Thymic basaloid carcinoma

We report a case of thymic basaloid carcinoma combined with multilocular thymic cyst (MTC). A 72-year-old man was found to have an abnormal shadow on a chest X-ray without pny symptoms. Chest computed tomography (CT) showed a smooth edged anterior mediastinum tumor projecting to the left lung field. After preoperative chemotherapy by irinotecan hydrochloride (CPT-11) and radiotherapy of 40 Gy, chest CT showed a large part of the tumor projecting to the left lung field had changed to a cyst. After the pericardium and upper lobe of the left lung to which the MTC adhered was partially resected via left thoracotomy, the tumor was resected with innominate vein via median sternotomy. The operation was followed by CPT-11 chemotherapy and radiotherapy of 20 Gy. The tumor was thymic basaloid carcinoma 3 x 2.5 x 2 cm in size combined with MTC 8.2 cm maximum in diameter. As he died of another disease 6 months after excision, sufficient postoperative observation was not obtained. Thymic basaloid carcinoma is rare and only 14 cases including the present case have been reported.     

A case of thymic carcinoma

A 41-year-old male visited with chief complaints of chest pain and cough. The patient was operated on under a diagnosis of invasive thymoma. The tumor was located in the left lobe of the thymus and measured 6 X 9 cm. Since the tumor invaded the left innominate vein, pericardium, and the upper lobe of the left lung, we resected it with adjacent structures. Postoperative pathological examination indicated squamous cell carcinoma of the thymus. Because the tumor metastasized also to the mediastinal lymph nodes, the patient was treated postoperatively by radiation therapy and adjuvant chemotherapy mainly with CDDP. The patient is well presently 2 years after operation without signs of recurrence.     

Basaloid Carcinoma of the Thymus: Report of a Case

We report a case of basaloid carcinoma of the thymus, confirmed by histopathological examination, in a 52-year-old man who underwent complete resection. Local recurrence and lung metastases developed, which were obliterated by radiation therapy. The patient survived for 81 months after surgery. We reviewed the 13 other cases of basaloid carcinoma of the thymus reported in the literature. Presumably, this tumor is radiosensitive and its metastatic route is blood-borne.     

Recurrent thymic carcinoid tumor--report of a case

A previously operated 62-year-old male with recurrent thymic carcinoid tumor was reported. This patient underwent resection of the thymic carcinoid tumor through left thoracotomy 7 years ago. Although the postoperative clinical course was uneventful, an anterior mediastinal tumor on the patient's chest was discovered after an X-ray examination due to a traffic accident in July, 1989. With the diagnosis of recurrent thymic carcinoid tumor, he underwent an excision of the anterior mediastinal tumor and residual thymus. He also underwent partial resection of the pericardium, mediastinal pleura, and left upper lobe of the lung. 42 cases with thymic carcinoid tumor that have been reported in the Japanese literature were reviewed. A perusal in the relevant literature suggested that total thymectomy was advisable because partial thymectomy was associated with a high risk of local recurrence and metastases.     

A case of mediastinal seminoma which penetrated pericardium and invaded left upper lobe]

A 35-year-old man admitted at our hospital, with a complaint of anterior chest pain. Chest x-ray film and CT showed an anterior mediastinal tumor. An invasive thymoma was suspected by the biopsy specimen, invading left upper lobe of the lung. Resections of the tumor, thymus, invasion to the part of the left upper lobe and the pericardium were performed. The pathology showed pure seminoma penetrating the pericardium. As testis and the retroperitoneum were normal, the tumor was diagnosed as mediastinal origin. Adjuvant chemotherapy (CDDP, BLM and etoposide) and irradiation were performed. The patient is alive and well for 7 months postoperatively.     

Solitary fibrous tumor of the thymus with local invasiveness and pleural dissemination: report of a case.

A 74-year-old asymptomatic female presented with an anterior mediastinal mass incidentally discovered on a routine chest X-ray. Systemic evaluation demonstrated no metastatic lesions. The patient underwent an extended thymectomy via median sternotomy on suspicion of a thymoma. The tumor had arisen from the left half of the thymus without a pedicle and had directly invaded into the left lung and pericardium. The tumor was resected with the entire thymic tissue, and the invaded lung and pericardium were resected en-bloc. The size of the tumor was 5.3x4.0 cm. A disseminated lesion on the mediastinal pleura was also resected. Histopathologically, the lesion mainly consisted of non-atypical spindle-shaped tumor cells in a so-called "patternless pattern" with various densities of collagenous background. Pleomorphism and mitoses were not significant. Immunohistochemical analysis revealed mesenchymal positive markers such as vimentin and CD34. Epithelial markers such as CAM 5.2 and AE1/AE3 were negative. S-100 protein and desmin were not stained. Solitary fibrous tumor of the thymus was diagnosed histologically. Postoperative adjuvant chemotherapy or radiotherapy was not undertaken because the benefits were uncertain. She is well without recurrence 3 months after the operation.     

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.     

Thymic carcinoma with combined resection of the hemisternum

We report a case of partial resection of the hemisternum of a thymic carcinoma invading the right anterior chest wall. A computed tomographic scan of the chest and positron emission tomography showed a mass invading the right anterior chest wall in the anterior mediastinum with high 18F-fluorodeoxyglucose accumulation. An operation was performed to obtain a definitive diagnosis and achieve complete resection. First, we assessed the boundaries of gross disease using left-sided video-assisted thoracoscopy. After delineating the margins of the lesion invading the anterior chest wall, a median sternotomy was added and the tumor was resected with the right half of the sternum, parts of the right third and fourth costal cartilages, part of the right upper lung lobe, and pericardium. Histopathological evaluation revealed a squamous cell carcinoma of the thymus with direct invasion to the right lung, pericardium, and the right third costal cartilages.     

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.     

电视纵隔镜手术128例

目的探讨电视纵隔镜检查术（video-mediastinoscopy，VM）在肺癌术前分期、纵隔肿物诊断和恶性胸腔积液诊治中的价值。方法采用全麻单腔螺纹气管插管，48例行颈部纵隔镜术，33例行胸骨旁纵隔镜检查术，47例行经肋间纵隔镜术。结果125例经电视纵隔镜术后确诊：肺腺癌38例，肺转移性低分化鳞癌33例，结核9例，淋巴结炎症8例，肺小细胞癌7例，胸腺鳞状细胞癌6例，非霍奇金淋巴瘤5例，纵隔神经母细胞瘤4例，胸腺瘤4例，胸膜间皮瘤3例，霍奇金淋巴瘤2例，后纵隔神经鞘瘤2例，结节病1例，胸腺增生1例，类癌1例，中纵隔原始神经外胚叶肿瘤1例。1例电视纵隔镜检查纵隔淋巴结为反应性增生，行左下肺叶切除，病理为鳞癌。2例术前纤维支气管镜病理确诊左下肺鳞癌，电视纵隔镜检查右气管旁淋巴结转移。术中发生气胸1例、出血1例、喉返神经麻痹和切口感染各2例。结论电视纵隔镜术不但是肺癌术前病理分期、纵隔疾病的重要检查方法，而且也是诊治恶性胸腔积液的简便方法。     

Aorticopulmonary paraganglioma

We describe a 61-year-old woman with an anterior mediastinal paraganglioma. The patient complained of a chronic cough that had lasted about 6 months. Her chest computed tomography (CT) showed a highly enhanced mediastinal tumor in the aorticopulmonary window. We surgically resected this tumor thorough a left anterior thoracotomy. Although numerous feeding vessels and firm adhesions with the pericardium hindered the procedure, macroscopically complete resection was achieved. Postoperatively, the tumor was diagnosed as an aorticopulmonary paraganglioma. As these highly enhanced tumors in the anterior mediastinum on CT images are unusual, a differential diagnosis including mediastinal hemangioma, epithelioid hemangioendothelioma, Castleman’s disease, choriocarcinoma, metastatic tumor (especially from renal cell carcinoma), and paraganglioma should be considered.     

Thymic carcinoma associated with multilocular thymic cyst: a clinicopathologic study of 7 cases

We present 7 cases of thymic carcinoma associated with a multilocular thymic cyst (MTC). The patients were 5 men and 2 women aged 22 to 71 years (mean, 49.3 y). Clinically, 6 patients presented with chest, sternal, or upper extremity pain, and in 1 patient the tumor was an incidental finding. Grossly, 4 tumors were described as multilobulated solid-cystic masses, whereas 3 cases were described as solid tumors with a white-yellow cut surface and areas of hemorrhage and necrosis. The tumor size ranged from 7.0 to 10.0 cm (mean, 8.1 cm). Histologically, 4 cases were classified as squamous cell carcinoma, and 1 each as sarcomatoid (spindle) cell carcinoma, papillary carcinoma, and basaloid carcinoma. In addition to the tumor component, prominent MTC changes were observed in the adjacent remnant thymic tissue. Immunohistochemical studies were conducted in 2 cases of squamous cell carcinoma. The neoplastic cells were positive for cytokeratin (CK), CK5/6, and p63, and showed variable reactivity for CK7 and CD5. Clinical follow-up showed that 4 patients were alive and well, 2 to 63 months after diagnosis, and 3 patients were alive with disease, 13 to 33 months after diagnosis. This study expands the morphologic spectrum of thymic carcinoma associated with MTC, detects a higher incidence than previously believed, and highlights the importance of adequate sampling and proper evaluation of all cystic lesions of the anterior mediastinum so as not to mistake malignancy for a benign cystic process.     

Differential diagnosis of calcitonin-secreting neuroendocrine carcinoma of the foregut by pentagastrin stimulation

BACKGROUND AND AIMS: This study assessed the suitability of pentagastrin stimulation in hypercalcitoninaemia for differential diagnosis of neuroendocrine carcinoma of the foregut. PATIENTS: A prospective institutional study (March 1997-September 1999) was conducted involving all patients admitted to the pneumological and general surgical wards for small cell lung cancer (SCLC) or primary medullary thyroid carcinoma (MTC). Basal and stimulated serum calcitonin levels were measured using an improved immunoradiometrical assay for the monomeric form of calcitonin. RESULTS: Increased basal calcitonin levels were noted in six non-MTC patients (one mediastinal and one laryngeal neuroendocrine carcinoma, and four SCLCs). Because of chronic renal failure, one SCLC patient had to be excluded. The remaining five non-MTC patients with normal renal function were compared to eight primary MTC patients. In terms of pentagastrin stimulation, an increase in serum calcitonin levels of less than twofold the baseline significantly correlated with both non-MTC (r=0.85; P=0.005) and SCLC (r=0.81; P=0.024). Immunostaining of tissue specimens for calcitonin was positive in the patients with mediastinal and laryngeal neuroendocrine carcinoma and in all eight patients with primary MTC, but was negative in the two SCLC patients with adequate tissue samples. CONCLUSIONS: Irrespective of the pathophysiological background, pentagastrin stimulation affords a differential diagnosis in neuroendocrine carcinoma of the foregut when chronic renal failure is excluded.     

Mucoepidermoid carcinoma of the thymus

Mucoepidermoid carcinoma of the thymus is a rare carcinoma and there is little agreement about the treatment of this tumor. According to the analysis of previously reported tumors, biologic behavior of the tumor correlated with the spread of the lesion and degree of differentiation. We report a case of this tumor in a 31-year-old man. Resection of the tumor included the left upper lobe of the lung the phrenic nerve, pericardium and disseminations in the pleura. The clinicopathological feature of this case was high-stage disease and low-grade histology. Postoperative chemotherapy and radiotherapy were performed, and the patient is alive without recurrence 14 months after surgery.     

Nonmalignant pericardial effusion associated with thymic cancer

We report a case of thymic carcinoma with massive pericardial effusion in a 74-year-old man. This patient with dyspnea was referred to our hospital because of pericardial effusion detected by echocardiography. A chest computed tomography and magnetic resonance imaging showed an anterior mediastinal mass measuring 8.0 × 5.0 cm with massive pericardial effusion. The mass lesion was suggestive of thymic carcinoma or invasive thymoma. Initially, he underwent pericardial drainage. The collected fluid was serous and yellow, and cytological examination found no malignant cells. The tumor with partial pericardium was resected. Histopathological findings confirmed the lesion to be squamous cell carcinoma of the thymus. The etiology of a massive nonmalignant pericardial effusion associated with thymic carcinoma warrants further studies. The patient is alive without recurrence and without pericardial effusion at 3 years to date after the operation. Not all pericardial effusion associated with thymic cancer involves malignant effusion.     

Pleomorphic lung cancer; a clinicopathologic study

Pulmonary pleomorphic carcinoma is a comparatively rare histologic type of lung carcinoma, and the incidence among all lung carcinomas has been reported to be 0.4%. We reported our experience with 8 patients who had been diagnosed as pulmonary pleomorphic carcinoma, and discussed clinicopathologically the preoperative diagnosis and treatment. In 2 of 8 patients, preoperative transbronchial lung biopsy revealed spindle cell component, highly suggesting pulmonary pleomorphic carcinoma. All patients underwent surgical treatment and 2 of then had incomplete resections because of intrathoracic disseminations or carcinomatous pericarditis. Pathological findings showed invasions into the surrounding thoracic organs such as the chest wall, pericardium, adjacent pulmonary lobe or mediastinal pleura in 5 cases, intrapulmonary metastasis of the same lobe in 3 and lymph node involvement in 3. Recurrence occurred in 6 patients immediately after the operation. Although the preoperative diagnosis of biphasic tumor such as pulmonary pleomorphic carcinoma is difficult, it is possible to suspect the diagnosis when sarcomatous components were detected by preoperative biopsy. The efficacy of chemotherapy and radiotherapy have not been established yet, and thus we would like to emphasize that surgery might be the treatment of choice.     

Thymic carcinoma incidentally detected on routine chest computed tomography; report of a case

We reported a case of thymic carcinoma. A 61-year-old man was admitted to evaluate an abnormal shadow of lung field by chest X-ray. Routine chest computed tomography (CT) showed no abnormal findings on the lung field, but thymic tumor was incidentally detected. We suspected thymoma, performed a mediansternotomy and thymectomy with partial resection of pericardium. Pathological findings diagnosed undifferentiated carcinoma (large cell type) of thymus, the patient underwent radiation therapy of the mediastinum at a total dosage of 50 Gy and chemotherapy [cisplatin (CDDP) + vinorelbine ditartrate + mitomycin C (MMC)]. He has been doing well without recurrence for 2 years after the operation.     

Recurrent mediastinal desmoid tumor treated by surgical resection ; report of a case

We report a rare case of mediastinal desmoid tumor in a 17-year-old man. The patient was a 17-year old man who had underwent surgery for mediastinal tumor at our hospital 2 years before. The tumor was diagnosed as a solitary fibrous tumor of the mediastinum. After 2 years, chest computed tomography(CT) and magnetic resonance imaging( MRI) showed a mass at the previously resected site. Surgery was performed again under the diagnosis of recurrent tumor. The tumor densely adhered to the superior vena cava, right innominate vein, pericardium, and the right lung. The tumor was completely resected with the aid of the partial extracorporeal circulation. Finally, both previously resected tumor and the recurrent tumor were diagnosed pathologically as desmoid tumors.     

A case report of widely recurrent carcinoid tumor of the thymus

We performed wide resection of recurrent carcinoid tumor of thymus. A 62-year-old male patient admitted to our department because of swelling of anterior chest wall. He had received extirpation of thymic carcinoid tumor 5 years ago and he was pointed out large mass formation in anterior mediastinum before admission. Wide resection of tumor including pericardium, chest wall, left lung and left brachiocephalic vein was performed. Left brachiocephalic vein was reconstructed and pericardium was replaced with Gore-Tex patch. The carcinoid tumor of thymus sometimes invade to adjacent organs and is apt to recur long time after first operation.     

Thymic metastasis from prostatic carcinoma: Report of a case

The thymus is an important organ involved in cell-mediated immunological function, and to our knowledge, there has never been a case of thymic metastasis reported. We recently examined a 65-year-old man who presented at our department with a cough and shortness of breath on exertion. He had a history of prostatic carcinoma for which he had undergone an orchiectomy 11 years previously. Investigations disclosed a mediastinal tumor, 14×9 cm in size, and histological examination of the resected tumor confirmed a diagnosis of thymic metastasis from prostatic carcinoma.