Recurrence and Malignant Transformation of Thymoma After 26 Years – A Rare Presentation

Ramseena Ibrahim, Sanjeev Shivashankaran, Jesin Kumar, Ravindran Chetambath

Ramseena Ibrahim, Sanjeev Shivashankaran, Jesin Kumar, Ravindran Chetambath Navaneeth, Sarovaram Road, Calicut, Kerala-673020

Keywords: Thymoma, thymic carcinoma, myasthenis gravis, recurrence

Abstract

Thymoma is a mediastinal tumour with malignant potential, which has a recurrence rate after complete resection ranging from 5 to 50%. It is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum. Here we present an interesting case of a 58 year old female patient on treatment for Myasthenia Gravis for the past 26 years. She had undergone thymectomy with dissection of pericardium and adjacent pleura 26 years back. Now she had presented with worsening myasthenia symptoms, underwent treatment comprising of steroid pulse therapy and plasmapheresis along with regular medications. She was evaluated for left lung collapse, which revealed a thymoma involving left lung and a solitary deposit on the right side probably metastasis. Though the recurrence rate of thymoma is high, this case is unique as it recurred as malignant thymoma after 26 years.

References

1. Wu TH, Jin JS, Huang TW, et al. Ectopic cervical thymoma in a patient with myasthenia gravis. J Cardiothorac Surg 2011;6:89.
2. Jung KJ, Kyung Soo Lee, Han J, Kim J, Tae Sung Kim, Kim EA. Malignant thymic epithelial tumors: CT-pathologic correlation. Am J Roentgenol. 2001; 176(2):433–39.
3. Suster S, Moran CA. Thymic carcinoma: Spectrum of differentiation and histologic types. Pathology 1998;30(2):111–22.
4. Detterbeck FC. Evaluation and treatment of stage I and II thymoma. J Thorac Oncol 2010;5:S318-22.
5. Tsukada J, Hasegawa I, Sato H, et al. Ectopic cervical thymoma located in the carotid triangle. Jpn J Radiol 2013;31:138- 42.
6. Debnath J, Chawla N, Talwar R, et al. Pleural and transdiaphragmatic retroperitoneal metastasis developing two and half years after resection of invasive thymoma. Singapore Med J 2008;49:e64-67.
7. Detterback F. International thymic malignancies interest group; away forward. J thorac Oncol. 2010;5(10 suppl 4):S365- 70
8. Mizuno T, Okumura M, Asamura H, Japanese Association of for research on thymus etal, surgical management of recurrent thymic epithelial tumors, a retrospective analysis based on the Japanese nationwide database. Jthorac Oncol . 2015;10(1):199-205
9. Awad WI, Symmans PJ, Dussek JE. Recurrence of stage I thymoma 32 years after total excision. Ann Thorac Surg. 1998;66(6):2106–108.
10. Hamaji M, Ali SO, Burt BM. A meta-analysis of surgical versus nonsurgical management of recurrent thymoma. Ann Thorac Surg. 2014;98(2):748–55.
11. Huang J, Rizk NP, Travis WD, et al. Comparison of patterns of relapse in thymic carcinoma and thymoma. J Thorac Cardiovasc Surg. 2009;138(1):26–31
12. Muller-Hermelink HK, Strobel P, Zettl A, et al. Combined thymic epithelial tumors. In: Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC, editors. Pathology and genetics: tumours of the lung, pleura, thymus and heart (WHO classification of tumours). Lyon: IARC Press; 2004. p. 196–201.
13. Wright CD, Wain JC, Wong DR, et al. Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size. J Thorac Cardiovasc Surg. 2005;130(5):1413–21.
14. Ruffini E, Filosso PL, Oliaro A. The role of surgery in recurrent thymic tumors. Thorac Surg Clin. 2009;19(1):121–31. 15. Venuta F, Rendina EA, Longo F, et al. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg. 2003;76(6):1866–72.
16. Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;76(3):878–84.