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Thymoma Presenting as a Giant Intrathoracic Mass FREE TO VIEW

Dharani Kumari Narendra, MBBS; Frances Schmidt, MD; Neerja Gulati, MBBS; Setu Patolia, MBBS; Maximo Mora, MD; Rakesh Vadde, MBBS; Saurav Pokharel, MBBS; Danilo Enriquez, MD; Joseph Quist, MD; Vikram Oke, MBBS; Ayyapa Rangaraju Mysore, MBBS; Bikas Bhattarai, MBBS; Jeffrey Wilson
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Interfaith Medical Center, Brooklyn, NY

Chest. 2013;144(4_MeetingAbstracts):609A. doi:10.1378/chest.1703491
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SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

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

INTRODUCTION: Thymoma is a rare neoplasm originating from epithelial cells of thymus. It accounts for 50% of all anterior mediastinal masses, commonly extends to one of the hemithorax but encroaching entire hemi thorax is rare. We report a case of thymoma presenting as a giant intrathoracic mass.

CASE PRESENTATION: 59 Year old African American nonsmoker woman with no significant past medical history referred to pulmonary clinic by her Primary care physician for abnormal chest radiograph(CXR).She complained of cough with mucoid sputum for 4-6 months. On review of symptoms, there was no shortness of breath, fever, chills, weight loss, night sweats, dizziness, chest pain, orthopnea, and lower extremity edema. HIV status was negative. PPD positive but never treated. Physical exam remarkable for thin built lady with decreased air entry at right base of the lung, palpable firm and mobile pelvic mass. Lab data was unremarkable. CXR revealed a large right hemithoracic mass (Image 1).Computerized Tomography(CT) of chest revealed a 15 x9 cm mass occupying majority of the right hemithorax with peripheral infiltration, hilar extension with bronchial occlusion and probable direct mediastinal extension (Image 2). Abdominopelvic CT revealed a large suprahepatic mass and a large pelvic mass. Because bronchoscopy was non diagnostic, the patient underwent CT guided biopsy and pathology confirmed Thymoma, WHO subtype AB (Mixed spindle cells and lymphocytes). PET scan showed the mass standard uptake value of 4.5.In view of ectopic thymoma and Masaoka stage III-IV, patient received neoadjuvant chemotherapy with 4 cycles of cisplatin, etoposide and 6 cycles of cisplatin, Adriamycin and cyclophosphamide, with minimal response on PET scan. Hence the patient underwent surgery with resection of mediastinal mass and total thymectomy. Intraoperatively, a 17 cm mass was found originating from thymus, weighing one kilogram, and well encapsulated, completely excised and resection margins were free of tumor (Masaoka stage I). Pathology confirmed Thymoma WHO subtype A. Repeat CT Chest after 4 months showed no recurrence of the thoracic mass. Uterine mass biopsy was consistent with leiomyoma.

DISCUSSION: Thymoma is a rare neoplasm with indolent nature. Although benign in most cases it has malignant potential due to its local invasion and rare distant metastasis. Surgical resection is the mainstay of treatment. Surgery in our patient was pivotal in staging and management. Tumor histology and invasion are the main predictors of prognosis.

CONCLUSIONS: Thymoma encroaching entire hemithorax is rare and albeit the tumor size, WHO Type A subtype thymomas have an excellent prognosis.

Reference #1: Thymoma: Benign Appearance, Malignant Potential Richard F. Riedel,The Oncologist September 2006 vol. 11 no. 8 887-894

DISCLOSURE: The following authors have nothing to disclose: Dharani Kumari Narendra, Frances Schmidt, Neerja Gulati, Setu Patolia, Maximo Mora, Rakesh Vadde, Saurav Pokharel, Danilo Enriquez, Joseph Quist, Vikram Oke, Ayyapa Rangaraju Mysore, Bikas Bhattarai, Jeffrey Wilson

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