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Ectopic thymoma presenting as a giant intrathoracic mass: A Case Report
© Takenaka et al.; licensee BioMed Central Ltd. 2012
Received: 7 March 2012
Accepted: 16 July 2012
Published: 16 July 2012
Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and, therefore, an intrathoracic origin is considered to be rare. This report presents a case of giant thymoma arising in the thoracic cavity. A 61-year-old male presented with a chronic cough and breathlessness. Chest CT revealed a well enhanced giant mass approximately 18 cm in diameter in the right thoracic cavity. FDG-PET showed that the SUVmax of the tumor was 5.0 in the center and almost 2.5 in the surrounding area. A trans- bronchial needle biopsy was performed to find atypical cells. Surgery was scheduled based on the radiological and histological findings. A well-defined giant mass in the thoracic cavity, measuring 18 × 14.5 × 11 cm had undergone expansive growth without apparent invasion. The tumor was completely resected without combined resection of the other organs. The weight of the tumor was 1350 g. The tumor was histologically diagnosed to be type AB thymoma according to the World Health Organization classification and Masaoka stage IIB.
KeywordsGiant thymoma Intrathoracic tumor Ectopic thymoma
Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and ectopic thymomas account for only 4% of all thymomas . Most ectopic thymomas present as superior or inferior mediastinum tumors, therefore intrathoracic origin was rare [1–3]. Although surgery is the most effective treatment modality for thymomas, in some cases, it is difficult to excise due to involvement of surrounding organs or tumor size. This report presents a case of ectopic thymoma that presented as a giant intrathoracic tumor histologically diagnosed as type AB thymoma and Masaoka stage IIB.
Thymomas develop mainly in the thymus and are usually located in the anterior mediastinum, only 4% of the tumors are ectopic tumors . Ectopic thymomas have been reported in the neck, middle or posterior mediastinum, lung and pleura, a few reports have described giant intrathoracic tumors [2, 3].
FDG-PET showing increased uptake of FDG is suggestive of malignant potential and SUVmax correlates with malignancy in mesenchymal tumors. Several authors reported a significant correlation between the histological subtype of thymicepitherial tumors and FDG-PET accumulation [4, 5]. Who type A, AB and B1 tumors have significantly lower SUV than that of the other types of tumors [4, 5]. In addition, SUVmax has a close correlation with the Masaoka stages . SUVmax of the tumor in the current case was not very high in the proportion to the size. Fortunately, the tumor did not invade the heart or great vessels, therefore curative resection could be performed. The tumor was diagnosed to be type AB thymoma according to the World Health Organization classification and Masaoka stage IIB.
Although thymomas can present as huge masses, the symptoms and stage may not always correlate with tumor size. A large tumor size is a significantly poor prognostic factor of thymomas . Limmer et al. reviewed previously reported giant thymomas . According to the article, all of the giant tumors were type A, AB and B1 according to WHO classification . Interestingly, although a large tumor size is a poor prognostic factor, the resected giant thymomas tended to be low-grade thymomas.
This report presented a very rare case of an intrathoracic giant thymoma, histologically diagnosed as type AB Masaoka stage IIB. Surgical resection must be considered regardless of tumor size if curative resection is possible. FDG-PET is useful modality for preoperatively evaluating the grade of thymomas.
Our Institution and the patient provided Clinical Consent for the publication of this case.
TT: concept and design, writing the article. YH, ST, HM made a critical review of the manuscript. TI: final approval of the article. All authors read and approved the final manuscript.
- Detterbeck FC, Parsons AM: Thymic tumors. Ann Thorac Surg. 2004, 77: 1860-9. 10.1016/j.athoracsur.2003.10.001.View ArticlePubMedGoogle Scholar
- Yamazaki K, Yoshino I, Oba T, Yohena T, Kameyama T, Tagawa T, Kawano D, Koso H, Maehara Y: Ectopic pleural thymoma presenting as a giant mass in the thoracic cavity. Ann Thorac Surg. 2007, 83: 315-7. 10.1016/j.athoracsur.2006.03.092.View ArticlePubMedGoogle Scholar
- Kitada M, Sato K, Matsuda Y, Hayashi S, Tokusashi Y, Miyokawa N, Sasajima T: Ectopic thymoma presenting as a giant intrathoracic tumor: a case report. World J Surg Oncol. 2011, 9: 66-10.1186/1477-7819-9-66.View ArticlePubMedPubMed CentralGoogle Scholar
- Endo M, Nakagawa K, Ohde Y, Okumura T, Kondo H, Igawa S, Nakamura Y, Tsuya A, Murakami H, Takahashi T, Yamamoto N, Ito I, Kameya T: Utility of 18FDG-PET for differentiating the grade of malignancy in thymic epithelial tumors. Lung Cancer. 2008, 61: 350-5. 10.1016/j.lungcan.2008.01.003.View ArticlePubMedGoogle Scholar
- Terzi A, Bertolaccini L, Rizzardi G, Luzzi L, Bianchi A, Campione A, Comino A, Biggi A: Usefulness of 18-F FDG PET/CT in the pre-treatment evaluation of thymic epithelial neoplasms. Lung Cancer. 2011, 74: 239-43. 10.1016/j.lungcan.2011.02.018.View ArticlePubMedGoogle Scholar
- Wright CD, Wain JC, Wong DR, Donahue DM, Gaissert HA, Grillo HC, Mathisen DJ: J Thorac Cardiovasc Surg. Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size. J Thorac Cardiovasc Surg. 2005, 130: 1413-21. 10.1016/j.jtcvs.2005.07.026.View ArticlePubMedGoogle Scholar
- Limmer S, Merz H, Kujath P: Giant thymoma in the anterior-inferior mediastinum. Interact Cardiovasc Thorac Surg. 2010, 10: 451-3. 10.1510/icvts.2009.225557.View ArticlePubMedGoogle Scholar
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