Thoracoscopic management of giant thymolipoma

Thymolipomas are rare benign thymic neoplasms that contribute 2 to 9% of thymic tumors. Surgical excision remains the primary treatment, with video-assisted thoracoscopic surgery (VATS) emerging as a valuable approach. Less than 50 cases of pediatric thymolipomas have been reported, with the youngest case documented at 6 months of age, and fewer than five pediatric cases have been managed using the thoracoscopy approach in the literature. This is India's first report in literature where giant thymolipomas have been excised by the thoracoscopic approach in the pediatric population. Herein, we present two pediatric patients with anterior mediastinal masses, each presenting with distinct clinical features undergoing successful thoracoscopic resections. In case 1, a 9-year-old male child was incidentally diagnosed with giant thymolipoma. Surgical excision was done through the right side by VATS approach and the residual mass through the left by VATS, resulting in an uneventful postoperative course with no recurrence upon 1-year follow-up. In case 2, a 5-year-old female previously diagnosed with giant thymolipoma presented with fatigability. Imaging revealed a massive thymolipoma occupying both hemithoraces. Careful dissection, preservation of vital structures, and successful vascular pedicle management ensured complete excision through a single left thoracic approach, leading to a smooth recovery and absence of mediastinal mass on follow-up X-ray. This case report highlights VATS as a safe and effective management for giant thymolipoma; though it is technically challenging, it is a feasible approach, contributing to improved patient outcomes.