Ann Thorac Surg 2007;83:1205
© 2007 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Atypical Presentation of Xanthoma Mimicking Thymoma
Taketomo Mizukami, MDa,*,
Masaki Hamamoto, MD, PhDa,
Kazumasa Orihashi, MD, PhDb,
Taijiro Sueda, MD, PhDb
a Department of Cardiovascular Surgery, Onomichi General Hospital, Hiroshima, Japan
b Department of Surgery, Graduate School of Biochemical Science, Hiroshima University, Hiroshima, Japan
* Address correspondence to Dr Mizukami, Department of Cardiovascular Surgery, Onomichi General Hospital, 7-19 Kohama-cho, Onomichi-city, Hiroshima, 722-8508 Japan (Email: qqen4nx9{at}violin.ocn.ne.jp).
A 56-year-old man was admitted to the hospital because of an abnormal mass on a chest roentgenogram. Computed tomography of the chest revealed an anterior mediastinal mass with a diameter of approximately 10 x 6.5 cm, and it was suspected to be thymoma rather than germ cell tumor or malignant lymphoma (Fig 1). The patient’s past history was the formation of an elastic hard mass in both Achilles tendons, resected as a lipoma approximately 20 years ago, and hyperlipidemia that was treated with medication. Results of the physical examination were negative except for arthrosteopedic hyperplasia. There were no typical symptoms suggesting myasthenia gravis. Biochemical and hematologic analyses did not reveal any abnormalities. Despite the fact that a percutaneous needle biopsy revealed an organized mural thrombus, we suspected the tumor to be thymoma and performed surgery to confirm the diagnosis.
Because there was no invasion of tissue around the tumor, we were able to remove it completely. The resected specimen was 95 x 92 x 55 mm in diameter and weighed 255 g (Fig 2). The cut surfaces were yellow-brown and had the consistency of soft cheese with a thick capsule. Histologic examination of the tumor revealed xanthoma cell proliferation, cholesterol cleft, and necrotic tissues (Fig 3; hematoxylin & eosin, x400). Based on these findings, the mediastinal tumor was diagnosed as xanthoma. Additional laboratory studies were carried out, and the serum cholesterol and triglyceride levels were 148 mg/dL and 102 mg/dL, respectively. Family history was negative for hyperlipoproteinemia. Arthrosteopedic hyperplasia was also suspected to be a xanthoma mass. The postoperative course was uneventful and the patient was discharged 2 weeks after surgery.
