A rare case of combined thymoma and a multilocular thymic cyst discovered due to chest pain

Abstract

Background A thymoma with chest pain and multilocular thymic cysts (MTCs) is very rare. Case presentation A 49-year-old man presented to another hospital complaining of an anterior chest pain. Chest computed tomography (CT) showed an anterior mediastinal tumor 60 × 30 × 55 mm in size. The boundary with the pericardium or left brachiocephalic vein seemed to be partially unclear while enhanced by the contrast medium, and so the tumor could have invaded them. No definitive diagnosis of myasthenia gravis was made although the serum anti-acetylcholine receptor antibody count was high. We performed an extended thymectomy with combined partial resection of left brachiocephalic vein, left upper lobe, and left phrenic nerve. He was discharged with no chest pain and no complications post-surgery. The tumor was pathologically type B2 thymoma with hemorrhage necrosis and MTCs, and we diagnosed Masaoka stage II because of no histological infiltration to the organs. Conclusions We speculated that hemorrhagic necrosis due to infarction in tumor caused the inflammation to spread to the surrounding organs, which was related to the chest pain and the development of MTCs.

Unilocular and multilocular thymic cysts: A study on the possible histomorphological and/or clinical differences

“…Thymic cysts and conditions characterized by cystic changes in the thymus can cause non-specific symptoms such as chest pain, dyspnea, and cough [9,10]. Cervical swelling, sternal swelling, and dorsalgia were observed in our patients and the most common symptom of TCs was dyspnea.…”

“…This might imply that not all MTCs are necessarily caused by acquired inflammation, and vice versa for UTC but to be certain, further clinical follow-up and histomorphological analysis of larger series are required. Although, they are not very common, concomitant lesions such as thymoma in the thymus tissue, and thymic and reactive follicular hyperplasia have been described in the literature [10,[16][17][18]. In fact, in one instance, no solid component was seen, and all of the thymoma areas surrounding the thymic cyst had a cystic structure [19].…”