Tuberc Respir Dis.  2011 Jan;70(1):74-78.

A Case of Pleural Metastasis 6 Years after Complete Surgical Resection of Invasive Thymoma

• Woo KJ
• Kim YK
• Kim KU
• Uh ST
• Kim DW
• Hwang JH
• Kim YH
• Park CS

Abstract

Herein, we report a case of recurrent pleural metastasis after complete resection of invasive thymoma that was successfully treated with surgical resection. Thymoma and thymic carcinoma are uncommon neoplasms derived from the epithelial cells of the thymus. Approximately 30% to 50% of thymomas are asymptomatic at the time of diagnosis. However, these cancers may present with constitutional or local pressure symptoms and sometimes with paraneoplastic syndromes, especially myasthenia gravis. Surgical resection is the mainstay of thymoma treatment and has been shown to remarkably improve long-term survival. Despite complete resection, local recurrences are frequent, and surgery is the cornerstone of therapy even in cases of recurrent thymoma. We experienced a 67-year-old male patient with pleural metastasis that developed 6 years after complete surgical resection of invasive thymoma. The pleural mass was excised by video-assisted thoracoscopic surgery. Histopathological examination revealed an invasive World Health Organization (WHO) type B2 thymoma.

Keyword

Thymoma; Recurrence; Pleural Neoplasms; Neoplasm Metastasis; Surgical Procedures, Operative

MeSH Terms

Aged
Epithelial Cells
Humans
Male
Myasthenia Gravis
Neoplasm Metastasis
Paraneoplastic Syndromes
Pleural Neoplasms
Recurrence
Surgical Procedures, Operative
Thoracic Surgery, Video-Assisted
Thymoma
Thymus Gland
World Health Organization

Figure

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  Figure 1 Chest radiograph shows a well-demarcated, lobulated mass in the left anterior mediastinum (arrow).

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  Figure 2 Chest radiograph shows the radiation fibrosis of central areas and mild left pleural thickening but no evidence of newly appearing lesions.

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  Figure 3 Chest CT scan with a mediastinal window image shows an enhanced pleural nodule (arrow) in the left lower posterior costal pleura.

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  Figure 4 PET CT scan shows slightly increased FDG uptake in the left lower hemithorax (maximal SUV, 1.95) probably due to tear-drop metastasis (arrow). PET CT: positron emission and computer tomography; FDG: fluorodeoxyglucose.

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  Figure 5 (A) Gross findings of the tumor showing tan-colored nodular pattern with whitish fibrous bands. (B) Microscopic findings showing lobular growth pattern with thick fibrous bands (H&E, ×12.5). (C) Invasion into the surrounding fat tissue (H&E, ×40). (D) High power showing large and polygonal epithelial cells and many number of lymphoid cells. The tumor cells have large nuclei with prominent single nucleoli (H&E, ×200).

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