Synchronous primary intrapulmonary and mediastinal thymoma-A case report

Journal of Cardiothoracic Surgery, Aug 2010

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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.cardiothoracicsurgery.org/content/pdf/1749-8090-5-69.pdf

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. - 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)


This is a preview of a remote PDF: http://www.cardiothoracicsurgery.org/content/pdf/1749-8090-5-69.pdf

Zuoqing Song, Xiaohong Xu, Shujun Li, Sen Wei, Jun Chen, Qinghua Zhou. Synchronous primary intrapulmonary and mediastinal thymoma-A case report, Journal of Cardiothoracic Surgery, 2010, pp. 69, 5, DOI: 10.1186/1749-8090-5-69