كشف اتفاقي يك توده بزرگ مدياستن در راديوگرافي قفسه سينه: گزارشي از يك تيموليپوما

An Incidental Finding of a Giant Mediastinal Mass on CXR: Report of a Thymolipoma

ﺗﻴﻤﻮﻟﻴﭙـﻮﻣﺎ ﻳﮏ ﻧﺌﻮﭘﻼﺳـﻢ ﺑﺴﻴـﺎﺭ ﻧﺎﺩﺭ ﺗﻴﻤـﻮﺱ ﻣﻲﺑﺎﺷﺪ. ﮔـﺰﺍﺭﺵ ﻣﺎ ﺩﺭ ﻣـﻮﺭﺩ ﻳﮏ ﺧﺎﻧﻢ 34 ﺳﺎﻟﻪ ﻣﻲﺑﺎﺷﺪ ﮐﻪ ﭘﺲ ﺍﺯ ﺗﺼﺎﺩﻑ ﺍﺗﻮﻣﺒﻴﻞ، ﺑﻪ ﺩﻧﺒـﺎﻝ ﺍﻧﺠﺎﻡ ﺭﺍﺩﻳﻮﮔ ـﺮﺍﻓﯽ ﻗﻔﺴﻪ ﺳﻴﻨﻪ، ﻳﮏ ﺗﻮﺩﻩ ﺣﺠﻴـﻢ ﻣـﺪﻳﺎﺳﺘﻦ ﺩﺭ ﻭﻱ ﮐﺸـﻒ ﺷﺪ. ﺑﻴﻤﺎﺭ ﻫﻴـﭻ ﺷـﮑﺎﻳﺘﻲ ﻧﺪﺍﺷﺖ ﻭ ﻣﻌﺎﻳﻨﻪ ﻓﻴﺰﻳﮑﻲ ﻭﻱ ﻧﮑـﺘﻪ ﺧﺎﺻﻲ ﻧﺪﺍﺷﺖ. ﺳﻲﺗﻲ ﺍﺳﮑﻦ-ﻫﺎﻱ ﻗﻔﺴﻪ ﺳﻴﻨﻪ ﻳﮏ ﺗـﻮﺩﻩ ﻟﻴﭙـﻮﻣﺎﺗﻮﺯ ﺗﻮﺩﻩ ﭼﺮﺑﻲ( ﺭﺍ ﮐﻪ ﺣﺎﻭﻱ ﻧﻮﺍﺣﻲ ﺑﺎ ﺩﺍﻧﺴﻴﺘﻪ ﺑﺎﻓﺖ ﻧﺮﻡ ﺩﺭ ﻣـﺪﻳﺎﺳﺘﻦ ﻗـﺪﺍﻣﻲ ﺑﻮﺩ، ﻧﺸﺎﻥ ﺩﺍﺩﻧﺪ. ﭘﺲ ﺍﺯ ﮐﺸﻒ ﺗـﻮﺩﻩ ﻣـﺪﻳﺎﺳﺘﻦ، ﺍﺯ ﺑﻴ ﻤﺎﺭ ﺩﺭ ﻣـﻮﺭﺩ ﻫﺮﮔﻮﻧﻪ ﻋﻼﻣﺖ ﻣﺮﺗﺒﻂ ﭘﺮﺳﺶ ﺷﺪ ﻭ ﻭﻱ ﻓﻘﻂ ﺑﻪ ﺍﺣﺴـﺎﺱ ﻧﺎﺭﺍﺣﺘـﻲ ﺩﺭ ﻗﻔـﺴﻪ ﺳﻴﻨﻪ ﺍﺷﺎﺭﻩ ﮐﺮﺩ ﮐﻪ ﺁﻥ ﺭﺍ ﺑﻪ ﻋﻨـﻮﺍﻥ ﻳﮏ ﻣﺸﮑﻞ ﺩﺭ ﻧﻈـﺮ ﮔﺮﻓﺘﻪ ﻭ ﺑﻪ ﭘﺰﺷﮏ ﻣﺮﺍﺟﻌﻪ ﻧﮑﺮﺩﻩ ﺑﻮﺩ. ﺑ ﻴﻮﭘﺴﻲﻫﺎﻱ ﺗﺤﺖ ﻫﺪﺍﻳﺖ ﺳﻲﺗﻲ، ﺑﺎﻓﺖ ﺗﻴﻤﻮﺱ ﻫﻤﺮﺍﻩ ﺑﺎ ﻋﻨﺎﺻﺮ ﺑﺮﺟﺴﺘﻪ ﭼﺮﺑﻲ ﺁﺷﮑﺎﺭ ﺳﺎﺧﺖ. ﺑﻴﻤﺎﺭ ﺗﺤﺖ ﺍﺳﺘﻮﻧﻮﺗﻮﻣﻲ ﺧﻂ ﻭﺳﻂ ﻗﺮﺍﺭ ﮔﺮﻓﺖ ﻭ ﺗﻮﻣﻮﺭ ﺑﻪ ﺻﻮﺭﺕ ﮐﺎﻣﻞ ﺧﺎﺭﺝ ﺷﺪ. ﺗﺸﺨﻴﺺ ﭘﺎﺗﻮﻟﻮﮊﻱ ﺿﺎﻳﻌﻪ، ﺗﻴﻤﻮﻟﻴﭙﻮﻣﺎ ﻫﻤﺮﺍﻩ ﺑﺎ ﺗﻐﻴﻴﺮﺍﺕ ﺩﮊﻧﺮﺍﺗﻴﻮ ﺑﻮﺩ. ﺗﻴﻤﻮﻟﻴﭙﻮﻣﺎ ﻣﻌﻤﻮﻻﹰ ﺍﺑﻌﺎﺩ ﺑﺰﺭﮔﻲ ﺩﺭ ﺯﻣﺎﻥ ﺗﺸﺨﻴﺺ ﺩﺍﺷﺘﻪ، ﺑﻲﻋﻼﻣﺖ ﺑﻮﺩﻩ ﻭ ﻣﻌﻤﻮﻻﹰ ﻋﻼﺋﻢ ﻣﺮﺑﻮﻁ ﺑﻪ ﺗﺤﺖ ﻓﺸﺎﺭ ﻗﺮﺍﺭ ﮔﺮﻓﺘﻦ ﺳﺎﺧﺘﺎﺭﻫﺎﻱ ﻣﺠﺎﻭﺭ ﻫﺴﺘﻨﺪ. ﺭﺯﮐﺴﻴﻮﻥ ﺟﺮﺍﺣﻲ، ﺩﺭﻣﺎﻥ ﺍﺻﻠﻲ ﺑﻮﺩﻩ ﻭ ﺗﻨﻬﺎ ﺭﺍﻩ ﮐﺎﺭ ﻋﻼﺝ ﺑﺨﺶ ﺑﻴﻤﺎﺭﻱ ﻣﻲ باشد

Thymolipoma is a very rare benign neoplasm of the thymus. We present the case of a 34-year-old female with a massive mediastinal tumor discovered on a chest X-ray after a car accident. The patient had no complaints and her physical examination was unremarkable. Chest CT scans revealed a lipomatous mass containing areas of soft tissue density in the anterior mediastinum. After discovering the mediastinal mass, patient was asked about any related symptom, and she mentioned just chest discomfort, which she did not consider it as a problem and so did not visit a physician. CT guided biopsy of the mass revealed thymic tissue associated with a prominent fatty component. The patient was submitted to median sternotomy, which resulted in the complete excision of the tumor. The pathological diagnosis was thymolipoma with degenerative changes. Thymolipoma usually attains enormous dimensions by the time of diagnosis, are usually asymptomatic, and the occasional symptoms are related to the compression of adjacent structures. Surgical resection is the treatment of choice and offers the only possibility of cure.