AB001. Late multiple extra-thoracic metastasis from thymoma biopsy seeding: a case report
Abstract

AB001. Late multiple extra-thoracic metastasis from thymoma biopsy seeding: a case report

Carlos S. Pinto, Rita Costa, Anita Paiva, Bruno Couto, Pedro Fernandes

Thoracic Surgery Functional Unit, Cardiothoracic Department, Local Health Unit – Hospital São João, Porto, Portugal

Correspondence to: Carlos S. Pinto, MD. Thoracic Surgery Functional Unit, Cardiothoracic Department, Local Health Unit – Hospital São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Email: carlos.pinto@chsj.min-saude.pt.

Background: In the past, biopsy was the gold standard for staging lesions from the mediastinum. Nowadays, National Comprehensive Cancer Network (NCCN) guidelines, advise not to do so, as the risk for tumor seeding (spread in thoracic wall) from surgical biopsy or tumor upstaging from transthoracic biopsy (pleural space spread) in this setting is real, although rare. Thymomas have long attracted the attention of the medical community, because of its variability in cell type and invasiveness despite a very bland histological appearance.

Case Description: We present a case of a 75-year-old lady, who presented progressive growth of hard of skin, pectoral muscle (major and minor) and intercostal place with pleural invasion, that were proven to be metastasis from previously surgical removed type A thymoma. The pattern, although more typically associated with surgical spread/seeding, is in fact, after imagological reconstruction, associated with a transthoracic biopsy made with echography, before the first surgery. Although the extension of the excision was considerable, the patient pressured the surgical team, as the lesions were very painful, especially the one in the skin. The patient was submitted to surgery, with a radical excision intent. The surgery allowed to confirm the diagnosis of all the lesions, that spatially were in a straight line, something that ticked the surgeon for the cause of spread. The first impression of distant recurrence was later considered as biopsy related seeding. Notice that these took 8 years to grow, as the diagnosis was made in 2023 and the first surgery in 2015, with marginal excision of a 11 cm × 9.5 cm × 6.0 cm, totally incapsulated anterior mediastinal mass. Back then, it was classified as atypical (high mitotic index and necrosis) type A thymoma. The patient had already lost follow-up, that lasted 5 years, standard in the past for these malignancies with no signs of relapse, although nowadays NCCN guidelines proposes a 10-year follow-up.

Conclusions: We believe that this is a case of worthy presentation, for its unconventional presentation, as a reminder to follow the guidelines that so many times one tends to break as a necessity for further staging evaluation before surgical treatment.

Keywords: Thymoma; recurrence; seeding; biopsy; case report

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://med.amegroups.com/article/view/10.21037/med-24-ab001/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 (as revised in 2013). Written informed consent was obtained from the patient for the publication of this case report. 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-24-ab001
Cite this abstract as: Pinto CS, Costa R, Paiva A, Couto B, Fernandes P. AB001. Late multiple extra-thoracic metastasis from thymoma biopsy seeding: a case report. Mediastinum 2024;8:AB001.

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