AB044. Late thymoma occurrence after thymectomy for thymic hyperplasia: case reports of our experience
Case Report

AB044. Late thymoma occurrence after thymectomy for thymic hyperplasia: case reports of our experience

Carmine Caso1, Martina Di Meo1, Lucia Salatiello1, Erica Pietroluongo1, Roberto Bianco1, Alberto Servetto1, Angelo Luciano2, Margaret Ottaviano3, Giovannella Palmieri4

1UOC Oncologia Medica, AOU Federico II di Napoli, Napoli, Italy; 2Oncoematologia, UOC DH/PACC Oncologia dell'Ospedale San Giovanni Di Dio e Ruggi d'Aragona, Salerno, Italy; 3Department of Melanoma, Cancer Immunotherapy and Development Therapeutics, IRCCS Istituto Nazionale Tumori Fondazione Pascale, Napoli, Italy; 4Rare Tumors Coordinating Center of Campania Region (CRCTR), AOU Federico II di Napoli, Napoli, Italy

Correspondence to: Carmine Caso, MD. UOC Oncologia Medica, AOU Federico II di Napoli, Via Sergio Pansini n.5, Napoli, 80131, Italy. Email: carmine.caso1996@gmail.com.

Background: Thymic hyperplasia (TH) is a rare condition, often diagnosed following the onset of myasthenia gravis (MG) symptoms. The standard treatment involves surgical thymectomy. However, in multiple cases, MG symptoms persist despite surgery. To date, no cases of thymoma occurrence have been reported following thymectomy performed for TH.

Cases Description: Patient A, a 46-year-old woman, underwent thymectomy in 1999 due to symptoms of MG. Histopathological examination revealed TH. Next, she received medical treatments for MG. In 2018, due to an exacerbation of myasthenic symptoms, a chest computerized tomography (CT) scan revealed a large, irregular soft tissue mass in the anterior mediastinum (62 mm × 22 mm × 67 mm), with pericardial infiltration. Biopsy of the lesion confirmed a World Health Organization (WHO) type A thymoma, stage III according to the Masaoka staging system. A 68Ga-DOTATOC positron emission tomography (PET) scan demonstrated focal tracer uptake (standardized uptake value, SUVmax 3.8), and the patient was initiated on octreotide long-acting release (LAR), 30 mg every 28 days. She remains on this treatment, with imaging studies showing stable disease. Patient B, a 41-year-old man, underwent thymectomy in 1994 for MG, with histologic confirmation of TH. In 2013, he experienced right-sided chest pain. CT-scan revealed pleural lesions, and video-assisted thoracoscopic surgery (VATS) biopsy confirmed a WHO type B2 thymoma. He performed 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) with mediastinal (SUVmax 7.2) and multiple pleural uptakes (stage IV A Masaoka). Therefore, he received six cycles of chemotherapy with the cisplatin, doxorubicin and cyclophosphamide schedule (PAC schedule), achieving a partial response. 18FDG-PET was negative for residual disease, but Octreoscan revealed focal tracer uptake (SUVmax 4.2). Octreotide LAR (30 mg every 28 days) was initiated, with stable disease until 2018, when progression was noted on CT. Consequently, he was candidate for oral therapy with etoposide (50 mg/day, 3 weeks on, 1 week off) administered until 2021. Due to further progression, Octreotide LAR was reintroduced and is currently ongoing. He remains on this treatment, with latest imaging studies showing stable disease (Figure 1).

Conclusions: These cases suggest the possibility of delayed thymoma development even after thymectomy for histologically confirmed TH. Further data are required to confirm this observation. Close and prolonged monitoring of patients undergoing thymectomy is recommended, particularly in the presence of recurrent or worsening myasthenic symptoms.

Keywords: Case report; thymic hyperplasia (TH); myasthenia gravis (MG); occurrence

Figure 1 Patient B latest CT-scan showing stable disease. CT, computerized tomography.

Acknowledgments

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Footnote

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-ab044/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 in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Declaration of Helsinki and its subsequent amendments. Written informed consent was obtained from the patients for publication of this case report and accompanying image. 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-ab044
Cite this abstract as: Caso C, Di Meo M, Salatiello L, Pietroluongo E, Bianco R, Servetto A, Luciano A, Ottaviano M, Palmieri G. AB044. Late thymoma occurrence after thymectomy for thymic hyperplasia: case reports of our experience. Mediastinum 2025;9:AB044.

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