A case of adenocarcinoma of the thymus

A case of adenocarcinoma of the thymus is reported in this paper. To the best of our knowledge, this is the first case of thymic adenocarcinoma in the world literature. A 51-year-old female was admitted to our hospital because of hyperthyroidism and anterior mediastinal tumor. After control of hyperthyroidism, thoracotomy was performed and the tumor was located in the right lobe of the thymus macroscopically. The tumor was extirpated and the specimen was revealed to be multiple thymic cyst with papillo-tubular adenocarcinoma proliferating in one of the cysts. The variability of the lining cells i.e. squamous, cuboidal, columnar, and transitional cell, suggest that the thymic cyst is of congenital origin and the adenacarcinoma is originated from multipotential lining cells of the cyst. She has no evidence of recurrence for 14 years postoperatively, therefore there is almost no possibility of metastasis from other organ to the anterior mediastinum.     

Pulmonary pleomorphic carcinoma; report of a case

We report a case of a 64-year-old man with pleomorphic carcinoma of the lung and thymic cyst. He was admitted to our hospital because of an abnormal shadow observed on chest X-ray. Computed tomography (CT) showed a mass lesion located in the right upper lobe and a non-invasive anterior mediastinal tumor adjacent to the left brachiocepharic vein. On enhanced CT, the lung mass showed central low-attenuation areas with a substantial enhancement in the periphery. Preoperative transbronchial blushing cytology of the mass revealed adenocarcinoma. With a diagnosis of primary lung cancer (cT3N0M0) and mediastinal tumor, an operation was performed through a median sternotomy. The mediastinal tumor was excised and a right upper lobectomy and were also accomplished, because the lung tumor did not show adhesion or pleural invasion. Histopathologic examination of the resected specimen revealed that the lung tumor composed of a mixture of spindle and giant cell features and contained a component of adenocarcinoma and squamous cell carcinoma. This finding yielded a pathological diagnosis of pleomorphic carcinoma (pT2N0M0). The mediastinal tumor was diagnosed as thymic cyst. The postoperative course was uneventful, and he is currently well 6 months after surgery.     

Adenocarcinoma of the thymus: report of two cases,including a previously undescribed mucinous subtype

We report two cases of primary thymic adenocarcinoma, a very uncommon neoplasm with limited information in the literature. Both patients were men (age 15 and 39 years). The first case was a mucinous carcinoma, a subtype of adenocarcinoma not previously recognized in the thymus. It comprised islands and strips of mucin-rich tumor cells floating in large pools of extracellular mucin. There was transition of carcinomatous epithelium to the attenuated epithelium of a thymic cyst. Immunostaining for high molecular weight cytokeratin furthermore highlighted in one area negatively stained tumor islands wrapped by positively stained residual thymic medullary epithelium, suggesting in situ origin of the carcinoma from the thymic epithelium. The second case was a papillary carcinoma with high nuclear grade and many psammoma bodies. It showed strong immunoreactivity for CD5 and did not stain for CA-125 as well as thyroid, pulmonary, and mesothelial markers. The findings in this study therefore broaden the morphologic spectrum of thymic adenocarcinomas to include a mucinous subtype. Review of the literature indicates that thymic adenocarcinomas usually arise from thymic cyst or type A thymoma, and the clinical outcome is variable.     

Papillary adenocarcinoma developed in a thymic cyst

In this report, we describe a case of a thymic carcinoma that developed in a thymic cyst, which was resected by video-assisted thoracic surgery (VATS). Chest radiography of a 68-year-old Japanese woman revealed an abnormal shadow. She was asymptomatic with normal physical examination findings. Chest computed tomography demonstrated a well-confined cystic mass that measured 4 cm in diameter occupying the anterior mediastinum. Based on these findings, a thymic cyst was suspected. It was completely resected by VATS. The excised cyst was multiloculated with a partially thick wall. Microscopic examination revealed that the nodular excrescence of the wall to be limited to papillary adenocarcinoma and the cyst wall to be lined by cuboidal cells. On the basis of this diagnosis, we performed multidrug adjuvant chemotherapy. The patient was alive without any sign of recurrence 15 months after the operation.     

Multilocular Mediastinal Cyst with Rim Calcification: Report of a Case

We report a case of a multilocular anterior mediastinal cyst with rim calcification and severe adhesion to the adjacent organs. We excised the cyst completely, with resection of the left phrenic nerve, pericardium, and left lung because of the severe adhesion. Histological examination revealed that the multilocular cystic walls were composed of fibrous connective tissue and calcifications, but the lining epithelial cells were absent because of dystrophic calcification resulting from chronic inflammation. On the basis of the location and pathological findings, we diagnosed a multilocular mediastinal cystic tumor; most likely a multilocular thymic cyst. It is important to distinguish a multilocular thymic cyst from a unilocular thymic cyst because a multilocular thymic cyst may recur postoperatively and coexist with a thymic epithelial tumor. Dense adhesion to the surrounding mediastinal structures may make removal difficult, especially if there is rim calcification.     

Resected case of thymic cyst with primary lung cancer

Thymic cyst is a rare and benign tumor of mediastinal tumor. A 77-year-old male was pointed out the tumor shadow on Chest X-ray film and diagnosed lung cancer. On admission some examination was performed and revealed mediastinal tumor accidentally. Primary lung cancer was completely resected and mediastinal tumor was extirpated. Pathological examination revealed lung cancer (poorly differentiated squamous cell carcinoma) and thymic cyst. Many methods of examination were tried for diagnosis of thymic cyst, but couldn't diagnose exactly before its resection. Some of the patients with thymic cyst was reported to develop SVC syndrome or change to malignant tumor. Therefore we think complete resection is the best treatment.     

Papillary adenocarcinoma in a thymic cyst: a pitfall of thoracoscopic excision

Carcinoma arising in a thymic cyst is very rare. We performed thoracoscopic subtotal resection of an assumed benign cyst. The patient had a reoperation when the diagnosis of papillary adenocarcinoma was established. Complete resection and pleural thermochemotherapy were performed. The patient died 26 months later from systemic metastases. Caution must be exercised when managing nontypical thymic cysts.     

Rapid enlargement of a mediastinal mass: thymoma hemorrhage into a thymic cyst

A 52-year-old man was admitted to Matsudo City Hospital because of an anterior mediastinal mass. One month prior, when he suddenly suffered chest pain, computed tomography (CT) showed a 4 x 3 cm mass in the chest. On admission, the symptom disappeared. However, chest CT revealed rapid enlargement of the mass to 10 x 6 cm. Based on the CT findings, we suspected a tumor. Therefore, we performed a thymothymectomy. The mass, measuring 12 x 8 x 6 cm, contained a solid tumor and a fl uid-filled cyst. Pathology showed a thymoma and a multilocular thymic cyst. We speculated that hemorrhage from the thymoma spread into the multilocular thymic cyst and enlarged the mass.     

Thymoma with intracystic dissemination arising in a unilocular thymic cyst

A 33-year-old asymptomatic woman was referred to our hospital for evaluation of an abnormal shadow on a chest radiograph. A chest-computed tomogram revealed a cystic, partially solid tumor in the right inferior mediastinum. Following an initial diagnosis of cystic teratoma, surgery was performed. The tumor, a well-encapsulated, thin-walled cyst located within the right inferior lobe of the thymus, was extirpated by partial resection of the thymus. The cut surface revealed a unilocular cyst containing multiple grayish-white tumors on the inner cyst walls. Some tumors detached from the wall owing to loose connections. Microscopic findings revealed that the cyst was lined with squamous epithelium. The tumor on the cyst wall was diagnosed to be a type B1 thymoma. Based on these findings, we diagnosed this case as a thymoma originating from the wall of a thymic cyst, accompanied by intracystic dissemination from the tumor.     

Mucinous adenocarcinomas of the thymus: report of 2 cases and review of the literature

BACKGROUND: Most adenocarcinomas of the mediastinum are metastatic lesions. Primary thymic adenocarcinomas are extremely rare neoplasms. We could find only 12 cases reported in the literature; of these 12, only 4 were of the mucinous subtype. DESIGN: We report 2 additional cases of the mucinous subtype, including a previously unreported mucinous variant with numerous psammoma bodies. RESULTS: The first case in a 61-year-old woman resembled a mucinous (colloid) carcinoma of other organs such as the breast and colon. It consisted of islands and strips of tumor cells floating in large pools of extracellular mucin. A unique feature of this tumor was the presence of numerous psammoma bodies. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) 7 and negative for CD5. The second case in an 82-year-old woman was a mucinous adenocarcinoma arising from a thymic cyst with areas of transition from benign to dysplastic epithelium. The tumor cells formed dilated glands, cords, and small nests that infiltrated the thymic cyst wall and exhibited evidence of mucin production. Immunohistochemically, the tumor cells were positive for CK 7 and focally positive for both CD5 and CK 5/6. CONCLUSIONS: Mucinous adenocarcinoma, with or without, psammoma bodies, may be of primary thymic origin and should be considered in the differential diagnosis of malignant mediastinal tumors. These 2 cases provide further documentation of the rare occurrence of primary mucinous adenocarcinomas of the thymic gland.     

Basaloid carcinoma originated from the wall of thymic cyst presenting as pericardial and thoracic effusion; report of a case

We report a case of basaloid carcinoma originated from the wall of a large thymic cyst, which is a very rare subtype of thymic carcinoma. A 60-year-old man admitted at our hospital due to dyspnea with pericardial and left thoracic effusion on chest X-ray. A computed tomography and a magnetic resonance imaging demonstrated a large anterior mediastinal cyst and a small mass lesion on the part of the wall. We performed as possible as resection of the thymic cyst and the tumor with median sternotomy. The pathological diagnosis was a thymic basaloid carcinoma originated from the wall of a thymic cyst, which classified into a low-grade histology in thymic carcinoma. He has been well with no evidence of recurrence for three years since operation followed by a post-operative radiation therapy (total 57 Gy) to the residual tumor and mediastinum.     

Invasive thymoma with thymic cyst; report of a case

A 27-year-old woman was pointed out an abnormal shadow on chest X-ray in 1999. Because of the enlargement of the chest abnormal shadow, she was admitted to our hospital in 2000. Chest computed tomography (CT) revealed anterior mediastinal solid mass with cystic lesion. A thymoma was suspected. The tumor was removed in June 2000, through a longitudinal incision of the sternum. There was a severe adhesion between the tumor and the right brachiocephalic vein. Histological examination revealed a thymoma with thymic cyst. The thymoma had a capsular invasion (stage II). There were few reports for cases of thymoma with thymic cyst.     

Primary thymic adenocarcinoma coexisting with type AB thymoma: a rare case with long-term survival

Thymic carcinoma is a rare tumor. The most common histological subtype is squamous cell carcinoma, and only a few cases of thymic adenocarcinoma have been reported. A case of papillary adenocarcinoma of thymic origin that coexisted with type AB thymoma as a separate nodule is presented herein. The patient was found to have an abnormal mediastinal shadow on chest X-ray. A computed tomography scan revealed a round, 6.5-cm-diameter mass in the right anterior mediastinum. The preoperative diagnosis was thymoma, and thymothymectomy was performed. On pathological examination, two tumors, which were diagnosed as papillary adenocarcinoma and type AB thymoma, respectively, were present in the thymus without any connection with each other. The patient has been alive without any signs of recurrence for 11 years after surgery. We diagnosed the adenocarcinoma in this case was a primary thymic carcinoma.     

Long-term survival with carcinoma arising from a congenital choledochal cyst

We report a case of 11-year survival with carcinoma arising from a congenital choledochal cyst. A 34-year-old Japanese woman was admitted due to epigastric discomfort. Ultrasonography revealed a choledochal cyst involving a polypoid tumor. Endoscopic retrograde cholangiopancreatography revealed pancreaticobiliary maljunction in which the main pancreatic duct joined the dilated common bile duct 2 cm above the papilla of Vater. A choledochal cyst containing a polypoid tumor was resected with the regional lymph nodes. Grossly, a 2×2-cm papillary tumor was noted in the posterior wall of the choledochal cyst. Microscopically, the tumor was well-differentiated tubular adenocarcinoma invading the mucosa and fibromuscular layer. Neither anticancer chemotherapy nor radiotherapy was performed. The patient recovered uneventfully after the operation and has been well for 11 years without evidence of recurrent cancer. The good results in this patient may have been due to the early stage of the cancer.     

Mediastinal cyst with rim calcification

A 58-year-old man who had been undergoing treatment for chronic pericarditis for 15 months was found to have a calcified mediastinal mass shadow on a chest X-ray and was referred to us for further study and treatment. Chest computed tomography and magnetic resonance imaging showed an anterior mediastinal multilocular tumor with rim calcification. Tumor markers were within normal limits. The patient was preoperatively diagnosed as having a calcified mediastinal cyst, and median sternotomy was performed to remove the cystic tumor and the surrounding thymic tissues. Histological examination revealed that the cyst wall consisted of dense fibrous tissue and calcification without epithelial cell lining on the inner surface. Thymic tissue was present around the cyst wall. Although we suspected a thymic cyst from the intraoperative findings, the final diagnosis was made as mediastinal cyst with rim calcification. We herein present a rare case of mediastinal cyst with rim calcification.     

Video-assisted mediastinoscopic resection of a thymic cyst by sternum lifting.

We performed mediastinoscopic surgery on two patients with a thymic cyst using a new instrument by sternum-lifting with tape. The merits of this technique are that a resection of the thymus and cyst can be achieved without a midline sternotomy, and under bilateral ventilation, and in cases with pleural adhesion. This technique can be applicable to most benign thymic lesions including thymectomy for myasthenia gravis and to selected cases with a malignant thymic tumor.     

Mediastinoscopic resection combined with a sternum lift technique in a case of thymic cyst]

We report on a case of thymic cyst which was successfully treated with mediastinoscopic resection combined with a sternum lift technique. A 62-year-old man was admitted to our hospital with a thymic cyst, which was causing chest discomfort and was increasing in size. The tumor was located above the pulmonary artery in the anterior mediastinum. He underwent mediastinoscopic resection while lifting the inferior portion of the sternum with a Laparolift. The cyst was resected sharply and bluntly with the Harmonic Scalpel without rupture. The patient was discharged on the 6th postoperative day in a good condition. Mediastinoscopic resection of a thymic cyst through a xiphoid approach is a useful surgical approach because of the absence of postoperative pain and because it allows early discharge from the hospital.     

Mucinous adenocarcinoma of the thymus: report of a case

Thymic mucinous adenocarcinoma is a very rare neoplasm. This tumor has a poor prognosis and its treatment is not established. In addition, the existence of KRAS mutations of thymic mucinous adenocarcinoma is still unknown, despite these mutations are common in lung mucinous adenocarcinoma. We present the case of a 79-year-old woman with primary thymic mucinous adenocarcinoma. Therefore, we reviewed clinico-pathological features of thymic mucinous adenocarcinoma in details and analyzed KRAS gene mutations of the present case.     

Thymoma arising in a thymic cyst.

We present a case of thymoma arising in the wall of the thymic cyst. A 77-year-old asymptomatic woman demonstrated an approximately 3.5 cm sized cystic mass in the left anterior mediastinum in the CT scan. The tumor was extirpated by a total thymectomy. Histologically, the cyst wall was lined by low cuboidal cells, but a markedly thickened wall was observed at the upper site of the mass, which was found to be thymoma. These findings may suggest that the thymoma originated from the wall of the thymic cyst.