Complete regression of a thymoma to glucocorticoids, commenced for palliation of symptoms

Barratt, Shaney; Puthucheary, Zudin; Plummeridge, Martin

doi:10.1016/j.ejcts.2007.02.032

Cited by 23 publications

(23 citation statements)

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“…The overall incidence of thymoma is 0.15 cases per 100,000 individuals and the majority of the patients with thymoma or thymic carcinoma are aged 40-60 years (2,3). The World Health Organisation (WHO) classification is based on histological analysis of epithelial cell atypia and the degree of infiltration of non-neoplastic lymphocytes (4). Although the great majority of these tumors exhibit more conventional histological characteristics, unusual types have also been described, such as sclerosing thymoma (5).…”

Section: Introductionmentioning

confidence: 99%

Thymoma exhibiting spontaneous regression in size, pleural effusion and serum cytokeratin fragment level: A case report

Furuya

Isobe

Sano

et al. 2015

Molecular and Clinical Oncology

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Abstract.A 30-year-old man was admitted to Toho University Omori Medical Center for assessment of right chest pain and fever. Chest computed tomography (CT) revealed an anterior mediastinal tumor sized 11.0x6.0x5.0 cm, with right pleural effusion. The laboratory analysis revealed elevated white blood cell count (11,000/µl), C-reactive protein (4.1 mg/dl) and cytokeratin fragment (CYFRA; 12.7 ng/ml; normal, <2 ng/ml). The level of CYFRA in the pleural effusion was also markedly elevated (143 ng/ml). On the first day after admission (6 days after the initial CT), there was a mild regression on CT (10.0x5.5x4.4 cm; reduction rate, 26.7%), with decrease of the pleural effusion volume. A CT-guided needle biopsy was performed, but the findings were not conclusive, as most of the tissue was necrotic. Seven days later (13 days after the initial CT), a CT revealed further regression (9.5x5.4x4.2 cm; reduction rate, 34.7%) with disappearance of the pleural effusion. The patient was followed up on an outpatient basis. At 35 days after the initial CT, the tumor continued to shrink without treatment (8.0x3.6x3.0 cm; reduction rate, 73.8%) and the serum CYFRA level had decreased to 0.8 ng/ml, although it had not returned to normal levels. At 62 days after the initial CT, the patient underwent surgical resection. The resected specimen was diagnosed as thymoma (World Health Organization type B2; Masaoka classification, stage II), with prominent degeneration and necrosis. One possible cause of the spontaneous regression may be increased internal pressure, probably associated with rapid tumor growth, leading to massive necrosis with resulting chest pain, inflammatory reaction with pleural effusion and subsequent tumor regression. The serum CYFRA level may be a useful marker for the evaluation of the clinical course of thymoma with extensive necrosis. IntroductionThymoma is derived from thymic epithelial cells and is one of the most common neoplasms in the anterior mediastinum (1). The overall incidence of thymoma is 0.15 cases per 100,000 individuals and the majority of the patients with thymoma or thymic carcinoma are aged 40-60 years (2,3). The World Health Organisation (WHO) classification is based on histological analysis of epithelial cell atypia and the degree of infiltration of non-neoplastic lymphocytes (4). Although the great majority of these tumors exhibit more conventional histological characteristics, unusual types have also been described, such as sclerosing thymoma (5). Spontaneous regression (SR) of thymoma without therapy has been reported, although its incidence is rare (6)(7)(8). This is the case report of a patient with thymoma exhibiting SR and disappearance of the pleural effusion. Case reportA 30-year-old man was admitted to Toho University Omori Medical Center with right chest pain and low-grade fever. The patient was a never-smoker and had no medical history. On physical examination, the temperature was 37.8˚C and the respiratory sounds were clear. A chest X-ray revealed a mass shadow in the right hilum a...

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Section: Introductionmentioning

confidence: 99%

Thymoma exhibiting spontaneous regression in size, pleural effusion and serum cytokeratin fragment level: A case report

Furuya

Isobe

Sano

et al. 2015

Molecular and Clinical Oncology

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“…Previous reports described a significantly better response in type B1 thymoma than in other thymoma subtypes, presumably due to the high content of glucocorticoid-sensitive immature lymphocytes in type B1 thymomas. However, these studies found apoptotic changes not only in lymphocytes but also in the neoplastic thymic epithelial cells [43, 44]. Furthermore, glucocorticoid receptors were identified in cultured human thymic epithelial cells, and it has been shown that low-dose steroids lead to an increased expression of the somatostatin gene in the thymus [30, 45].…”

Section: Discussionmentioning

confidence: 99%

Octreotide LAR and Prednisone as Neoadjuvant Treatment in Patients with Primary or Locally Recurrent Unresectable Thymic Tumors: A Phase II Study

et al. 2016

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Therapeutic options to cure advanced, recurrent, and unresectable thymomas are limited. The most important factor for long-term survival of thymoma patients is complete resection (R0) of the tumor. We therefore evaluated the response to and the induction of resectability of primarily or locally recurrent unresectable thymomas and thymic carcinomas by octreotide Long-Acting Release (LAR) plus prednisone therapy in patients with positive octreotide scans. In this open label, single-arm phase II study, 17 patients with thymomas considered unresectable or locally recurrent thymoma (n = 15) and thymic carcinoma (n = 2) at Masaoka stage III were enrolled. Octreotide LAR (30 mg once every 2 weeks) was administered in combination with prednisone (0.6 mg/kg per day) for a maximum of 24 weeks (study design according to Fleming´s one sample multiple testing procedure for phase II clinical trials). Tumor size was evaluated by volumetric CT measurements, and a decrease in tumor volume of at least 20% at week 12 compared to baseline was considered as a response. We found that octreotide LAR plus prednisone elicited response in 15 of 17 patients (88%). Median reduction of tumor volume after 12 weeks of treatment was 51% (range 20%–86%). Subsequently, complete surgical resection was achieved in five (29%) and four patients (23%) after 12 and 24 weeks, respectively. Octreotide LAR plus prednisone treatment was discontinued in two patients before week 12 due to unsatisfactory therapeutic effects or adverse events. The most frequent adverse events were gastrointestinal (71%), infectious (65%), and hematological (41%) complications. In conclusion, octreotide LAR plus prednisone is efficacious in patients with primary or recurrent unresectable thymoma with respect to tumor regression. Octreotide LAR plus prednisone was well tolerated and adverse events were in line with the known safety profile of both agents.

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“…En 2003, dix cas seulement avaient été rapportés au Japon [5]. Barratt et al avaient rapporté un cas de régression complète d'une tumeur épithéliale thymique de type B1 chez une patiente de 86 ans, après corticothé-rapie [6]. Ils avaient retrouvé trois autres cas identiques dans la littérature.…”

Section: Discussionunclassified

“…L'évolution spontanément régressive et l'ensemble des éléments cliniques, biologiques et radiologiques avaient autorisé une surveillance rapprochée prolongée. Si le phé-nomène de régression spontanée est rare, il pourrait inciter néanmoins à remettre en question le traitement chirurgical d'emblée lorsqu'une diminution de diamètre est observée sur deux scanners successifs et à envisager la surveillance clinique et radiologique comme une alternative chez des patients très sélectionnés [6]. L'exérèse chirurgicale reste le traitement de référence des tumeurs épithéliales thymiques, mais il paraît cependant légitime de reconsidérer l'indication chirurgicale en cas de régression de la lésion et de la réévaluer constamment en fonction de la cinétique de celle-ci.…”

Section: Discussionunclassified

Tumeurs épithéliales thymiques de régression spontanée

Michel

Sanctis

Abdessalem

et al. 2012

Revue des Maladies Respiratoires

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Complete regression of a thymoma to glucocorticoids, commenced for palliation of symptoms

Abstract: A patient is presented with Type B1 thymoma that showed complete regression to oral glucocorticoids commenced for palliation of symptoms. The patient has remained symptom free without radiological recurrence after 12 months.

Cited by 23 publications

References 10 publications

Thymoma exhibiting spontaneous regression in size, pleural effusion and serum cytokeratin fragment level: A case report

Thymoma exhibiting spontaneous regression in size, pleural effusion and serum cytokeratin fragment level: A case report

Octreotide LAR and Prednisone as Neoadjuvant Treatment in Patients with Primary or Locally Recurrent Unresectable Thymic Tumors: A Phase II Study

Tumeurs épithéliales thymiques de régression spontanée

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