Atypical behaviour of thymic carcinoma

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COD: 2321_21_11_2014_ep Categorie: ,

Alberto Oldani, Sergio Gentilli, Manuela Monni, Paolo Bellora, Glenda Grossi,Caterina Casadio, Marcello Garavoglia

Ann. Ital. Chir.Published online (EP) 21 November 2014

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AIM: To describe the case of a thymic carcinoma with atypical clinical behavior that has arisen with a voluminousmetastasis at the right hemidiaphragm while the primitive thymic neoplasm was initially occult.
CASEREPORT: A 42 years female patient came to clinical observation for a voluminous thoraco-abdominal mass locat-ed in right side, infiltrating the diaphragm. The patient was submitted to surgical excision of the mass; definitive his-tological examination: non-keratinizing spinocellular carcinoma suggestive for neoplasia on ectopic thymic tissue or metas-tasis from carcinoma of the thymus. Three 3 months after surgery MR and CT-scan restaging identified the presence ofanterior mediastinal mass of about 3 cm of diameter, compatible with thymical origin; thymectomy was performed (his-tology: Lymphoepithelial thymoma). Eight months after the first surgical procedure a restaging by CT, MR and PET CTshowed the presence of disease recurrence at the right diaphragmatic level. The patient underwent surgical exploration,with right thoracotomic approach: a metastasis in the hepatic segment VII was found and radically removed. Six monthsafter liver metastasis resection, CT scan showed disease progression in mediastinum, with involvement of pericardiumand aorta; the patient died for disease recurrence five months later, 22 months after the first surgical procedure.
CONCLUSION: Thymic neoplasms are the most common tumors of the mediastinum; a small percentage of these tumorsare however extremely aggressive carcinomas. Rare but not exceptional findings are also cancers arising from ectopic thymic tissue.