterior mediastinal mass in the right paracardiac region, predominantly composed of fatty tissue. The patient underwent right thoracoscopic surgery, during which the tumor was successfully resected. The postoperative course was uneventful. Histopathological examination confirmed the diagnosis of a thymolipoma.

DISCUSSION

Thymolipomas are rare benign tumors composed of mature adipose tissue and thymic tissue, typically located in the anterior mediastinum. They account for less than 9 % of all thymic tumors and are often discovered incidentally. Patients with thymolipomas may present with nonspecific symptoms, such as dyspnea, chest pain, or recurrent respiratory infections, depending on the size and compressive effects of the tumor. Imaging plays a crucial role in identifying thymolipomas, with CT scan often showing a well-encapsulated mass with fat and soft tissue components. Complete surgical resection remains the cornerstone of treatment, ensuring both accurate diagnosis and symptomatic relief.

CONCLUSION

This case underlines the exceptional presentation of a thymolipoma, emphasizing its rarity and the critical role of surgical management in achieving optimal outcomes. Early recognition and intervention are crucial, especially for large or symptomatic lesions.

摘要

引言

胸腺脂肪瘤是一种罕见的良性前纵隔肿瘤,由胸腺组织和脂肪组织构成。早期诊断和准确的手术治疗对于防止误诊和优化患者预后至关重要。

病例介绍

一名17岁男性,无重大病史,因劳力性呼吸困难和胸闷前来我院胸外科就诊。鉴于症状加重,进行了胸部计算机断层扫描(CT),结果显示在心旁右侧区域有一个边界清晰的前纵隔肿块,主要由脂肪组织构成。该患者接受了右胸腔镜手术,术中肿瘤被成功切除。术后恢复顺利。组织病理学检查确诊为胸腺脂肪瘤。

讨论

胸腺脂肪瘤是由成熟脂肪组织和胸腺组织构成的罕见良性肿瘤,通常位于前纵隔。它们占所有胸腺肿瘤的比例不到9%,且常为偶然发现。胸腺脂肪瘤患者可能出现非特异性症状,如呼吸困难、胸痛或反复呼吸道感染,具体取决于肿瘤的大小和压迫效应。影像学检查在识别胸腺脂肪瘤方面起着关键作用,CT扫描通常显示一个边界清晰、含有脂肪和软组织成分的肿块。完整的手术切除仍然是治疗的基石,既能确保准确诊断,又能缓解症状。

结论

本病例突出了胸腺脂肪瘤的特殊表现,强调了其罕见性以及手术治疗在实现最佳预后方面的关键作用。早期识别和干预至关重要,尤其是对于较大或有症状的病变。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b718/12019025/ff7718b38a59/gr1.jpg

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