Thymic lipofibroadenoma accompanied with largish calcifications
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CASE REPORT
Thymic lipofibroadenoma accompanied with largish calcifications Shuhei Hakiri1 · Koji Kawaguchi1 · Hisashi Tateyama2 · Takayuki Fukui1 · Shota Nakamura1 · Naoki Ozeki1 · Shunsuke Mori1 · Toyofumi F. Chen‑Yoshikawa1 Received: 24 June 2020 / Accepted: 27 August 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Thymic lipofibroadenomas are extremely rare; their radiological features have never been reported. We report the first case of a lipofibroadenoma with some largish calcifications mimicking a teratoma. A 28-year-old man had an anterior mediastinal tumor with some calcifications on preoperative computed tomography, which was suspected to be a mature teratoma and resected through robot-assisted thoracic surgery. This tumor had strands of epithelial cells separated by abundant fibrous stroma containing fat cells and was thus diagnosed as a lipofibroadenoma. He was well without any recurrence 6 months postoperatively. Largish calcifications on preoperative computed tomography make distinguishing between teratomas and lipfibroadenomas difficult. Keywords Lipofibroadenoma · Calcification · Rare thymomas
Introduction Thymic lipofibroadenomas are categorized under “other rare thymomas” and described as “benign tumor” in the World Health Organization (WHO) classification 4th edition because of no reports on recurrence [1]. It is a very rare tumor, and only five cases have been reported in English literature [2–6]. Furthermore, no detailed radiological features have been assessed. Herein, we report a rare case of a thymic lipofibroadenoma, which was suspected to be a mature teratoma because of some largish calcifications in the tumor on preoperative computed tomography (CT).
Case A 28-year-old man with current smoking history accidentally presented a round-shaped shadow in the right hilum on a chest X-ray image for flu (Fig. 1a). He had no tumor-related * Shuhei Hakiri h‑shuhei‑[email protected]‑u.ac.jp 1
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai‑cho, Showa‑ku, Nagoya 466‑8550, Japan
Department of Pathology, Kasugai Municipal Hospital, Kasugai, Japan
2
symptoms and comorbidities. Contrast-enhanced chest CT showed a lobulated solid mass at the right edge of the heart (diameter: 8.8 × 6.7 × 4.2 cm), which was enhanced heterogeneously in early phase scan with some intratumoral fat components and calcification sites were identified (Fig. 1b–c). Some calcification sites were relatively large (largest site diameter: 4.3 × 4.0 × 0.9 cm). The serum levels of tumor makers such as carcinoembryonic antigen, alphafetoprotein, and beta-human chorionic gonadotropin were within normal ranges; serum antiacetylcholine receptor antibody levels were also not elevated. The mass was suspected to be a mature teratoma based on radiological findings and the patient’s young age; subsequently, the mass was resected through robot-assisted thoracoscopic surgery with the right chest cavity approach. Three 8-mm robot ports and one extended assist port were use
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