Case Report
AB025. When the thymus crosses the line: an unusual case of lung-infiltrating endobronchial thymoma—a case report
Giacomo Rabazzi1, Vittorio Aprile1, Maria Giovanna Mastromarino2, Alessandra Lenzini2, Stylianos Korasidis2, Greta Alì1, Iacopo Petrini3, Marcello Carlo Ambrogi1, Marco Lucchi1
1Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy;
2Division of Thoracic Surgery, Cardiac, Thoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy;
3Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
Correspondence to: Giacomo Rabazzi, MD. Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Savi, 10, Pisa, Tuscany, 56126, Italy. Email: giacomo.rabazzi@gmail.com.
Background: Thymomas typically demonstrate an indolent growth pattern, showing a non-infiltrative behaviour and displacing adjacent structures, even when they reach a great size. However, high-grade thymomas may invade the capsule and directly extend into neighbouring organs. Airway involvement is exceedingly rare, with only a few cases documented in the literature.
Case Description: We report an uncommon case of invasive thymoma with endobronchial growth in a 75-year-old female. The patient initially presented with hemoptysis. Chest computed tomography imaging revealed a calcified mass in the anterior mediastinum with invasion of the left upper pulmonary lobe. Due to the extent of bronchial obstruction to a subsegmental bronchus of the left upper lobe, the radiological findings were initially interpreted as being most consistent with a primary lung neoplasm. Flexible bronchoscopy confirmed the presence of a polypoid lesion originating from the subsegmental bronchus of the left upper lobe (Figure 1). Histopathological examination of endobronchial biopsies revealed a B2 thymoma. Following multidisciplinary evaluation and staging investigations that excluded distant metastases, the patient was initially referred for neoadjuvant chemotherapy due to suspected involvement of the left main pulmonary artery and mediastinal lymph nodes. However, owing to significant toxicity after the first cycle, an upfront surgical approach was considered more appropriate. The patient subsequently underwent an en-bloc extended thymectomy with left upper lobectomy via a left posterolateral thoracotomy. Histopathological analysis of the surgical specimen confirmed tumour invasion into the pulmonary parenchyma and the bronchial lumen. All surgical margins, including the bronchial stump, were negative, and no lymph node metastases were identified [pT3N0, stage IIIa according to the 9th dedicated tumor-node-metastasis (TNM) classification, although the latest system does not yet consider bronchial involvement]. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. She was subsequently enrolled in a pulmonary rehabilitation program to support recovery. Adjuvant radiotherapy targeting the anterior mediastinum was administered without complications. Follow-up bronchoscopies showed no abnormalities, and the patient remains disease-free on initial post-surgical surveillance imaging.
Conclusions: In conclusion, this rare case of invasive thymoma with endobronchial involvement emphasises the significance of prompt diagnosis, effective multidisciplinary treatment, and successful surgical management, leading to a favourable post-treatment outcome.
Keywords: Thymoma; airway invasion; multimodality treatment; case report
Acknowledgments
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Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-25-ab025/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration and its subsequent amendments. Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
doi: 10.21037/med-25-ab025
Cite this abstract as: Rabazzi G, Aprile V, Mastromarino MG, Lenzini A, Korasidis S, Alì G, Petrini I, Ambrogi MC, Lucchi M. AB025. When the thymus crosses the line: an unusual case of lung-infiltrating endobronchial thymoma—a case report. Mediastinum 2025;9:AB025.
