Intrapulmonary metastasis developing eighteen years after complete resection of thymoma

We present a case of intrapulmonary metastasis developing 18 years after complete resection of thymoma. An 8 mm nodule in the lower lobe of the left lung was noted on chest X-ray in a 76-year-old woman who had undergone complete resection of Masaoka’s stage II thymoma 18 years earlier. Since the nodule grew to 17 mm during a 2-year follow-up, wedge resection was performed. The lesion was histologically diagnosed as an intrapulmonary metastasis from thymoma. Extremely late recurrence after complete resection of thymoma is discussed.     

Metastatic lung tumor developing 15 years after resection of invasive thymoma

A 57-year-old man with myasthenia gravis had undergone extended thymothymomectomy for invasive thymoma and postoperative irradiation 15 years ago. At present, an abnormal shadow on his left lung field on chest X-ray and an elevated SCC-Ag level led us to suspect primary lung cancer (squamous cell lung cancer). He underwent left lower lobectomy and partial resection of the upper lobe. After the operation, this tumor was indentified pathologically as a thymoma. Comparing this tumor with the previous invasive thymoma, we concluded that the present lesion was a metastasis of the former thymoma. This case suggests that a metastatic lung tumor should be suspected when an abnormal shadow is detected on chest X-ray following extended thymothymomectomy for invasive thymoma.     

Metastatic lung tumor developing 15 years after resection of invasive thymoma]

A 57-year-old man with myasthenia gravis had undergone extended thymothymomectomy for invasive thymoma and postoperative irradiation 15 years ago. At present, an abnormal shadow on his left lung field on chest X-ray and an elevated SCC-Ag level led us to suspect primary lung cancer (squamous cell lung cancer). He underwent left lower lobectomy and partial resection of the upper lobe. After the operation, this tumor was identified pathologically as a thymoma. Comparing this tumor with the previous invasive thymoma, we concluded that the present lesion was a metastasis of the former thymoma. This case suggests that a metastatic lung tumor should be suspected when an abnormal shadow is detected on chest X-ray following extended thymothymomectomy for invasive thymoma.     

Adjuvant radiotherapy after complete resection of thymoma.

Seventy patients were studied after undergoing complete resection of thymoma to determine the effect of postoperative adjuvant mediastinal radiotherapy on prognosis, with regard to clinical stage, histological type, and pleural factor. Pleural factor was defined as follows: p0, no adhesion to the mediastinal pleura; p1, fibrous adhesion to the mediastinal pleura without microscopic invasion; and p2, microscopic invasion of the mediastinal pleura. Recurrence of thymoma after complete resection was observed in 13 patients, 12 (92%) with pleural dissemination, 6 (46%) with local recurrence, and 2 (15%) with distant metastasis (types of recurrence are overlapping). In stage I and stage II p0 patients, no recurrence was observed, regardless of mediastinal radiotherapy. Whereas mediastinal irradiation completely prevented recurrence in stage II p1 patients, 4 (36.4%) nonirradiated stage II p1 patients experienced recurrence. In stage II p2 patients, 75% had pleural dissemination even after radiotherapy. A high incidence of recurrence was also observed in stage III, nonirradiated (25%) and irradiated (30%) patients. The results suggest that mediastinal irradiation for stage I and II p0 patients is not always necessary, and that therapy for stage II p1 is essential and also expected to decrease the recurrence rate. On the other hand, in stage II p2 and stage III thymomas, mediastinal irradiation is not sufficient to prevent pleural recurrence even after complete resection. Our classification based on pleural factor is useful for better selection of appropriate postoperative treatment for thymoma patients.     

Renal oncocytoma followed for eighteen years without resection

The natural history of unresected renal oncocytomas is unknown. We report a renal oncocytoma which was mistakenly diagnosed as benign renal cyst and followed up for eighteen years. We are unable to find other oncocytomas without resection which were followed up. The apparent lack of change in size over eighteen years supports the concept of slow growth. Malignant histologic characteristics confirm the potential for malignant degeneration in what is generally considered to be a benign lesion.     

A rare case of hepatic metastasis 20 years after surgical resection of a thymoma: A case report

IntroductionThymoma is the most common solid, primary mediastinal tumour, accounting for 20% of mediastinal neoplasms. Malignant thymus tumours (thymomas and thymic carcinomas) metastasize primarily locally. Distant metastases, especially to liver are very rare.Presentation of caseWe review the case of a 59 year-old female patient, who underwent resection of the thymus with a diagnosed type B2 thymoma 20 years ago. The patient was referred to our hospital with a newly discovered space-occupying lesion in the liver, which had been detected in a routine follow-up magnetic resonance imaging scan. Since a malignant tumour of the liver could not be excluded, a conventional left hemihepatectomy was performed. Histological examination revealed a liver metastasis of the type B2 thymoma, which had been removed 20 years ago.Clinical discussionThe case was discussed in the interdisciplinary tumour board. Based on the very long history of the primary removal of the thymoma as well as the R0 resection of the liver metastasis, a follow-up regimen with CT scans on a regular basis was recommended.ConclusionsNewly discovered lesions of the liver in patients even with a long history of a thymoma should raise the suspicion of a liver metastasis that should be surgically resected as the therapy of choice. Further, this case indicates the importance for long-term radiographic follow-up.     

Testicular metastasis 10 years after resection of appendiceal carcinoid

Testicular carcinoids are very rare and account for less than 1% of all testicular neoplasms. They may present as primary testicular tumors or secondary tumors from extratesticular sources. We report a case of a secondary testicular carcinoid occurring 10 years after surgical treatment of an appendiceal carcinoid. The patient underwent radical orchiectomy and at 24 months of follow-up had no evidence of metastases elsewhere. Because secondary carcinoids have a worse clinical course and prognosis than primary tumors, metastatic disease should be excluded before the tumor is identified as a primary. Long-term follow-up is necessary for patients with carcinoid tumor owing to its indolent course and the risk of metastasis several years after treatment of the primary.     

胸腺瘤切除术后重症肌无力的临床分析

目的 探讨胸腺瘤切除术后出现重症肌无力(MG)患者的临床病理特点。方法 回顾性分析15例胸腺瘤切除术后出现MG患者的临床资料,并与同时期手术平均随诊5．5年未发现：MG的全部112例单纯胸腺瘤患者的临床资料比较。15例胸腺瘤切除术后出现MG患者中女性9例、男性6例;胸腺瘤Masaoka分期Ⅰ期7例、Ⅱ期4例、Ⅲ期4例;上皮细胞型3例、淋巴细胞型4例、混合型7例、不定1例。平均随诊时间为76．7个月(8～178个月)。结果 (1)胸腺瘤切除术后出现MG的时间为术后麻醉苏醒时至术后137个月(平均33．9个月),MG症状完全缓解时间平均为术后30．9个月(0．5～120个月);(2)麻醉苏醒时即出现：MG的4例患者中,均使用了非去极化肌松剂;(3)术后放射治疗患者中3例出现MG(3／67),出现时间平均为治疗第24天,已照剂量平均为36 Gy;(4)女性、病程较长,混合型,肿瘤较大,病期稍晚者,可能有发生术后MG的倾向。结论 手术、术后放射治疗及麻醉中肌松药选择和剂量控制,均可影响术后MG的发生。     

Evaluation of the prognostic factors after thymoma resection

We discuss the prognostic factors of thymoma clinicopathologically. Regarding the survival rate by the clinical stage classification of Masaoka, significant correlation was made between stage I and stage III (P < 0.05) and stage I and stage IVa (P < 0.03). The tumor resectability was classified into complete and incomplete resection, and a significant difference was shown by the survival rate of the complete resection at P < 0.0001. Regarding the survival rate by the invasive organ of the tumor, significant correlation was made between no invasion and the great vessel invasion (P < 0.0004) and between invasion except for the great vessel and great vessel invasion (P < 0.004). As for the histological type, the tendency in which the epithelial cell type predominancy increased with the progress of the clinical stage was shown. A significant correlation was not shown in the evaluation by adjuvant therapy. However, recently we have done chemotherapy and/or radiotherapy periodically for invasive thymoma.     

Recurrence of stage I thymoma in sternum, 13 years after "complete" excision.

Recurrence after complete excision of non-invasive thymoma is infrequent. We report a case of recurrent thymoma in the sternum in a 76-year-old man 13 years after complete surgical resection of stage I thymoma.     

Oral erosive lichen planus regression after thymoma resection

Thymomas are neoplasms known to be frequently associated with autoimmune disorders. Oral lichen planus is an immunologically based, chronic inflammatory oral mucosal disease of undetermined cause. We describe a 79-year-old patient with a 6-month history of generalized oral erosive lichen planus in whom a chest roentgenogram led to the discovery of an anterior mediastinal mass consistent with thymoma. Transsternal complete thymoma resection achieved erosive oral lichen planus regression. The clinical correlations between erosive oral lichen planus and thymoma are presented.     

Sacral chordoma developing two years after low anterior resection for rectal cancer

A 43-year-old male with sacral chordoma associated with rectal cancer is herein reported. A presacral tumor with extensive destruction of S4 and S5 was found 2.5 years after a low anterior resection for advanced rectal mucinous carcinoma. Under the preoperative diagnosis of a solitary sacral metastasis of rectal cancer, the lower sacral segments together with the tumor were removed by amputation at S3. Histologically, the tumor was a chordoma composed of polyhedral cells with an abundant eosinophilic cytoplasm mixed with typical vascuolated physaliferous cells within a myxoid matrix. Colorectal cancer associated with an extracolic primary malignant neoplasm is not uncommon; however, this is only the second case of colorectal cancer associated with chordoma to the best of our knowledge.     

Assessment of the prognostic role of neutrophil-to-lymphocyte ratio following complete resection of thymoma

Background

The introduction of the new TNM staging system for thymic epithelial malignancies produced a significant increase in the proportion of patients with stage I disease. The identification of new prognostic factors could help to select patients for adjuvant therapies based on their risk of recurrence. Neutrophil-to-lymphocyte ratio (NLR) has recently gained popularity as reliable prognostic biomarker in many different solid tumors. The aim of this study is to assess the utility of NLR evaluation as a prognostic marker in patients with surgically-treated thymoma.

Methods

A retrospective analysis was conducted among patients who underwent resection for thymoma in a single center. Patients were divided in two groups, under (low-NLR-Group?=?47 patients, 60%) and above (high-NLR-Group?=?32 patients, 40%) a ROC-derived NLR cut-off (2.27). Associations with clinical-pathological variables were analyzed; disease-free survival (DFS) was identified as the primary endpoint.

Results

Between 2007 and 2017, 79 patients had surgery for thymoma. Overall 5-year DFS was 80%. Univariate survival analysis demonstrated that NLR was significantly related to DFS when patients were stratified for TNM stage (p?=?0.043). Five-year DFS in the low-NLR-Group and in the high-NLR-Group were respectively 100 and 84% in stage I-II, and 66 and 0% in stage III. TNM stage resulted as the only independent prognostic factor at multivariate analysis, with hazard ratio of 3.986 (95% CI 1.644–9.665, p?=?0.002).

Conclusions

High preoperative NLR seems to be associated to a shorter DFS in patients submitted to surgery for thymoma and stratified for TNM stage.

     

Endobronchial metastasis from adenocarcinoma of gastric cardia 7 years after potentially curable resection

Endobronchial metastasis (EBM) is a rare form of metastasis from extrapulmonary malignant tumors, although there are few reports of EBM from gastric cancer specifically. We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography. On diagnosis of primary lung cancer, she underwent pulmonary lobectomy, but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer. Six months later, she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen. She is still alive at 33 mo after the lobectomy. Generally, the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival. Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.     

Appearance of thymoma 15 years after extended thymectomy for myasthenia gravis without thymoma.

Several cases of thymoma recurrence after resection have been reported. However, thymoma appearance following an extended thymectomy for non-thymomatous myasthenia gravis is very rare. We report a case of thymoma in a 48-year-old woman, 15 years after an extended thymectomy for non-thymomatous myasthenia gravis. The importance of a complete dissection of mediastinal adipose tissue during the extended thymectomy as well as careful follow-up for such patients is also noted.     

Comparison of stages I-II thymoma treated by complete resection with or without adjuvant radiation

BACKGROUND: Adjuvant radiation after resection of Masaoka stage II thymoma is widely advocated, but the evidence supporting it is controversial. Studies addressing this issue generally report few patients and lump all patients beyond stage I together in the analysis. METHODS: We retrospectively compared outcomes of stage I and II thymomas treated by resection alone with thymomas treated by resection plus radiation. Histology was re-reviewed to confirm pathologic staging and resection margin status. RESULTS: Between February 1992 and 2002, we performed 167 resections for thymoma. Of these, 70 patients were believed to have tumors in stage IIb or less intraoperatively, and all of these patients underwent complete resection. We reviewed the histopathology of 62 of 70 patients. Thirty thymomas demonstrated less than complete transcapsular microscopic invasion (stage I) and 40 thymomas demonstrated microscopic transcapsular invasion or macroscopic invasion into surrounding fatty tissue (stage II). Forty-seven patients underwent surgery without postoperative mediastinal radiotherapy. Dosages in the 23 radiated patients (3 stage I and 20 stage II) consisted of 45 to 55 Gy. Median follow-up was 70.3 months. Stage II patients who were radiated (n = 20) and those who were not radiated (n = 20) consisted of identical proportions in stages IIa and IIb. Two patients recurred (1 unradiated stage I patient and 1 radiated stage IIb patient). Overall 5-year survival rate was 91%. All who died were free of recurrence at time of death. Log-rank test showed no difference in Kaplan Meier survival curves (p = 0.32) between the radiated and unradiated groups. CONCLUSIONS: These data support the contention that margin-negative surgical resection alone is sufficient treatment for both stages I and II thymoma.