0
Lung Cancer |

Primary Intrapulmonary Thymoma

Steven Hobson, MD; Terence McGarry, MD; Anatoly Leytin, MD
Author and Funding Information

The Icahn School of Medicine (Elmhurst Hospital), Department of Pulmonary Critical Care Medicine, Elmhurst, NY


Chest. 2014;146(4_MeetingAbstracts):644A. doi:10.1378/chest.1989244
Text Size: A A A
Published online

Abstract

SESSION TITLE: Cancer Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Primary intrapulmonary thymomas are rare ectopic thymic epithelial neoplasms with 32 cases reported to date1. Tumors are identified and characterized with various imaging modalities, whereas microscopic morphology and immunohistochemistry provide diagnosis and staging. Treatment involves surgical excision and, if indicated, adjuvant radiation therapy.

CASE PRESENTATION: 46 year old male with no medical history presented with odonyphagia and weight loss. Physical exam revealed oral candidiasis and clear lung fields. He was HIV negative and had no history of taking immunosuppresive therapy. During the next two months, his candidiasis was refractory to antifungal therapy and he lost an additional 14 pounds. Computed tomography (CT) imaging revealed a right-sided 10.5 cm x 7.4 cm x 10.5 cm intrathoracic mass without contrast enhancement in the anterior mediastinum (Figure 1). Fiberoptic bronchoscopy with transbronchial biopsy and cytology was suggestive of T-Cell Lymphoma, and cytology from a CT-guided needle biopsy also suggested lymphoma. Following surgical excision, pathology confirmed an ectopic thymoma, World Health Organization (WHO) Type B1, while the anterior mediastinum was thymic tissue.

DISCUSSION: An ectopic thymoma is a thymic epithelial neoplasm located outside the anterior mediastinal compartment. The mechanism of disease is unsettled with one hypothesis claiming embryologic displacement during the descent of thymic primordia from the third pharyngeal pouch, while another theorizes origin from uncommitted germinative cells. It has been shown to occur across a broad age range and equally affect men and women. Patients typically present with chronic respiratory complaints such as shortness of breath or chest pain, but they may be asymptomatic or have paraneoplastic syndromes. CT imaging may reveal a well demarcated mass or diffuse pleural thickening with lung encasement2. Histology reveals cell nests composed of epithelial cells and small lymphocytes separated by fibrous stroma. Immunohistochemistry stains are positive for Epithelial Membrane Antigen (EMA) and Cytokeratin AE1/AE31.

CONCLUSIONS: Primary intrapulmonary thymomas are rare - this being the 33rd reported case. The current WHO classification system identifies five histologic subtypes that are based on the morphology of the neoplastic epithelial cells and the lymphocyte to epithelial cell ratio3 (Table 1). 5-yr survivability ranges from 90-100% for Stage 1 lesions. Surgical excision is the standard of care and adjuvant radiation should be considered when there is incomplete excision of mass or signs of extracapsular disease as it has been shown to improve 5-yr survival.

Reference #1: Katsura M, et al. Primary Intrapulmonary Thymoma. Gen Thorac Cardiovasc Surg. 2013 Jun 30.

Reference #2: Marom EM. Advances in Thymoma Imaging. J Thorac Imaging 2013;28:69-83.

Reference #3: Girard N, et al. Thymoma: A Focus on Current Therapeutic Management. J Thorac Oncol. 2009;4: 119-126.

DISCLOSURE: The following authors have nothing to disclose: Steven Hobson, Terence McGarry, Anatoly Leytin

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Topics

thymoma

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Pure red cell aplasia. Blood 2016;128(21):2504-2509.
Rabbit Oncology: Diseases, Diagnostics, and Therapeutics. Vet Clin North Am Exot Anim Pract 2017;20(1):135-182.
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543