Synchronous primary intrapulmonary and mediastinal thymoma-A case report
Zuoqing Song
0
Xiaohong Xu
0
Shujun Li
0
Sen Wei
0
Jun Chen
0
Qinghua Zhou
0
0
Department of Lung Cancer Surgery, Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital
,
Tianjin 300052
,
China
We report an extremely rare case of Synchronous primary intrapulmonary and mediastinal thymoma in a Chinese patient. We describe the histological and radiological findings, which support the possibility of multicentric thymoma. Resection of the mass in the left anterior superior mediastinum and upper lobectomy of right lung were performed, with lymph Nodes clearance, superior vena cava, left and right brachiocephalic veins resection, reconstruction of left brachiocephalic vein to right auricle and reconstruction of right brachiocephalic vein to superior vena cava.
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Introduction
Thymomas are tumors derived from thymic epithelial
cells and have an incidence of 0.15 per 100000[1].
Primary intrapulmonary thymomas are defined as
thymomas arising in an intrapulmonary location without an
associated mediastinal component and are very rare[2].
Here we present a successfully resected case of
synchronous primary intrapulmonary and mediastinal thymoma
with vascular reconstruction.
Case report
A 55-year-old Chinese man was admitted with a history
of progressive exertional dyspnea of 55 days duration
and a radiological finding of an anterior mediastinal
mass for 7 days. The patient had no clinical features of
myasthenia gravis. An enhanced Chest computed
tomographic scan revealed a 5.5 cm 6.0 cm 4.1 cm mass
in the anterior segment of the right upper lobe with
continuation to some mediastinal swelling lymph nodes.
Multiple swelling lymph nodes could be found in the
mediastinum (Figure 1A, B, Figure 2A, B, C). Three-D
reconstruction showed the superior vena cava, whose
lumen was unobstructed but deformated under the
compression of the mass (Figure 1C). A computed
tomographic scanning of the brain and bones were
normal. An exploratory limited right thoracotomy was
undertaken through a median sternotomy. A soft
encapsulated mass(3.5 cm 4.0 cm 5 cm) was found
in the left anterior superior mediastinum, with invasion
to the left pericardium and visceral pleura, adhesive to
partial superior lobe of right lung and brachiocephalic
vein(Figure 1G, I). In the anterior segment of the right
upper lobe, a mass was 6 cm in diameter, invading the
junction of right and left brachiocephalic veins and
upper segment of superior vena cava (Figure 1F, H).
Both masses are solitary. Therefore resection of the
mass in the left anterior superior mediastinum and
upper lobectomy of right lung were performed, with
lymph Nodes clearance, superior vena cava, left and
right brachiocephalic veins resection, reconstruction of
left brachiocephalic vein to right auricle and
reconstruction of right brachiocephalic vein to superior vena cava.
Microscopically according to the WHO classification,
the mediastinal tumor(MT) was a B3/B2 primary
thymoma and the mass in the upper lobe of right lung is
mainly a B3/B2 primary intrapulmonary thymoma(PIT)
with local A type tumors. Histologic evaluation
indicated that, CK5 & CK6 +, EMA + locally, CD5 -, CD99
+(Figure 2. No lymph metastasis was found. Warfarin
was applied to the patient as anticoagulation and 50 Gy
mediastinal irradiation was given as adjuvant therapy.
The patient has since recovered uneventfully and is now
being followed up as an outpatient (Figure 1D, E). After
follow-up of eight months, there was no significant
metastasis or recurrence found by radiological
examinations.
Figure 1 Chest computed tomographic scan. Figure 1A, 1B An enhanced Chest computed tomographic scan revealed a mass in the anterior
segment of the right upper lobe with continuation to some mediastinal swelling lymph nodes. Multiple swelling lymph nodes could be found
in the mediastinum. Figure C Three-D reconstruction showed the superior vena cava, whose lumen was unobstructed but deformated under the
compression of the mass. Figure 1D, 1E Postoperative enhanced Chest computed tomographic scan images. Figure 1F, 1G Surgical findings of
the mediastinal mass. Figure 1H Surgical findings of the intrapulmonary mass. Figure 1I Reconstruction of left brachiocephalic vein to right
auricle and reconstruction of right brachiocephalic vein to superior vena cava.
Discussion
Primary intrapulmonary thymuses are very uncommon,
with 28 cases reported to date[2]. Even rarer cases were
reported for Synchronous primary intrapulmonary and
mediastinal thymoma. The incidence for lung cancer in
China increased by 1.63% from 1988 to 2005. Some
special thoracic malignancies should be paid attention
to in China[3]. Primary intrapulmonary thymomas
appear to fall into two groups: one is in the hilus of the
lung, in relation to the wall of a major bronchus or
attached to the pericardium, and the other is peripheral
in the lung and beneath the visceral pleura[4] (...truncated)