Idiopathic anterior mediastinal lymphangioma in a young adult: a rare case report and review of management.

Introduction and importance: Mediastinal lymphangiomas are rare benign malformations, comprising less than 1% of adult mediastinal tumors. Idiopathic cases in the anterior mediastinum are exceptional in young adults and often mimic malignancies like lymphoma, posing significant diagnostic challenges. Case presentation: A 24-year-old male presented with chest pain and B-symptoms (fever, night sweats). Imaging revealed a 7.5 cm well-circumscribed anterior mediastinal mass. Biopsy confirmed idiopathic lymphangioma. The patient underwent robotic-assisted thoracoscopic resection. Intraoperative findings showed pericardial involvement and compression of the superior vena cava and pulmonary artery. Complete excision was achieved without complications. Symptoms resolved immediately, and 3-month follow-up showed no recurrence. Clinical discussion: Differentiation from the "four T's" (thymoma, teratoma, thyroid, lymphoma) requires histopathology. Although benign, these lesions compress vital structures. Robotic surgery offers superior visualization for precise dissection around major vessels compared to open thoracotomy, facilitating complete resection, critical to preventing recurrence (10-50% risk if incomplete). Conclusion: Robotic-assisted surgery is a safe short-term option for resecting rare idiopathic anterior mediastinal lymphangiomas. Early biopsy and complete excision aid in excluding malignancy and lowering recurrence risk, with longer-term follow-up essential.