AB039. Complex management of thymic epithelial tumors associated with immuno-haematological disorders at the diagnosis: case reports of our experience
Abstract

AB039. Complex management of thymic epithelial tumors associated with immuno-haematological disorders at the diagnosis: case reports of our experience

Angelo Luciano1, Erica Pietroluongo1, Margaret Ottaviano2, Pietro De Placido3, Rocco Morra1, Annarita Peddio1, Mara Memoli1, Francesco Grimaldi1, Giorgia Battipaglia1, Marianna Tortora4, Mario Giuliano1, Roberto Bianco1, Alberto Servetto1, Giovannella Palmieri4

1Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 2Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Fondazione G. Pascale, Naples, Italy; 3Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; 4Regional Coordinating Center for Rare Tumors (CRCTR) of Campania Region at University Federico II, Naples, Italy

Correspondence to: Giovannella Palmieri, MD. Regional Coordinating Center for Rare Tumors (CRCTR) of Campania Region at University Federico II, via Sergio Pansini, 5, Naples 80131, Italy. Email: giovpalm@unina.it.

Background: Thymic epithelial tumors (TETs) can be associated with immune-haematological disorders that influence the therapeutic approach. The pathogenesis is not well explained and single case reports and small retrospective cohort studies are reported in literature. We present peculiar histories of two patients diagnosed with concurrent subtype A thymoma and immune-haematological disorders at diagnosis.

Case Description: The first patient, 68 years old, in March 2023 underwent surgery for anterior mediastinal mass. Diagnosis of stage I subtype A thymoma was made. Subsequently, Good’s syndrome was diagnosed. In April 2023, the patient was affected by SARS-Cov-2 infection and treatment with antiviral drugs was promptly administered, resulting in a resolution of symptoms, but tests for SARS-COVID-2 viremia were still positive. The patient presented several life-threating upper respiratory tract infectious diseases by various pathogen agents and was continuously hospitalized. In April 2024, for anaemia and thrombocytopenia, osteo-medullary biopsy (BOM) was performed. Medullary aplasia was diagnosed, then corticosteroids, cyclosporine, immunoglobulins and blood transfusion were promptly administered. In May 2024, the radiological evaluation for TET was negative. The second patient, 60 years old, underwent biopsy of a mass in anterior mediastinum in July 2023, showing a subtype A thymoma. Subsequently, for the onset of grade 3 anaemia and grade 4 thrombocytopenia, BOM was performed revealing medullary aplasia. Anaemia and thrombocytopenia prevented curative surgery or systemic treatment for TET. Treatment with corticosteroids, cyclosporine, blood transfusions and antilymphocyte serum was ineffective and the patient died in March 2024. The cases we present support the evidence that thymoma A can be insidious for association with immune-haematological diseases that can preclude the treatment of TET, although is considered to be biologically less aggressive histotype. We review literature finding that immune-haematological disorders are less than 1% of cases of TETs and regroup several clinical conditions, including pure red cell aplasia (occurring in 5% of thymomas), aplastic anaemia, haemolytic anaemia, paroxysmal nocturnal haemoglobinuria, pure white cell aplasia and acquired amegakaryocytic thrombocytopenia.

Conclusions: The history of these two patients show that the management of patients with TETs and medullary disorders at diagnosis condition the therapeutic process of thymic tumors, influencing prognosis.

Keywords: Thymic epithelial tumors (TETs); immunological disorders; 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-ab039/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 patients 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-ab039
Cite this abstract as: Luciano A, Pietroluongo E, Ottaviano M, De Placido P, Morra R, Peddio A, Memoli M, Grimaldi F, Battipaglia G, Tortora M, Giuliano M, Bianco R, Servetto A, Palmieri G. AB039. Complex management of thymic epithelial tumors associated with immuno-haematological disorders at the diagnosis: case reports of our experience. Mediastinum 2024;8:AB039.

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