Introduction: Thymoma is a rare tumour arising from anterior mediastinum. Surgery for early stages and multimodal management for the advanced ones can provide a durable remission of disease. Even many years after the first presentation, Thymomas can show metastatic spread. CASE Ten years ago a 55-years old woman came to our observation for a large mediastinal mass associated with multiple pleural lesions. Diagnosis of Thymoma was achieved by a transthoracic biopsy. After induction chemotherapy with remarkable debulking, we performed an extended thymectomy combined with a left pleuro-pneumonectomy. Masaoka staging was IVa. All the resection margins were negative. Follow-up was negative for 5 years until an abdominal CT-Scan revealed a splenic mass of about 3 cm: splenectomy was then performed. Two years later, a PET-Scan found a bone metastasis in a lumbar vertebra; after radiotherapy, a CT-PET Scan showed a left paracholic hypermetabolic spot, surgically removed by omental partial resection . To date the patient is disease-free . Discussion: In advanced staged Thymomas, recurrences may occur in up to 50% of patients. Recurrence, if operable, should be surgical eradicated, offering good long-term survival. The exceptional nature of our case lies in the long disease-free period, in the site of the metastases and in the final outcome which was beyond all expectation.

Unusual Methastatic Spread from Resected Masaoka IVa Thymoma

CASSANELLI, NICOLA;DAVOLI, FABIO;LUCIANO, GIULIA;DOLCI, GIAMPIERO;BINI, ALESSANDRO;STELLA, FRANCO
2010

Abstract

Introduction: Thymoma is a rare tumour arising from anterior mediastinum. Surgery for early stages and multimodal management for the advanced ones can provide a durable remission of disease. Even many years after the first presentation, Thymomas can show metastatic spread. CASE Ten years ago a 55-years old woman came to our observation for a large mediastinal mass associated with multiple pleural lesions. Diagnosis of Thymoma was achieved by a transthoracic biopsy. After induction chemotherapy with remarkable debulking, we performed an extended thymectomy combined with a left pleuro-pneumonectomy. Masaoka staging was IVa. All the resection margins were negative. Follow-up was negative for 5 years until an abdominal CT-Scan revealed a splenic mass of about 3 cm: splenectomy was then performed. Two years later, a PET-Scan found a bone metastasis in a lumbar vertebra; after radiotherapy, a CT-PET Scan showed a left paracholic hypermetabolic spot, surgically removed by omental partial resection . To date the patient is disease-free . Discussion: In advanced staged Thymomas, recurrences may occur in up to 50% of patients. Recurrence, if operable, should be surgical eradicated, offering good long-term survival. The exceptional nature of our case lies in the long disease-free period, in the site of the metastases and in the final outcome which was beyond all expectation.
23rd National Congress of the Italian Society of Young Surgeon (SPIGC)
246
246
N. Cassanelli; F. Davoli; G. Luciano; G. Dolci; A. Bini; F.Stella
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11585/101936
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