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 : رتخدرامیب 6 هلاس 14 هفرس لابندب زونایسو هفرس لیلدب هک تسا یمرگولیک زا هک 5 ناکدوک هاگنامرد هب ییاپرس هدش عورش هتسپ ندروخ لابندب لبق زور تسا هدرک هعجارم هب کشاب اذلدشیم هدینش هنیس تسار تمسرد بلق تانابرض هنیاعمرد دش تساوخرد یدراکورتسکد CXR
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 o Poor weight gain for 2 years o Night sweats o Mild epigastric pain , occurs immediately after meal o Constipation o Lack of appetite o 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 تسار تمس هب بلق تفیشاب پچ فرطرد هنیس سکع رد : یامن white lung تسار رلبیهاراپ کوکشم ترودکو پچ مگارفاید یمه یگدش سوکعمو مین 160 160 نکسا یت یس رد : و یبرچ یواح گرزب دیلوس نژورته هدوت 130 X X تسار هب بلق تفیش اب پچ هنیس یرانا داتسا یقارتفا صیخشت :1 ) اموتسلبب یرانوملوپ 2 ) اموتسلببورون 3) PNET یویر یاموکراس 5 ) یباهتلا روموت کیتسلببوربیفویم 6 ) کیتامگارفاید ینره ) 4 رخآ صیخشترد عیسو
دهاجرتکد مناخ : ) یتیسوفنل ریغ یمکول 2 GERM CELL TUMOR - Teratoma( 1 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 of 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 مناخ 21 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
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