Abstract
AB016. A case of invasive thymoma with rapid response to PAC therapy, after an early postoperative recurrence
Chika Harada1, Kentaro Kitano1, Hiroki Umezawa2, Chiyoko Kono2, Hiroki Tanaka3, Rie Ohtomo3
1Department of Thoracic Surgery, JR Tokyo General Hospital, Tokyo, Japan;
2Department of Respiratory Medicine, JR Tokyo General Hospital, Tokyo, Japan;
3Department of Pathology, JR Tokyo General Hospital, Tokyo, Japan
Correspondence to: Chika Harada, MD. Department of Thoracic Surgery, JR Tokyo General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo 151-8528, Japan. Email: chika-harada@jreast.co.jp.
Background: Thymomas typically exhibit local progression, with metastasis to abdominal lymph nodes being relatively rare. Recurrence of thymoma usually occurs months or years after surgical treatment. However, we present a case with rapid postoperative recurrence and metastasis to abdominal lymph nodes.
Case Description: A 66-year-old female was referred to our hospital for treatment of breast cancer. A preoperative computed tomography (CT) scan revealed a 7.5 cm anterior mediastinal tumor, suspected to invade the pericardium and left lung. Extended thymothymectomy plus partial resection of the left lung, and pericardial resection and reconstruction was performed. There were no signs of pleural implants, and pleural effusion cytology was negative for malignant cells. The patient was discharged on post-operative day (POD) 9. The pathology was thymoma (AB type, Masaoka stage III), with microscopically positive margins, leading to a planned postoperative radiotherapy. On POD 18, the patient visited our outpatient clinic with dyspnea. An X-ray showed a large amount of left pleural effusion. After multiple times of removal by centesis, the effusion recurred, thus the patient was readmitted for continuous drainage. On POD 43, swelling of the left anterior chest wall was noticed. A CT scan showed a massive lesion along the left thoracic wall adjacent to the pericardium, with multiple small nodes in the left lung and two massively enlarged abdominal lymph nodes. CT-guided needle biopsy performed on POD 47 confirmed recurrent thymoma. Cisplatin, doxorubicin, and cyclophosphamide (PAC) chemotherapy initiated on POD 57 induced clinical tumor lysis syndrome. Three days later, there were almost no signs of remaining thoracic lesions on the X-ray. A CT scan after 2 courses of PAC showed the disappearance of the pleural mass and normalization of the abdominal lymph nodes. Following four PAC courses, remaining pleural effusion disappeared, achieving a complete response.
Conclusions: Although thymoma is generally considered less aggressive compared to thymic carcinoma, incomplete resection can lead to early recurrence and progression, as seen in this case. In cases of incomplete resection, efforts should be made to avoid missing the opportunity for postoperative radiotherapy or chemotherapy.
Keywords: Rapid progression; subdiaphragmatic metastasis; case report
Acknowledgments
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-24-ab016/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-ab016
Cite this abstract as: Harada C, Kitano K, Umezawa H, Kono C, Tanaka H, Ohtomo R. AB016. A case of invasive thymoma with rapid response to PAC therapy, after an early postoperative recurrence. Mediastinum 2024;8:AB016.
