Cardiothoracic Surgery |

Multimodal Radical Treatment of a Stage IVa Thymoma: A Case for Pleuropneumonectomy FREE TO VIEW

Rocio Carrera-Ceron, MD; Juan Jacinto-Tinajero, MD; Luis Marcelo Argote Greene, MD; Patricio Santillán Doherty, PhD
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Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico

Chest. 2014;145(3_MeetingAbstracts):41A. doi:10.1378/chest.1823710
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SESSION TITLE: Surgery Cases

SESSION TYPE: Case Reports

PRESENTED ON: Sunday, March 23, 2014 at 09:00 AM - 10:00 AM

INTRODUCTION: Thymoma show a variable and unpredictable evolution, ranging from an indolent non-invasive attitude to a highly infiltrative and metastasising one. For invasive thymoma, the optimal treatment method remains controversial. We present the case of a woman with a thymoma with pleural and pericardial dissemination who received multimodality therapy.

CASE PRESENTATION: A 46-year-old woman was admitted to our hospital with a one year history of pain in the left arm and dorsal region, accompanied by dyspnea and weight loss of 6 Kg. A chest CT scan revealed abundant left pleural effusion and multiple nodules throughout the pleural cavity and in the left upper lobe; probable clinical diagnosis was mesothelioma. On thoracocentesis hematic fluid was negative for malignant cells. Left thoracosopy with pleural biopsy and talc pleurodesis was performed. Final pathology showed a lymphocytic type B1 thymoma of the WHO classification, metastatic to pleura; Masaoka stage IVa. Systemic chemotherapy with cisplatin, doxorubicin and cyclophosphamide was administered during 3 cycles with partial response. Subsequently, PET-CT scan demonstrated a slight decrease of the lesion with intense metabolic uptake in all lesions within the pleura and a hypermetabolic mediastinal mass became apparent due to absence of pleural fluid. Radical resection was proposed after a thorough clinical assessment. A left pleuropneumonectomy with resection of the thymoma, pericardium, diaphragm and rib was performed. Pathology was lymphocyte-rich thymoma (WHO B1) widely invasive to the pleura, extended to the skeletal muscle of diaphragm, mediastinal tissue and lung, without vascular or lymphatic invasion (Masaoka’s stage IVa). Reconstruction of the diaphragm was achieved with a dual Polypropylene-Goretex mesh. The patient was discharged on the ninth postoperative day. She has completed radiation to the thorax with 6 Gy. Ten months post pleuropneumonectomy a thoracic CT-scan is free of disease.

DISCUSSION: The treatment of thymomas involves combinations of surgery, radiation, and chemotherapy depending mostly by the stage of the disease. Although surgical resection is considered the treatment of choice for thymoma, the standard therapy for thymoma with pleural and pericardial dissemination has not been established. It is also know that thymomas have a propensity for late recurrence even after complete resection, so it is very important to monitor closely the clinical outcome of the patients.

CONCLUSIONS: Multimodal treatment of extensive Masaoka IVa thymoma with chemotherapy, pleuropneumonectomy and radiation can be an option in selected cases prolonging the survival of these patients.

Reference #1: Venuta F, Anile M, Diso D, et al. Thymoma and thymic carcinoma. Eur J Cardiothorac Surg 2010;37:13-25.

DISCLOSURE: The following authors have nothing to disclose: Rocio Carrera-Ceron, Juan Jacinto-Tinajero, Luis Marcelo Argote Greene, Patricio Santillán Doherty

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