Disorders of the Mediastinum |

An Invasive Thymoma Resulting in SVC Syndrome FREE TO VIEW

Kyle Long, MD; Vyacheslav Vilensky, MD; Marina Dolina, MD
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York Hospital, York, PA

Chest. 2015;148(4_MeetingAbstracts):420A. doi:10.1378/chest.2265976
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SESSION TITLE: Disorders of the Mediastinum Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Thymomas and Thymic Carcinomas are rare neoplasms arising in the mediastium from thymic tissue that are often found incidentally but also can be the cause of significant and wide spread symptoms. They are most frequently associated with myasthenia gravis, but also symptoms due to local invasion and mass effect on other mediastinal structures.

CASE PRESENTATION: We present a patient with a past medical history only significant for hypertension use who initially presented to his primary care provider with complaints of chest congestion and upper respiratory infection symptoms. He was initially treated as an outpatient with with antibiotics, but after symptoms failed to resolve he sought additional care. Chest X-ray revealed a large opacity involving the mediastium and left hilum as well as a left sided pleural effusion. A follow-up Chest CT was performed which showed an extensive mass in most of the superior mediastinum that encompased the SVC and extented into the right atrium, along with collapse of the left lung. The patient underwent EBUS with transbronchial aspirations suspicious for malignancy. Several days later a Left Chamberlain procedure was performed and biopsy findings were consistent with WHO B3 likely invasive Thymoma. A PET scan showed that the mass almost completely involved the anterior mediasium, surrounded the aorta, and infiltrated the aorta but no extrathoracic masses Final Staging was IVa and due to the extensive involvment of all mediastinal structures in addition to the size of the mass, the patient was started on chemotherapy with cisplatinum, doxorubicin, and cyclophosphamide; with the plan to reevaluate for possible surgical resection after completion of 3-4 rounds of chemotherapy.

DISCUSSION: Cases of Thymoma are most successfully treated with surgical resection, but in situations such as this, complete resection is often impossible. Current chemotherapy regimens vary slightly but all seem to provide similar percentages of remission and survival time, the addition of methylprednisone in some cases has proved to also be beneficial.

CONCLUSIONS: Thymomas are frequently incidentally found masses that can be resolved successfully with surgery, however because of serious implications that can occur in advanced disease they should be considered frequently in differential diagnoses in order to prevent serious complications from a missed diagnosis.

Reference #1: Thymomas and thymic carcinomas: Clinical Practice Guidelines in Oncology. Ettinger DS, et al; J Natl Compr Canc Netw. 2013 May 1;11(5):562-76.

Reference #2: Clinical management of thymoma patients, Casey EM, et al; Hematol Oncol Clin North Am. 2008 Jun;22

DISCLOSURE: The following authors have nothing to disclose: Kyle Long, Vyacheslav vilensky, Marina Dolina

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