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Presented by Risa Mann, M.D. and prepared by Greg Seidel, M.D.
Case 5: 81-year-old male with mediastinal mass.
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1. Question
Week 105: Case 5
81-year-old male with mediastinal mass./images/0923025a.jpg
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/images/0923025d.jpgCorrect
Answer: Thymolipoma
Histology: Most of this lesion is composed of mature appearing adipose tissue with numerous small scattered areas of thymic tissue throughout the lesion. Germinal centers are not observed within the thymic tissue. The adipose tissue is mature in appearance.
Discussion: Thymolipomas almost always present as asymptomatic mediastinal masses. This lesion may be seen at any age. These lesions may reach a large size, however, the overall shape of the thymus is usually still observed. Some of these tumors have weighed over 500 gms. The tumor appears to be yellow and may have a thin capsule. The lesion is easily distinguished from a lymphoma or thymoma based on the lack of cytologic atypia in the former and the lack of proliferative activity in the thymus that is observed within the lesion.
Radiologically, this lesion may simulate cardiomegaly or a pulmonary sequestration. There is debate as to whether this lesion represents a true neoplastic process. It is important to be familiar with this lesion because of the large size that they may attain, and the fact that it can be clinically confused with other processes in the mediastinum.
Incorrect
Answer: Thymolipoma
Histology: Most of this lesion is composed of mature appearing adipose tissue with numerous small scattered areas of thymic tissue throughout the lesion. Germinal centers are not observed within the thymic tissue. The adipose tissue is mature in appearance.
Discussion: Thymolipomas almost always present as asymptomatic mediastinal masses. This lesion may be seen at any age. These lesions may reach a large size, however, the overall shape of the thymus is usually still observed. Some of these tumors have weighed over 500 gms. The tumor appears to be yellow and may have a thin capsule. The lesion is easily distinguished from a lymphoma or thymoma based on the lack of cytologic atypia in the former and the lack of proliferative activity in the thymus that is observed within the lesion.
Radiologically, this lesion may simulate cardiomegaly or a pulmonary sequestration. There is debate as to whether this lesion represents a true neoplastic process. It is important to be familiar with this lesion because of the large size that they may attain, and the fact that it can be clinically confused with other processes in the mediastinum.
