A Case of a Thymoma with Liver Metastases and Peritoneal Dissemination Surviving for 21 Years by Multidisciplinary Approach

Abstract

DepartmentsofGastroenterologicalSurgery 1) ,ImagingDignostics 2) ,andPathology 3) ,HamamatsuMedicalCenter Wereportafemalepatientwhohadundergoneextendedthymectomyforathymomaat53yearsof age.ThetumorwashistopathologicallydiagnosedasTypeB3+B2thymomaaccordingtotheWHOclassification. The patient received left hepatectomy for a liver tumor 9 years after the thymoma surgery. Although recurrent liver tumors were discovered 6 years after the liver resection, they disappeared by chemotherapyandradiationtherapy.Twoyearsaftertheliverrecurrence,agynecologistdiagnosedher tohaveperitonealdisseminationofthethymoma(TypeB3)byabiopsy,whichwaspreoperativelysuspectedofarightovariantumor,butcouldnotberesectedduetoabundantbloodsupply.Wetreatedthis disseminatedtumorbyradiotherapyandthetumorexhibitedcompleteresponse.However,intraperitonealtumorsandalivertumornewlyappearedtwoyearsafterwards.Radiotherapywasveryeffectivefor thosetumors,butnewperitonealandliverlesionspersistedtogrow.Multidrugchemotherapywasadoptedandhasbeencontinued.Morethan21yearsormorethan12yearshaveelapsedafterthethymoma surgeryoraftertheresectionoflivermetastasis,respectively.Therearefewcasesoflivermetastasesof athymomawhichwereoperatedonandthisistheonlyreportedcaseofathymomaofwhichperitoneally disseminatedtumorswereefficientlytreatedbyradiotherapy.Multidisciplinaryapproachincludingsurgicalresectionmightcontributetolong-termsurvivalevenformetastaticthymomapatient.