Shaza Mortada¹*, Melissa Abou Khalil², Racha Abdallah³, Mazen Basbous¹, Perla Audi², Julie Ferzli² and Sarkis Ejbeh⁴

¹Department of General Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Lebanon
²Department of Radiology, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Lebanon
³Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
⁴Department of Cardiothoracic Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Lebanon

*Corresponding Author: Shaza Mortada, Department of General Surgery, Lebanese American University Medical Center-Rizk Hospital, Achrafieh, Lebanon.

Received: November 08, 2023; Published: January 02, 2024

Abstract

Background: Intrathoracic tumors of aggressive potential are rare, especially when talking about extra axial intrathoracic chordomas and lipomas. Usually, chordomas more commonly present as axial skeleton tumors and lipomas more commonly involve the extremities and trunk. Due to their low incidence, only a few cases of intrathoracic tumors are reported to be either chordomas or lipomas.

Cases Presentation: In this case series, 2 cases were reported as rare mediastinal tumors. The first case, we report a 78-year-old female patient presenting with a large right superior mediastinal mass resulting in dyspnea and cough, found to be a chordoma on histopathology after surgical excision. The second case, a 76-year-old male patient presenting with dyspnea and pleuritic chest pain, found to have a large left pleural-based fat-containing tumor on imaging resulting in contralateral mediastinal deviation to the right with left pulmonary parenchymal volume loss, which turned out to be a myxolipoma on histopathology following complete surgical resection. Finally, a literature review is performed to showcase the prevalence of these tumors, epidemiology, radiological and histopathological findings as well as the appropriate management.

Conclusions: Intrathoracic tumors with aggressive potential are rare, especially chordomas and lipomas. Total excision is the treatment of choice, aiding in both diagnosis and symptom relief.

Keywords: Chordomas; Myxolipoma; Liposarcoma; Sternotomy

References

1. Steven Tenny Matthew Varacallo. Chordoma (2023).
2. Karele EN and Paze AN. “Chordoma: To know means to recognize”. Biochimica et Biophysica Acta 5 (2022): 188796.
3. Wedekind MF., et al. “Chordoma: Current status, problems, and future directions”. Current Problems in Cancer4 (2021): 100771.
4. Rena O., et al. “Giant chordoma of the upper thoracic spine with mediastinal involvement: A surgical challenge”. Asian Spine Journal3 (2014): 353-356.
5. Suster S and Moran CA. “Chordomas of the mediastinum: Clinicopathologic, immunohistochemical, and ultrastructural study of six cases presenting as posterior mediastinal masses”. Human Pathology12 (1995): 1354-1362.
6. Murphy JM., et al. “CT and MRI appearances of a thoracic chordoma”. European Radiology9 (1998): 1677-1679.
7. Mahmoud A., et al. “Mediastinal extraosseous chordoma in a teenager: Diagnosis by ultrasound-guided percutaneous biopsy”. Radiology Case Reports10 (2022): 3859-3862.
8. A C J van Akkooi., et al. “Extra-axial chordoma”. The Journal of Bone and Joint Surgery (2008): 88-B (9): 1232-1234.
9. Selvaraj A and Wood AJ. “Superior mediastinal chordoma presenting as a bilobed paravertebral mass”. European Journal of Cardio-Thoracic Surgery 2 (2003): 248-250.
10. Delgado R., et al. “Thoracic chordoma”. Arquivos de Neuro-psiquiatria2B (2008): 405-407.
11. Ulici V and Hart J. “Chordoma: A review and differential diagnosis”. Archives of Pathology and Laboratory Medicine (1976)3 (2022): 386-395.
12. Creytens D. “A contemporary review of myxoid adipocytic tumors”. Seminars in Diagnostic Pathology2 (2019): 129-141.
13. Daniel Bulyashki., et al. “Pulmonary lipoma in an atypical location of the pulmonary fissure, extirpated by uniportal VATS – case report and review of literature”. European Medical Journal. Respiratory. (2020).
14. Sakellaridis T., et al. “Subpleural lipoma: Management of a rare intrathoracic tumor”. International Journal of Surgery Case Reports 5 (2013): 463-465.
15. Iwasaki H., et al. “Extensive lipoma-like changes of myxoid liposarcoma: Morphologic, immunohistochemical, and molecular cytogenetic analyses”. Virchows Arch4 (2015): 453-464.
16. MUNK PL., et al. “Lipoma and liposarcoma: Evaluation using CT and MR imaging”. American Journal of Roentgenology (1976) 2 (1997): 589-594.
17. Oster LH., et al. “Large lipomas in the deep palmar space”. The Journal of Hand Surgery (American ed.).4 (1989): 700-704.
18. Rodriguez JA., et al. “A rare cause of cough: Tracheobronchial myxoid spindle cell lipoma”. Case reports in Pulmonology 2020 (2020): 9727281-9727284.
19. Schulberg SP., et al. “Intrathoracic myxoid spindle cell lipoma: A rare presentation of a myxoid neoplasm”. The Annals of Thoracic Surgery5 (2020): e343-e345.
20. Wei S., et al. “Soft tissue tumor immunohistochemistry update: Illustrative examples of diagnostic pearls to avoid pitfalls”. Archives of Pathology and Laboratory Medicine (1976)8 (2017): 1072-1091.
21. TAKI S., et al. “Posterior mediastinal chordoma: MR imaging findings”. American Journal of Roentgenology (1976) 1 (1996): 26-27.

Citation

Citation: Shaza Mortada., et al. “Rare Intra-Thoracic Tumors with Aggressive Potential: Case Series and Literature Review". Acta Scientific Clinical Case Reports 5.2 (2024): 03-08.

Copyright

Copyright: © 2024 Shaza Mortada., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.