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A child with a huge mediastinal mass: a case report

ییافو دیجمرتکد یناخ یسوم یداهرتکد نایاقآ- اهینییوخ رتکد(یژولوتاپ )– رتکد نلبرط (ناکدوک حارج ) هدازدمحمرتکد(سکاروت حارج )– ینیعمرتکد( یشوهیب قوف ناکدوک )– یحتفرتکد(یژرلآو مسآ ) هدازیلعرتکدو(ناکدوک هیر ) اهمناخو یآ یپ یولف ینیگچرتکد مناخ و تسیژولویدار یرساکلچ یدمحم همطافرتکد ول هدنبادخاضردیمح نرتسکاو وی یس

لاح حرش:

• رتخدرامیب6 هلاس14 هفرس لابندب زونایسو هفرس لیلدب هک تسا یمرگولیک

زا هک5 ناکدوک هاگنامرد هب ییاپرس هدش عورش هتسپ ندروخ لابندب لبق زور تسا هدرک هعجارم

• هب کشاب اذلدشیم هدینش هنیس تسار تمسرد بلق تانابرض هنیاعمرد

یدراکورتسکد CXR دش تساوخرد

رامیب هنیس سکع

رامیب لاح حرش همادا

Chief Complaint: Cough Present Illness:

A 6-year-old girl presents to Emergency Department of Qods Hospital with cough and low grade fever This condition has been started 5-days before admission Cyanosis after cough Vomiting +(once) Abdominal pain +

Past medical history

• Admission for Abdominal pain & Leukocytosis 2 years ago with normal

BMA

• Admission for Dysentery about 5 years ago
• Drug History
• Syr pedicough
• Syr Co-Amoxiclav
• Family History
• Irrelevant
• Social History
• Low Socioeconomic status

ROS

• Poor weight gain for 2 years
• Night sweats
• Mild epigastric pain , occurs immediately after meal
• Constipation
• Lack of appetite
• No dyspnea or other breathing problems before this

condition - No other complaints

EXAMINATION

General appearance

• The patient was fully conscious, alert and she wasn’t ill or toxic.

Vital Signs:

• BP: 110/60 RR: 48 T: 37.4 O2sat: 85%
• PR: 130

Head And Neck

• Trachea shifted to right
• No enlarged thyroid gland
• No congested neck veins
• No lymphadenopathy

Chest

• Breath sound was absent on the left side
• Tactile fremitus was absent on the same side
• The percussion sound was hyperresonant on left side

Heart

• Normal heart sounds heard on right side of chest
• No added sounds or murmur

Abdomen

• Lax abdomen,no organomegaly or ascites or bruit

Extremities

• Normal pulse and capillary filling, no color changes or any skin lesions

Musculoskeletal examination

• No joint swelling, tenderness or limitation of movements

Neurological examination

• Sensation and Motor power and Deep reflexes were normal

هداس نوخ شیامزآ

CT Scan

Radiologist report

هنیس سکع رد : یامن white lung تسار تمس هب بلق تفیشاب پچ فرطرد تسار رلبیهاراپ کوکشم ترودکو پچ مگارفاید یمه یگدش سوکعمو نکسا یت یس رد :و یبرچ یواح گرزب دیلوس نژورته هدوت130 X 160 X 160 مین تسار هب بلق تفیش اب پچ هنیس یرانا داتسا یقارتفا صیخشت :1 ) اموتسلبب یرانوملوپ2 ) اموتسلببورون3) PNET 4 ) یویر یاموکراس5 ) یباهتلا روموت کیتسلببوربیفویم6 ) کیتامگارفاید ینره رخآ صیخشترد عیسو

دهاجرتکد مناخ: GERM CELL TUMOR - Teratoma( 1 2 )یتیسوفنل ریغ یمکول 3 ) اموکراس

PBS: Normal mature lymphocytes

هدش هیهت شیامزآ نیا زا لباب ملب

Bone marrow aspiration

ونوس دیاگریز یژولوتاپ باوج

یشوهیبریز زاب یسپویب

پوکسورکیم ریز یسپویب هنومن

زاب یسپویب شرازگ

After surgry,1025gr mass excised

هنیس سکع نیرخآ

نوخ شیامزآ نیرخآ

ردام همان تیاضر

لمعزا لبق(هتفرگ نوتروک)

وی یس یآ یپ ردو هدش یموتوکاروت

یحارج لمعزا دعب هتفه کی کدوک

اموپیلومیت

اموپیلومیت درمرد ییا هصلبخ

• Thymolipomas are very rare, slow-growing mediastinal tumors,

accounting for only 2%–9% of all thymus tumors

• Thymolipomas are characterized by mesodermic (fatty) and

endodermic (thymic epithelium) elements

• They are lobulated and well encapsulatedwith septal divisions
• They consist of large lobules of mature adipose tissue interspersed

with small areas of thymic tissue

مئلبع

• Thymolipomas usually present as asymptomatic tumors
• When the patient does have symptoms, these are usually due to compression
• f adjacent structures
• Occasionally, this benign tumor may be associated with certain autoimmune

disorders, such as myasthenia gravis, hypogammaglobulinemia or red cell aplasia

کیژولویدار صیخشت

• Although the finding of soft fatty tissue within the tumor with no invasion of

adjacent structures on imaging studies clearly suggests a diagnosis of thymolipoma, it is impossible to make a definitive diagnosis or to even distinguish benign disease from malignancy.

نکسا یت یس رد اه هتفای

• The characteristic signs of thymolipoma on CT consist of a fatty tissue with

strands of white tissue, probably corresponding to islets of normal thymic components.

• On T1-weighted MRI, fatty tumor tissue is isointense, and in T2-weighted

sequences it is suppressed, while the thymic tissue remains are enhanced

• Differential diagnosis includes other adipose tumors, such as prominent

epicardial fat pad, lipomas, liposarcomas or thymoliposarcomas

صیخشت کیژولوتاپ

• Definitive diagnosis is based on histopathological findings
• We must consider whether a preoperative fine needle biopsy aspirate (FNAB)

is really necessary in all patients with radiological suspicion of thymolipoma

• It is not always easy to differentiate between a thymolipoma and other fatty

mediastinal lesions, such as well-differentiated liposarcoma.

• Romero Guadarrama et al reported a false positive result on FNAB in a patient

with an erroneous diagnosis of well-differentiated liposarcoma

نامرد

• The only curative treatment of thymolipomas is surgical excision
• This treatment is helpful in reducing symptoms caused by the compression of

adjacent structures and autoimmune diseases

ناجاقآرتکد یاقآ شرازگ تشررد هاوخ کی درم 30 زا سفن یگنتاب هلاس کی لاسلبق

Manouchehr Aghajanzadeh, et al., Clinics in Surgery - Thoracic Surgery 2017 | Volume 2 | Article 1619

کی پچ هنیس مینرد هدوت شرازگ مناخ21 یگنت اب یرصم هلاس لبق لاسکیزا سفن

Enormous thymolipoma: A case report Hoda A. Eida, Ahmed E. Alib, Mohmed

• A. Elsabryb

Egyptian Journal of Bronchology, Vol. 11 No. 2, April-June 2017