An unusual approach for a cervical mass: sternotomy for the treatment of a giant cervico-thoracic lipoma Sternotomy for the treatment of a giant cervico-thoracic lipoma

Main Article Content

Gerardo Petruzzi
Lucrezia Trozzi
Silvia Moretto
Armando De Virgilio
Enrico Melis
Filippo Tommaso Gallina
Barbara Pichi
Flaminia Campo
Francesco Facciolo
Raul Pellini


Sternotomy, Lipoma, Combined approach, Liposarcoma, Mediastinum.


Background and aim: Lipoma is a benign mesenchymal tumor. It is a very common tumor and in 13% of cases occurs in head and neck. Giant lipomas are extraordinary and cervical involvement with mediastinal extension is an exceedingly rare presentation. Only a few cases of thoracic extension are reported in literature.

Methods: We describe the case of a 62-years-old man with a giant cervico-mediastinic lipoma which required a combined approach through cervicotomy and sternotomy to ensure surgical radicality. Differential diagnoses could be thymolipoma, liposarcoma or familiar lipomatosis.

Results: The mass was removed en-bloc with thymus and locoregional lymph nodes. The patient recovered uneventfully.

Conclusions: The aim of this report is to discuss potential pitfalls of differential diagnosis and implementation of the therapeutic treatment. Focus on the relevance of performing fluorescence in situ hybridization (FISH) for MDM2 amplification is reported, a necessary technique for the differential diagnosis.



Download data is not yet available.
Abstract 273 | PDF Downloads 133


1. Abd El-Monem, M. H., Gaafar, A. H., Magdy, E. A. Lipomas of the head and neck: presentation variability and diagnostic work-up. The Journal of laryngology and otology, 2006: 120(1), 47.

2. Som, P. M., Scherl, M. P., Rao, V. M., et al. Rare presentations of ordinary lipomas of the head and neck: a review. American journal of neuroradiology, 1986: 7(4), 657-664.

3. Medina, C. R., Schneider, S., Mitra, A., et al. Giant submental lipoma: Case report and review of the literature. Canadian Journal of Plastic Surgery, 2007: 15(4), 219-222.

4. Sharma, B. K., Khanna, S. K., Bharati, M., et al. Anterior neck lipoma with anterior mediastinal extention–a rare case report. Kathmandu University Medical Journal, 2013: 11(1), 88-90.

5. Eryılmaz, Mehmet Akif, et al. "Cervico-thoracic giant lipoma in a child." Turkish Archives of Otorhinolaryngology 54.2 (2016): 82.

6. Venkatramani, H., Ramani, V., & Sabapathy, S. R. Giant Cervicothoracic Lipoma as a Manifestation of Human Immunodeficiency Virus–Associated Lipodystrophy. Plastic and reconstructive surgery, 2010: 126(6), 316e-318e.

7. Cutilli, T., et al. "Giant cervico-mediastinal lipoma." A clinical case. Minerva Stomatol. 48 (1999).

8. Ganesh, Y., Yadala, V., Nalini, Y., et al. Huge mediastinal mass with minimal symptoms: thymolipoma. Case Reports, 2011: bcr0520102984.

9. Choi HJ, Kim S. Symptomatic Giant Lipoma Under the Latissimus Muscle. Journal of Craniofacial Surgery, 2016: October 2016 - Volume 27 - Issue 7 - p e599-e600. doi: 10.1097/SCS.0000000000002910

10. Pellini R., Ruggieri M., Pichi B., A case of cervical metastases from temporal bone carcinoid. Head and Neck, 2005: 27(7), pp. 644-647

11. Daralioti T, Petruzzi G., Zocchi J. et al. Myxoid Liposarcoma Metastasizing to the Parotid Gland, Journal of Craniofacial Surgery: October 2020 - Volume 31 - Issue 7 doi: 10.1097/SCS.0000000000006613

12. Dei Tos, A. P. Liposarcoma: new entities and evolving concepts. Annals of diagnostic pathology, 2000: 4(4), 252-266.

13. G.Mercante, C. Marchese, D. Giannarelli et al. Oncological outcome and prognostic factors in malignant parotid tumours, Journal of Cranio-Maxillofacial Surgery, Vol 42, Issue 1,
14. 2014, Pag 59-65, ISSN 1010-5182,

15. Tadisina, K. K., Mlynek, K. S., Hwang, L. K., et al. Syndromic lipomatosis of the head and neck: a review of the literature. Aesthetic Plastic Surgery, 2015: 39(3), 440-448.

16. Singh, K et al. "Facial infiltrating lipomatosis: a case report and review of literature." International journal of surgery case reports 2.7 2011: 201-205.

17. Tan, T. W., Kim, D. S., Wallach, M. T., et al. Thoracoscopic resection of a giant thymolipoma in a 4-year-old girl. Journal of Laparoendoscopic & Advanced Surgical Techniques, 2008: 18(6), 903-905

18. Rieker, Ralf J., et al. "Thymolipoma. A report of nine cases, with emphasis on its association with myasthenia gravis." Surgery today 40.2 (2010): 132-136

19. Woo S., Hong KY, Chang H. Giant ventral lipoma of the neck. Journal of Craniofacial Surgery: July-August 2020 - Volume 31 - Issue 5 - p e501-e503. doi: 10.1097/SCS.000000000000657

20. Kammerer-Jacquet, S. F., Thierry, S., Cabillic, F., et al. Differential diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma and dedifferentiated liposarcoma: utility of p16 in combination with MDM2 and CDK4 immunohistochemistry. Human Pathology, 2017: 59, 34-40.

21. Zhang, H., Erickson-Johnson, M., Wang, X., et al. Molecular testing for lipomatous tumors: critical analysis and test recommendations based on the analysis of 405 extremity-based tumors. The American journal of surgical pathology, 2010: 34(9), 1304-1311.

22. Clay, M. R., Martinez, A. P., Weiss, S. W., et al. MDM2 amplification in problematic lipomatous tumors. The American journal of surgical pathology, 2015: 39(10), 1433-1439.

23. Patel, R. V., Evans, K., Sau, I., & Huddart, S. Paediatric giant cervicomediastinal thymolipoma. Case Reports, 2014: bcr2014203585.

24. Gupta A., Palkar A., Narwal P., et al. mediastinal lipoma as cause of dyspnea. Respiratory medicine Case Reports, 27 (2019) 100828

25. Julian OC, Lopez-Belio M, Dye WS, et al. The median sternal incision in intracardiac surgery with extracorporeal circulation: a general evaluation of its use in heart surgery. Surgery, 1957: 42:753–61

26. Dosio C, Brucoli M, Boffano P et al. Lipoma of the tongue: overview, clinical presentation and management of a case. Otorinolaringologia 2020 September;70(3):106-8 DOI: 10.23736/S0392-6621.20.02268-7

27. Abdul Ghafar M, Mohammad N, Nadarajan C et al. Unilateral facial numbness as a presenting feature of intraosseus lipoma of sphenoid bone. Otorinolaringologia 2017 September;67(3):96-8 DOI: 10.23736/S0392-6621.17.02118-X

Most read articles by the same author(s)