Case Report of An Unusual Mediastinal Mass - Thymolipoma

Thymolipomas are rare, slow-growing, benign anterior mediastinal neoplasms which are very often detected incidentally. Here we present a case of a 47 year old female who presented with chest discomfort and radiology revealed an anterior mediastinal mass. Total thymectomy was done and histopathology showed features consistent with thymolipoma. Very few cases of thymolipomas have been reported in Indian and world literature.

Primary Mediastinal Neoplasms

neoplasms and lymphoma characteristically affect the anterior mediastinum while neurogenic neoplasms typically occur in the paravertebral regions. Patients with mediastinal neoplasms may be asymptomatic or may present because of symptoms of compression or local invasion. Patients with thymoma may also present with paraneoplastic syndromes including myasthenia gravis. Thymoma is the most common primary anterior mediastinal neoplasm and usually manifests as a unilateral soft tissue mass with lobular contours that may exhibit local invasion or drop pleural metastases. Mature teratoma often demonstrates a spherical morphology and cystic change; intrinsic fat attenuation in such a lesion is virtually diagnostic. Malignant germ cell neoplasms almost exclusively affect men and manifest as anterior mediastinal soft tissue masses that may be homogeneous or exhibit areas of low attenuation from central necrosis and are indistinguishable from lymphoma with nodal coalescence on imaging. Neurogenic neoplasms are paravertebral lesions that may produce skeletal erosion and intraspinal extension and are optimally evaluated with MRI. Imaging diagnosis of primary mediastinal neoplasms requires identification of a mediastinal mass, placement of the mass in a specific mediastinal compartment and characterization of the lesion with cross-sectional imaging to formulate a focused differential diagnosis and appropriate management recommendations.

Distinguishing thymoma from T-lymphoblastic leukaemia/lymphoma: a case-based evaluation

T-lymphoblastic lymphoma and thymoma are distinct primary mediastinal neoplasms that can have similar clinical presentations and overlapping histological features. Microscopic distinction is occasionally difficult because the immature lymphocytes associated with thymoma may resemble T-lymphoblastic leukaemia/lymphoma cells, morphologically and immunohistochemically. An accurate diagnosis assumes particular importance since the treatment approaches for these two entities differ considerably. Multimodality diagnostic approaches incorporating histological, flow cytometry immunophenotypic‚ and molecular approaches are required. In this article, we describe four patients, each presenting with a mediastinal tumour in different clinicopathological settings. A detailed report of each case will follow, illustrating the challenges involved in the diagnosis in patients with these mediastinal neoplasms.