Rarity among the rare-large and invasive thymoma, a case report and review

Abstract

Thymomas are rare tumors of the thymic epithelium with an incidence of 1.5 cases in a million, with a wide spectrum of morphological, pathologic characteristics, and clinical presentations. Despite its benign histological appearance, it can invade nearby structures or metastasize hence clinicians need to have a high index of suspicion for early diagnosis. The natural history of the disease is seldom predictable and ranges anywhere from indolent to aggressive malignant course. In this review, we report a case of invasive thymoma in a patient whose presenting complaint was intermittent chest pain x 2 years that had gone undiagnosed. Complete surgical resection is the cornerstone of treatment in early presentation, but with the case of our patient who presented with a locally advanced thymoma treatment, her treatment options were challenging and had to be a multimodal approach with a combination of surgery, chemotherapy and radiation therapy to reduce the chances of recurrence and improve survival. Given the rarity of this presentation, the clinicopathological characteristics that influence the survival of patients with these tumors are still under debate, and guidelines for management for advanced disease are yet to be defined hence warranting our review on this discussion.

Mediastinal Tumor Thymoma Type B1 T4N2M1B Stage IVB with Multimodality Therapy

“…The prognosis of thymoma depends on the staging, histopathological cell type and the resection status of the tumor. The higher the staging, the worse the prognosis, and histopathological cell types with type A thymoma have a good prognosis with 5 years survival 100% and 10 years survival 95% and type C has the worst prognosis with 5 years survival 23% [7]. Therefore, the authors are interested in bringing up a case report of a mediastinal thymoma type tumor at a young age with multimodality therapy.…”

A huge thymoma accidentally discovered during minimally invasive aortic valve surgery

“…Although neoplasms of this type are well known in thoracic surgery, they are a rare condition in cardiac surgery [ 3 ]. Due to slow growth, they can be unrecognized for an extended period, and usually patients are asymptomatic in the early stages of the disease [ 6 ]. Tumours can be accidentally detected through routine computed tomography (CT) and magnetic resonance imaging (MRI) before and during cardiac surgery [ 2 ].…”

“…If surgery is an option for the treatment of thymic neoplasm, the usual approach is medial sternotomy [ 6 ]. In our case, we performed partial upper sternotomy, as a routine step for minimally invasive aortic valve surgery, and we decided to perform a thymectomy through this surgical approach.…”