Title : Surgical resection of a massive mediastinal tumour with mass effect
Abstract:
Thymolipoma is a rare subtype of benign thymic tumour containing a combination of thymic and adipose tissue. They are often found incidentally or when the tumour causes compression with symptoms varying depending on the location.
A 52-year-old female presented to the emergency department with anxiety attacks, dyspnoea and chest pain. She had no risk factors for cancer, cardiac or respiratory disease. On examination she was normotensive, tachycardic, afebrile and saturating at 97% on room air. Chest auscultation revealed abscent air-entry and dullness to percussion on the left to the midzone. Chest x-ray was performed demonstrating opacification of the left hemithorax to the mid-zone with mediastinal shift, consistent with a large pleural effusion, or space occupying lesion. CT scan demonstrated a large mass measuring 14.4 x 16.7 x 25.7cm in the left hemithorax with significant positive mass effect on the mediastinum. Tumour density was consistent with fat with no evidence of calcification, cystic or solid components. The tumour was supplied by multiple traversing vessels and there was no evidence of invasion. Surgical resection was performed via median sternotomy due to the lesion size and complex blood supply. The lesion was excised as a complete specimen, measuring 34.2 x 23.9 x 8.0cm and weighing 3111g. Histopathology confirmed thymolipoma with a well circumscribed lesion composed of adipose and thymic tissue with a thin fibrous capsule.
We discuss the surgical and anaesthetic complexities of resecting a large tumour causing significant mediastinal mass effect.
