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Recurrent Type B1 Stage 1 Thymoma in Lung in a Young Woman FREE TO VIEW

Shipeng Yu, MD; Michael Apostolis, MD; Ahmed Abdelkarim, MD; Vasuki Anandan, MD; Michael Hake, MD; Nauman Siddiqui, MD; Cheryl Chen, BS; Youngsook Yoon, MD
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University of Toledo Medical Center, Toledo, OH

Chest. 2013;144(4_MeetingAbstracts):965A. doi:10.1378/chest.1698582
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SESSION TITLE: Miscellaneous Student/Resident Case Report Posters II

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Thymoma is a rare tumor derived from thymus epithelial cells and occurs mostly in patients between 40 and 60 years old with slight male predominance; Up to 50% of patients with thymoma have myasthenia gravis symptoms. The stage of disease and tumor histology are two main factors influencing prognosis.

CASE PRESENTATION: A young female patient was diagnosed with WHO Type B1 Masaoka stage 1 thymoma at 26 years old and also had myasthenia gravis at the time of diagnosis. She then underwent a complete surgical resection of thymoma immediately. However, patient had respiratory failure requiring intubation and MICU admission 6 month after surgery, which resolved after 6 plasma exchange. She did well on anticholinesterase agents and chronic immunomodulating treatments for 7 years thereafter. Then she had myasthenia gravis exacerbation and was found to have a recurrent thymoma in the right lower lobe of lung; The recurrent thymoma is surgically resected and is found to be histologically more aggressive than the primary thymoma (recurrent thymoma is type B3).

DISCUSSION: It was reported that WHO Type A, AB and B1 thymoma mostly presents as Masaoka stage 1 and 2 disease, for which total surgical resection is feasible and desired; Stage 1 thymoma presents with an excellent prognosis and relapses or recurrences are rare, reported to be about 0% ~ 3% after total surgical resection. The recurrence rate for B1 thymoma varies between 0-9% and the time for relapse is about 13 months to 25 years. In patients with recurrent thymoma, the rate associated with myasthenia gravis ranges from 54% to 93%; but there is no significant difference in recurrent rate between MG and non-MG thymomas1. And furthermore, the recurrence of thymoma in patients with MG can be either symptomatic, e.g. MG symptom exacerbation which is reported to be in 54% patients with MG1, or asymptomatic.

CONCLUSIONS: Thymoma is a rare tumor, but the recurrent thymoma can be more histologically aggressive than the primary tumor. It is therefore warranted that annual image in thymoma patient after total surgical resection, even for type B1 or stage I thymoma, as the recurrence can be asymptomatic, with time for relapse varied in a big range, from 1 to 25 years, and the recurrent thymoma can be more aggressive histologically.

Reference #1: Haniuda, M., et al. (2001). "Recurrence of thymoma: clinicopathological features, re-operation, and outcome." J Surg Oncol 78(3): 183.

DISCLOSURE: The following authors have nothing to disclose: Shipeng Yu, Michael Apostolis, Ahmed Abdelkarim, Vasuki Anandan, Michael Hake, Nauman Siddiqui, Cheryl Chen, Youngsook Yoon

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