PURPOSE: Lipomas are extremely rare in the intra-thoracic cavity. There is only a single case report of an extremely large intra-thoracic lipoblastoma (14X12.7X6.5 cm) in an 18-month old child. We report the first case of a gigantic intra-thoracic lipoma in an adult.
METHODS: Case report of the largest intrathoracic lipoma reported till date in adults
RESULTS: 86 year-old White Caucasian woman with past medical history of breast cancer with right mastectomy and hypertension presented with bilateral leg swelling and worsening shortness of breath for 10 days. She denied smoking. On admission, she was not in respiratory distress. However, she had marked diminution of breath sound along with dullness to percussion of the entire left chest. Further investigation revealed anemia along with renal insufficiency. Chest x-ray exhibited opacity of the entire left hemi-thorax suspicious for massive left pleural effusion. CT chest with contrast showed mild deviation of mediastinum to the right due to a large mass (23.5X18.5X9 cm) occupying almost the entire left hemi-thorax (Hounsfield unit of -106 likely representing a fatty tumor). There were areas of increased attenuation within the mass suspicious for liposarcoma. Multiple CT guided biopsies showed fibrous and adipose tissue with thick vascular channels compatible with lipoma. The patient refused further investigation and treatment.
CONCLUSIONS: Intra-thoracic lipomas arise from mediastinum, diaphragm, bronchus, lung or thoracic wall. Deep-seated lipomas may not have sharp borders and can exhibit infiltrating behavior. Depending upon the life expectancy and general condition of the patient, management strategies include either radiological follow up or surgical excision, as liposarcoma needs to be excluded.
CLINICAL IMPLICATIONS: Although most intrathoracic lipomas are asymptomatic, symptoms are likely to depend on their site and size. They may occasionally lead to manifestations including coughing, dyspnea, or even death. In other circumstances, deep-seated lipomas, including intrathoracic lipomas, need to be carefully differentiated from the potential of malignancy such as liposarcoma or infiltrating tumor spread, because lipomatous malignancy commonly occurs at sites deeper than the subcutaneous region. However, little is known about the clinicopathological features of intrathoracic lipomas because there have been few reports on scattered cases in the literature.
DISCLOSURE: The following authors have nothing to disclose: Kshitiz Alekh, Arya Karki, Muhammad Ali, Muhammad Khan
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