Complete excision and panpleuropneumonectomy resulting in long-term survival for a teenager with invasive thymoma: Report of a case

An 18-year-old girl with invasive thymoma and pleural dissemination underwent a complete removal of the tumor with combined resection of the pericardium and a panpleuropneumonectomy of the left lung. At the time of writing, 70 months later, she was doing well under the classification of grade I performance status with no signs of recurrence. Thus, complete surgical removal of this tumor can prolong the survival time of patients with invasive thymoma and pleural dissemination.     

Spontaneous regression of an invasive thymoma

Although there are many reports of spontaneous regression of noninvasive thymoma, there are no reports of spontaneous regression of an invasive thymoma. Moreover, the mechanism of the spontaneous regression is still unknown. The present case concerns a 47-year-old man who presented with chest pain. Computed tomography (CT) showed a large anterior mediastinal mass with left pleural effusion that occluded the innominate vein. The tissue obtained by video-assisted thoracic surgery suggested a diagnosis of invasive thymic carcinoma. One month later CT showed prominent regression of the tumor, and the tumor was completely resected. On pathology, the diagnosis was thymoma type B3.     

The sarcomatous guise of cervical ectopic hamartomatous thymoma

BACKGROUND: Ectopic hamartomatous thymoma is a rare benign neoplasm occurring in the deep soft tissues adjacent to the sternoclavicular joint. Although clinical presentation and diagnostic imaging can be consistent with a malignant lesion such as a sarcoma, recognition of pathologic features can readily exclude such a diagnosis. However, this remains a challenge caused by their unusual histologic features and diverse composition. Recognition of this tumor is, however, important, because it follows a benign clinical course, and conservative surgical excision is the therapy of choice. METHODS: A literature review of all reports of ectopic hamartomatous thymoma was undertaken and compared with our indexed case. RESULTS: From this review, we identified 26 previous reports. Most patients were men, with a 4.5:1 predominance. There was a wide range of ages at presentation, from 26 to 79 years. All tumors were located in the lower neck, with the exception of one arising presternally. Treatment predominantly consisted of tumor resection, with no reported recurrences on follow-up. CONCLUSIONS: We conclude that ectopic hamartomatous thymoma is an extremely rare neoplasm usually presenting in the lower neck. Correct identification of this tumor is important, because it follows a benign course, and surgical excision is adequate therapy.     

恶性胸腺瘤的外科治疗进展

胸腺肿瘤在所有恶性疾病中占0．2～1．5％，是成人较常见的前纵隔肿瘤之一，大约占50％，其中恶性胸腺瘤约占纵隔肿瘤的8％～10％。目前主要通过WHO胸腺肿瘤组织学分型进行分类，临床上常用Masaoka分期。手术治疗是目前公认的治疗胸腺瘤，尤其是恶性胸腺瘤的主要方法之一。本文对国内外有关恶性胸腺瘤的治疗方法、手术方式及预后进行综述。     

Resected invasive thymoma with multiple endocrine neoplasia type 1

We report a rare case of multiple endocrine neoplasia (MEN) type 1 with thymoma. A 57-year-old woman with a chronic duodenal ulcer and hypoglycemia had been seen at a nearby clinic. Abdominal echogram revealed two nodules in the pancreas and she was referred to our hospital for evaluation. Her diagnosis was MEN type 1, gastrinoma and hyperparathyroidism with anterior mediastinal tumor. There were high calcium levels in the blood and urine. Gastrin was quite high. A chest X-ray revealed a retrosternal tumor. Computed tomography revealed an anterior mediastinal tumor without sign of invasion to the surrounding organs, and two small masses in the pancreas. Cervical echogram revealed a few masses in both sides behind the thyroid. From these findings, her preoperative diagnosis was MEN type 1 with thymic carcinoid or thymoma. We performed thymectomy and parathyroidectomy concomitantly. The mediastinal tumor was diagnosed as invasive thymoma. (Jpn J Thorac Cardiovasc Surg 2006; 54:171-173)     

Excision After Chemoradiotherapy of Invasive Thymoma Extending into the Right Atrium: Report of a Case

We report a case of invasive thymoma with intracardiac extension, resulting from the progression of intracaval growth, in a 56-year-old woman. Initially, the patient received two courses of chemotherapy, but the tumor showed only a modest response; however, subsequent radiotherapy reduced the tumor size further and the intracardiac lesion disappeared, making it possible to excise the tumor without cardiopulmonary bypass. Thus, when a thymoma does not respond well, we recommend radiotherapy as another treatment option, because its effects may allow for less invasive and more complete tumor excision.     

Encapsulated thymoma metastasizing to a pectoralis major muscle

An extensive review of the literature suggests that ours is the first case of encapsulated thymoma metastasizing to a skeletal muscle. A 43-year-old man underwent thymothymectomy for encapsulated Masaoka's stage I thymoma. Four years after complete resection, the tumor metastasized to the left pectoralis major muscle. Although a few reports exist on encapsulated thymoma metastasizing to a distant site, the literature does not describe encapsulated thymoma metastasizing to a skeletal muscle insofar as we could find.     

Invasive thymoma with endobronchial polypoid growth

A rare case of invasive thymoma with endobronchial polypoid growth is presented. A 68-year-old woman presented with coughing and sputum. The chest X-ray and computed tomography (CT) findings demonstrated a large mass with a calcified lesion in the left hilar region. A bronchoscopic examination showed a polypoid tumor in the left B³b bronchus. The tumor was surgically resected and revealed a unique polypoid endobronchial extension. This tumor was pathologically diagnosed to be invasive thymoma.     

Trans-arterial infusion chemotherapy for recurrence of pleural dissemination after thymectomy

We present a report of trans-arterial infusion chemotherapy through the intercostal arteries and subphrenic artery for pleural dissemination of recurrent thymoma after thymectomy. The disseminated tumor did not enlarge for more than a year after this treatment, and there were no side effects. Trans-arterial infusion chemotherapy appears to be a preferable procedure for pleural dissemination of thymoma.     

Primary malignant thymoma in a-6-year-old boy

Although not uncommon in adults, thymomas are the least common mediastinal tumors in children. The behavior of these tumors in children is partially distinct with a much more rapid course and a poor prognosis. A symptom-free 6-year-old boy was treated for malignant thymoma detected incidentally on a chest X-ray in a school mass examination. At operation, the tumor was found to have already invaded the surrounding tissue. Complete removal at the base of the invasive tumor is the treatment of choice.     

Multiple thymoma with myotonic dystrophy

A case of multiple thymoma associated with myotonic dystrophy is reported. The patient was a 42-year-old man who had two separate encapsulated thymoma in the anterior mediastinum, at 3 cm in diameter on the right side, and at 4 cm in diameter on the left. Extended thymo-thymomectomy was performed. Microscopically, the tumor in the right thymic lobe was predominantly mixed type, and that in the left predominantly epithelial type. Neuromuscular disease appeared to develop, with severe sputum retention in the larynx and he was referred to neurology at 6 months after surgery. On examination, he presented a characteristic hatchet face, muscle atrophy, muscle weakness, percussion myotonia and grip myotonia, and diagnosis was revised to be multiple thymoma associated with myotonic dystrophy. This association is extremely rare. It is difficult to clarify whether this association was a syndrome or coincidence.     

Is postoperative radiotherapy for thymoma effective?

OBJECTIVE: The authors determined the effect of postoperative mediastinal irradiation in preventing local and pleural recurrence of thymoma. SUMMARY BACKGROUND DATA: The role of mediastinal irradiation after incomplete resection or biopsy of an invasive thymoma is well established. However, routine use of adjuvant mediastinal irradiation for patients with thymoma after complete resection remains controversial. METHODS: During the 19-year period from 1973 to 1992, operations were performed on 89 patients with thymoma. Of these 89 patients, 80 patients who underwent gross complete tumor resection including adjacent tissues that appeared to be invaded by tumor were selected for this study. The effects of postoperative mediastinal irradiation on the recurrence rate of thymoma were analyzed according to histologic type, clinical stage, and whether adhesions to or invasion of the pleura or pericardium were present. RESULTS: Recurrence of thymoma was observed in 13 of 80 (16.3%) patients. No recurrence was observed in 23 patients with noninvasive thymoma. In patients with invasive thymoma whose tumor was macroscopically adherent to the pleura but not microscopically invasive (p1), recurrence was observed in 4 of 11 patients (36.4%) when mediastinal irradiation was not performed, but in none of 10 patients who received mediastinal irradiation. However, in patients with microscopic pleural invasion (p2), a high recurrence rate was observed with mediastinal irradiation (40%, 6/15 patients) or without mediastinal irradiation (30%, 3/10 patients). Postoperative mediastinal irradiation for patients with microscopical invasion to pericardium (c2) did not decrease the recurrence rate. Analysis of the mode of recurrence showed that mediastinal irradiation may have been effective in preventing local recurrence, but it did not control the pleural dissemination that was observed in 12 of 13 recurrent cases. CONCLUSIONS: Mediastinal irradiation is not necessary for patients with noninvasive thymoma. In patients with invasive thymoma, postoperative mediastinal irradiation is effective in preventing recurrence in patients with p1 thymoma, but not in patients with p2 or c2 tumors. Further adjuvant therapy should be performed to supplement mediastinal irradiation in patients with p2 or c2 thymoma, even after complete resection.     

Thymoma: Clinicopathologic features,therapy, and prognosis

We have treated 40 patients with thymoma. All the 18 with benign thymoma were treated with resection alone and none had a tumor recurrence or died from disease-related causes. Postoperative survival in this group ranged from 2 months to 14 years. Of the 22 patients with malignant thymoma, 2 underwent total resection, 10 partial resection and 10 were non-resectable. Fifteen of the 20 patients with non-resectable and partially excised thymomas were given radiotherapy. The cumulative 5- and 10-year survival rate of irradiation treated patients was 45.6%, and 34.4%, respectively. Of 6 non-irradiated patients, only one who underwent complete excision of tumors survived for more than 10 years, and 5 died within 3 years after treatment. Based on our findings we suggest that all patients with malignant thymoma, irrespective of the extent of surgical treatment, should be given postoperative irradiation.     

Pleuropneumonectomy with thymectomy for invasive thymoma with pleural disseminations--a case report

A case of invasive thymoma with pleural disseminations, treated with pleuropneumonectomy and thymectomy , is presented. A 30-year-old woman was admitted with abnormal shadows in left lung field and mediastinum. On chest CT examination, the tumor shadows were located anterior mediastinum and left chest wall. Thymoma with pleural disseminations was the most likely consideration by the needle biopsy specimen of the tumor under left chest wall. Preoperative radiotherapy for anterior mediastinum mass was effective. Pleuropneumonectomy and thymectomy combined with partial resections of intercostal muscles and diaphragm were performed. Histologically, the tumor was arranged in lobular structure, composed of epithelial cells, with poorly infiltration of lymphocytes, and invaded into intercostal muscles or lung. Postoperative radiotherapy for mediastinum and left chest wall was added. Tumors may be removed completely by pan-pleuropneumonectomy and thymectomy for invasive thymoma with pleural disseminations.     

A case of encapsulated noninvasive thymoma (stage I) with myasthenia gravis showing metastasis after a 2-year dormancy

We herein describe a case of thymoma in which metastasis to the left lower visceral and parietal pleura was noticed after a 2-year dormancy. A closer examination revealed no evidence that the metastatic tumors were of lymph node origin. The initial thymoma was well encapsulated, and thus it was thought that the development of metastasis might have reflected a sudden rapid growth of the thymoma cells after a 2-year period of inactivity.     

Spontaneous regression of thymoma; report of a case

A 44-year-old woman was admitted to our hospital with chest pain. Chest roentgenograms and computed tomography (CT) scan revealed an anterior mediastinal tumor and bilateral pleural effusion. However, CT scan 3 days after magnetic resonance imaging (MRI) revealed regression of the tumor. Extended thymo-thymectomy was performed via median sternotomy. The tumor was in the right lobe of the thymus. Pathologically the tumor was diagnosed as a mixed type non-invasive thymoma, but some parts of the tumor cells were necrotic. This is the 10th case of spontaneous regression of thymoma reported in the Japanese literature.     

Intrapulmonary metastasis developing eighteen years after complete resection of thymoma

We present a case of intrapulmonary metastasis developing 18 years after complete resection of thymoma. An 8 mm nodule in the lower lobe of the left lung was noted on chest X-ray in a 76-year-old woman who had undergone complete resection of Masaoka’s stage II thymoma 18 years earlier. Since the nodule grew to 17 mm during a 2-year follow-up, wedge resection was performed. The lesion was histologically diagnosed as an intrapulmonary metastasis from thymoma. Extremely late recurrence after complete resection of thymoma is discussed.     

High-dose methylprednisolone-containing chemotherapy in advanced invasive thymoma —Report of three cases—

During the period from May, 1995 to August, 1996, three patients with Stage III or IVa invasive thymoma received chemotherapy consisting of cisplatin, doxorubicin and methylprednisolone (1000 mg on days 1 through 5, and 500 mg on days 6 and 7). The first case, a 55-year-old woman, who underwent extended thymectomy 7 years ago, was found to have a recurrent tumor in the left pleural cavity. The second case, a 38-year-old man, who had first operation 3 years ago, developed recurrent tumor in the right pleural cavity. These two patients were treated with the above regimen as the primary mode of therapy. The third case, a 61-year-old woman, had a thymoma with direct invasion to right upper lobe. The same chemothrapy regimen was employed as the induction chemotherapy. All patients show3ed a major response to treatment with only a small amount of tumor remaining. The effectiveness of chemotherapy in the treatment of malignant tumors has been recently reported to be at least partly due to induction of apoptosis. Steroids are known to induce apoptosis in normal thymic cells, and thus steroid in chemotherapy regimen against invasive thymoma may enhance the effect of anti-cancer drugs through the induction of apoptosis.