Tumors of the thymus

Abstract

CLINICAL SUMMARYJ.V., a 40-year-old white male with a past medical history of myasthenic symptoms for 15-20 years, underwent a resection of his thymus in March 1986. He was told he had a non-invasive thymoma that required no further treatment. He did well until August 1986, when he noted left shoulder pain. Because his shoulder pain persisted, a bone scan was done in October 1986. This study revealed multiple lesions involving the left clavicle, sternum, spine at the eleventh thoracic and first lumbar vertebrae, both sacroiliac joints, the right iliac crest, and the left ischium. These findings were interpreted as being consistent with diffuse metastatic disease. The left clavicle was biopsied, with the finding of metastatic squamous cell carcinoma. A review of the patient's original thymic pathology revealed anaplastic epithelial thymic carcinoma.The question of whether metastases from a thymic carcinoma could show some degree of differentiation or whether the patient had a new primary squamous cell carcinoma, possibly of head and neck or bronchial origin, was raised. The patient was a non-smoker, had no pulmonary symptomatology, and a negative chest x-ray, so no further pulmonary work-up was pursued. He subsequently underwent biopsy of both the base of tongue and nasopharynx, with no evidence of tumor.The patient was seen in the Rush Medical Oncology Section in late October 1986. At that time he had also developed bilateral hip pain and back pain consistent with the bone scan findings. Medications included Mestinon 60 mg orally (p.0.) four to five times daily and prednisone 30 mg and 10 mg on alternate days, both prescribed for myasthenic symptoms.The physical examination showed a 40-year-old white male with a cushingoid appearance. His eyelids were drooping somewhat, though no other striking motor weahess was present on neurologic examination. The musculoskeletal assessment demonstrated bilateral sacroiliac and hip tenderness on palpation.A diagnosis of metastatic thymic carcinoma was made.He was started on Adriamycin 60 mg/m2 and cisplatin From the Section