{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:38:11Z","timestamp":1759970291156,"version":"build-2065373602"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,12]],"date-time":"2025-01-12T00:00:00Z","timestamp":1736640000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca","award":["CIF 49997510"],"award-info":[{"award-number":["CIF 49997510"]}]},{"name":"Asociatia Thoracare, Romania","award":["CIF 49997510"],"award-info":[{"award-number":["CIF 49997510"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Mediastinal tumors, regardless of their location, can grow to significant sizes, causing compression-related symptoms. The term \u201cgiant\u201d mediastinal tumor is inconsistently defined in the literature. This study presents a new clinical\u2013radiological classification (CRC) for mediastinal tumors and evaluates its applicability through a systematic review and a detailed case analysis of a giant thymolipoma. Methods: A systematic review of the literature from the past decade was conducted using PubMed to identify relevant studies on \u201cgiant\u201d mediastinal tumors. The inclusion criteria focused on studies involving adult patients with documented tumor size and symptomatology. The review identified 22 studies, with most anterior mediastinal tumors classified as CRC 3 (81%), indicating \u201cgiant\u201d tumors. Thymolipomas accounted for 58% of these cases. Tumor volume and weight correlated with symptom severity, guiding surgical approaches. The proposed CRC effectively standardized the definition of \u201cgiant\u201d tumors. The case analysis of a 6.84 kg thymolipoma highlighted the challenges of surgical resection, confirming the importance of tailored surgical strategies for large tumors. Results: The review of the literature revealed a significant variation in tumor size and weight across the different mediastinal compartments. Symptomatic tumors (CRC stage 3) located in the anterior mediastinum exhibited the largest volumes and weights, with an average volume of 4949 mL (range: 2013\u20138840 mL) and an average weight of 4137 g (range: 1575\u20137500 g). In comparison, tumors in the posterior mediastinum ranked second in terms of size, with an average volume of 2128 mL (range: 1040\u20135460 mL) and an average weight of 2489 g (range: 1009\u20136000 g). Tumors located in the middle mediastinum were considerably smaller, with an average volume of 536 mL (range: 21\u20131092 mL). Among the largest symptomatic tumors in the anterior mediastinum, thymolipomas were the most frequently observed histologic type. These findings underscore a clear size gradient across the mediastinal compartments, with the anterior mediastinum harboring the largest symptomatic tumors, followed by the posterior mediastinum, and the smallest tumors in the middle mediastinum. Conclusions: The novelty of the study lies mainly in the new clinical\u2013radiological classification (CRC) of mediastinal tumors. This classification integrates clinical presentation and cross-sectional imaging findings, offering a standardized framework for tumor reporting. In addition, it provides a precise definition of \u201cgiant\u201d mediastinal tumors. The findings emphasize the need for early surgical intervention to prevent severe symptoms and complications. This study also showcases the largest enbloc-resected thymolipoma reported in the recent literature, supporting the utility of the proposed classification in clinical practice.<\/jats:p>","DOI":"10.3390\/diagnostics15020159","type":"journal-article","created":{"date-parts":[[2025,1,13]],"date-time":"2025-01-13T04:01:52Z","timestamp":1736740912000},"page":"159","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Defining \u201cGiant\u201d Mediastinal Tumors: Proposal of a New Clinical\u2013Radiological Classification and Case Report"],"prefix":"10.3390","volume":"15","author":[{"given":"Emanuel","family":"Palade","sequence":"first","affiliation":[{"name":"Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania"},{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George Bucur","family":"Delaca","sequence":"additional","affiliation":[{"name":"Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania"},{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3577-8341","authenticated-orcid":false,"given":"Ioana-Medeea","family":"Titu","sequence":"additional","affiliation":[{"name":"Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania"},{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergiu Adrian","family":"Ciulic","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Clinic, Leon Daniello Clinical Hospital of Pneumology, 400371 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7352-9584","authenticated-orcid":false,"given":"Gabriel","family":"Cismaru","sequence":"additional","affiliation":[{"name":"4th Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania"},{"name":"Cardiac Rehabilitation Clinic, Rehabilitation Hospital, 400347 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5574-3969","authenticated-orcid":false,"given":"Adrian","family":"Stef","sequence":"additional","affiliation":[{"name":"Department of Surgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania"},{"name":"Niculae Stancioiu Heart Institute, Calea Motilor 19-21, 400001 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8492-5777","authenticated-orcid":false,"given":"Simona","family":"Manole","sequence":"additional","affiliation":[{"name":"Niculae Stancioiu Heart Institute, Calea Motilor 19-21, 400001 Cluj-Napoca, Romania"},{"name":"Department of Radiology and Medical Imaging, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1148\/rg.2017160095","article-title":"ITMIG Classification of Mediastinal Compartments and Multidisciplinary Approach to Mediastinal Masses","volume":"37","author":"Carter","year":"2017","journal-title":"Radiographics"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.21037\/med-23-23","article-title":"Histopathological features of giant mediastinal tumors-a literature review","volume":"7","author":"Brcic","year":"2023","journal-title":"Mediastinum"},{"key":"ref_3","first-page":"bcr0520102984","article-title":"Huge mediastinal mass with minimal symptoms: Thymolipoma","volume":"2011","author":"Ganesh","year":"2011","journal-title":"BMJ Case Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1055\/s-2006-923940","article-title":"Thymolipoma of the anterior mediastinum: Videothoracoscopic removal using a bilateral approach","volume":"54","author":"Ferrari","year":"2006","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1177\/0218492315596465","article-title":"Huge thymolipoma compressing the heart in a 20-year-old patient","volume":"25","author":"Oliemy","year":"2017","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"200309","DOI":"10.1183\/16000617.0309-2020","article-title":"Mediastinal tumours and pseudo-tumours: A comprehensive review with emphasis on multidisciplinary approach","volume":"30","author":"Ghigna","year":"2021","journal-title":"Eur. Respir. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"670","DOI":"10.18295\/squmj.4.2021.052","article-title":"Giant Intrathoracic Lipoma","volume":"21","author":"Siddiqi","year":"2021","journal-title":"Sultan Qaboos Univ. Med. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"102859","DOI":"10.1016\/j.amsu.2021.102859","article-title":"Giant thymoma presenting as a large bilateral intrathoracic mass: A case report and a comparison between median sternotomy and hemiclamshell approach","volume":"70","author":"Daoud","year":"2021","journal-title":"Ann. Med. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.12998\/wjcc.v11.i5.1137","article-title":"Surgical resection of a giant thymolipoma causing respiratory failure: A case report","volume":"11","author":"Gong","year":"2023","journal-title":"World J. Clin. Cases"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"24","DOI":"10.21037\/med-22-49","article-title":"Giant middle mediastinal lesions: When tumor size correlates with mesenchymal origin-a retrospective single-center analysis","volume":"7","author":"Collaud","year":"2023","journal-title":"Mediastinum"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1177\/0218492313504576","article-title":"Thymoma type B1 arising in a giant supradiaphragmatic thymolipoma","volume":"22","author":"Kaplan","year":"2014","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1111\/1759-7714.12231","article-title":"Giant mediastinal thymolipoma in a patient with Gardner\u2019s syndrome","volume":"6","author":"Pei","year":"2015","journal-title":"Thorac. Cancer"},{"key":"ref_13","first-page":"3469395","article-title":"Progressive Dyspnea in a 40-Year-Old Man Caused by Giant Mediastinal Thymolipoma","volume":"2016","author":"Vaziri","year":"2016","journal-title":"Case Rep. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1177\/0218492315599689","article-title":"Giant thymolipoma: A rare case presentation","volume":"25","author":"Goswami","year":"2017","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.4103\/jfmpc.jfmpc_228_17","article-title":"Giant thymolipoma of mediastinum and neck\u2014initially misdiagnosed as liposarcoma by core needle biopsy","volume":"7","author":"Aghajanzadeh","year":"2018","journal-title":"J. Family Med. Prim. Care"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e12873","DOI":"10.1097\/MD.0000000000012873","article-title":"Giant primary liposarcoma of the anterior mediastinum: A case report","volume":"97","author":"Yang","year":"2018","journal-title":"Medicine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e11806","DOI":"10.1097\/MD.0000000000011806","article-title":"Successful removal of giant mediastinal lipoma and liposarcoma involving both chest cavities: Two case reports","volume":"97","author":"Chen","year":"2018","journal-title":"Medicine"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e117","DOI":"10.1016\/j.athoracsur.2018.03.018","article-title":"Giant Mediastinal Liposarcoma: A Rare Yet Distinct Clinical Entity","volume":"106","author":"Nguyen","year":"2018","journal-title":"Ann. Thorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1007\/s12055-018-0700-9","article-title":"A giant mediastinal thymolipoma: A rare pathological entity","volume":"35","author":"Sharma","year":"2019","journal-title":"Indian J. Thorac. Cardiovasc. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1186\/s13019-022-01954-z","article-title":"Successful removal of the largest reported intrathoracic lipoma with bilateral extension: A case report","volume":"17","author":"Rahman","year":"2022","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1177\/10668969221137523","article-title":"Two Thymomas of Different Histological Subtypes Arising in a Giant Thymolipoma: Case Report and Review of the Literature","volume":"31","author":"Daniel","year":"2023","journal-title":"Int. J. Surg. Pathol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e8530","DOI":"10.1002\/ccr3.8530","article-title":"A rare case of giant mediastinal thymolipoma in an 18-year man","volume":"12","author":"Soleimani","year":"2024","journal-title":"Clin. Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"549","DOI":"10.12659\/AJCR.903680","article-title":"Mediastinal Solitary Fibrous Tumor Diagnosed by Endobronchial Ultrasound-Directed Biopsy","volume":"18","author":"Webb","year":"2017","journal-title":"Am. J. Case Rep."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1177\/0218492315589201","article-title":"Giant primary mediastinal liposarcoma: A rare cause of atrial flutter","volume":"23","year":"2015","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s12055-018-0703-6","article-title":"Giant bilateral posterior mediastinal liposarcoma excision","volume":"35","author":"Kandakure","year":"2019","journal-title":"Indian. J. Thorac. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3527","DOI":"10.21873\/invivo.12194","article-title":"Giant Intrathoracic Schwannoma: A Case Report","volume":"34","author":"Savu","year":"2020","journal-title":"In Vivo"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1186\/s13256-023-04121-7","article-title":"Mediastinal liposarcoma: A case report and review of the literature","volume":"17","author":"Ataya","year":"2023","journal-title":"J. Med. Case Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1186\/s13019-024-02605-1","article-title":"Huge mediastinal ancient schwannoma causing acute respiratory failure: A case report","volume":"19","author":"Huang","year":"2024","journal-title":"J. Cardiothorac. Surg."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/2\/159\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:27:14Z","timestamp":1759919234000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/2\/159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,12]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["diagnostics15020159"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15020159","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,1,12]]}}}