AB015. Remarkable long-term survival following surgical resection and chemotherapy in type A thymoma with bilateral pulmonary metastasis: a rare case report
Abstract

AB015. Remarkable long-term survival following surgical resection and chemotherapy in type A thymoma with bilateral pulmonary metastasis: a rare case report

Hao-Xian Yang1,2,3, Wei Gan1,2,3, Mu-Zi Yang1,2,3, Chu-Long Xie1,2,3, Tian-Yu Sun1,2,3, Hao Yang1,2,3, Zi-Hui Tan1,2,3

1Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China; 2State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China; 3Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China

Correspondence to: Hao-Xian Yang, MD. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, No. 651, Dongfeng East Road, Guangzhou 510060, China; State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China; Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, China. Email: yanghx@sysucc.org.cn.

Background: Thymoma, the most common tumor of the anterior mediastinum, originates from the epithelial cells of the thymus. The World Health Organization (WHO) classifies thymomas into several subtypes based on histopathological features: type A, AB, B1, B2, and B3. Type A thymomas are generally considered low-risk due to their indolent behavior; hence, distant metastasis, particularly to the lungs, is exceptionally rare. Managing such advanced cases requires individualized treatment approaches.

Case Description: A 50-year-old male presented with right shoulder pain persisting for over a month. A chest computed tomography revealed a 43 mm × 40 mm anterior mediastinal mass with multiple small nodules scattered in both lungs. Positron emission tomography-computed tomography confirmed a hypermetabolic mediastinal mass and non-metabolic lung nodules, suggestive of thymoma with pulmonary metastasis, clinically staged as T1N0M1a (IVA). Due to the small size of the primary tumor and lack of invasion, surgery was chosen to alleviate symptoms, establish a definitive diagnosis, reduce tumor burden, and guide treatment. Subsequently, the patient underwent thoracoscopic resection of the primary tumor and biopsy of the left lower lung nodule. Histopathology confirmed type A thymoma, characterized by sheets of oval or spindle-shaped cells with abundant cytoplasm. Immunohistochemical staining showed positivity for cytokeratin (CK) (AE1/AE3), CK5/6, p63, and CD99, and negativity for epithelial membrane antigen (EMA), terminal deoxynucleotidyl transferase (TDT), CD20, CD117, and Vimentin, with a Ki-67 index of approximately 5%. The lung nodule exhibited similar immunohistochemical profiles but had a higher Ki-67 index (8%), indicating increased proliferative activity. Postoperatively, the patient received four cycles of systemic chemotherapy {[cyclophosphamide, adriamycin (doxorubicin), and cisplatin] (CAP) regimen: cyclophosphamide, doxorubicin, and cisplatin}. Over 5 years of follow-up, there was no recurrence of the primary tumor, and the metastatic lesions remained stable.

Conclusions: This case demonstrates the potential benefits of combining surgery and systemic chemotherapy in managing advanced thymoma with metastasis. The patient’s 5-year survival and stable disease status highlight the importance of individualized treatment strategies and continuous monitoring to achieve favorable outcomes.

Keywords: Type A thymoma; pulmonary metastasis; multimodal therapy; 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-ab015/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-ab015
Cite this abstract as: Yang HX, Gan W, Yang MZ, Xie CL, Sun TY, Yang H, Tan ZH. AB015. Remarkable long-term survival following surgical resection and chemotherapy in type A thymoma with bilateral pulmonary metastasis: a rare case report. Mediastinum 2024;8:AB015.

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