Primary pulmonary thymoma

Primary intrapulmonary thymoma a case report

Primary intrapulmonary thymoma (PIT), defined as the presence of thymoma tissue in the lung without an accompanying mediastinal component, is uncommon and so offers a diagnostic quandary. We describe the case of PIT in an 81-year-old man.

Multifocal Primary Intrapulmonary Thymoma: A rare subtype of ectopic thymoma

Primary Intrapulmonary Thymoma (PIT) is an infrequent ectopic lung tumor that poses a diagnostic dilemma and has a poorly understood origin. We report a previously healthy 61-year-old lady who presented with cough and weight loss for a month. Diagnostic imaging showed a large left upper lobe mass and two multifocal pleural based nodules in the left lower lobe. She underwent Computed Tomography (CT) guided biopsy of the lung mass and histopathological findings was consistent with a combined Type B1 and B2 thymoma. She was planned for 6 cycles of neoadjuvant chemotherapy with the intent of achieving tumor downstaging and resectability. Due to the lack of established evidence for management of unresectable disease, we wish to highlight the importance of multidisciplinary consensus before pursuing multimodality treatment.

AB thymoma revealed by a huge intraparenchymal lung mass: a case report

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum. Unusually it can be found in other locations as well. Ectopic thymoma rarely presents as an intrathoracic tumor. We report a case of ectopic thymoma presenting as a giant right intrathoracic tumor, the patient was 51-year-old, and who was presented with heaviness in chest and breathlessness. Detailed investigation including chest computed tomography scan revealed a well-defined large solid tumor in the right thoracic cavity, in this case, immunohistochemical analysis demonstrated a thymome AB. The tumor was metastatic to the lung. Patient received a neoadjuvant chemotherapy, with favorable evolution.

Primary Intrapulmonary Thymoma Presenting as a Solitary Pulmonary Nodule

Primary intrapulmonary thymoma (PIT) is a very rare lesion of uncertain pathogenesis. PIT should be considered when the histopathological appearance of a lung tumor shows features that are uncommon but similar to those of a thymoma. In this case report, we discuss the case of a 59-year-old female with a solitary pulmonary nodule that was confirmed to be PIT on the basis of pathological tests. Treatment with complete resection showed good results.

Primary Intrapulmonary Spindle Cell Thymoma with Marked Granulomatous Reaction: Report of a Case with Review of Literature

Primary intrapulmonary thymoma is a rare lesion with around 20 cases reported so far in the literature. A pure spindle cell morphology in these lesions is rarer still with only a single case recorded to date. We report herein an interesting case of a 47-yearold-man, status post surgical resection and radiotherapy for a squamous cell carcinoma of the floor of mouth, who was being followed up for a radiologic opacity in the right lower lobe of the lung. The lesion remained stable in size for almost 5 years and then an increase in size was noted. A right lower lobectomy was performed with a preoperative suspicion of metastasis. Histologic and immunohistochemical evaluation revealed a primary intrapulmonary spindle cell thymoma that displayed a prominent granulomatous reaction, a phenomenon not described so far in the literature. We discuss the possible embryologic origins and the pitfalls in diagnosis of these rare neoplasms. The remarkable granulomatous response observed in the tumor raises the possibility that similar lesions might conceivably occur in the thymus as well.

Primary intrapulmonary thymoma

Primary intrapulmonary thymoma (PIT), which is an intrapulmonary tumor without an associated mediastinal component, is rare. We herein report a resected case of PIT in a 55-year-old female who presented with a 2.5 × 2.4 cm mass in the left upper lobe. We also summarize the clinicopathological features and discuss the diagnosis, pathogenesis, and treatment of PIT.

Primary Intrapulmonary Thymomas: Case Report and Review of the Literature

Primary intrapulmonary thymomas (PIT), which are intrapulmonary tumours without an associated mediastinal component, are very rare; only 29 cases of PIT have been described in the literature since 1951. This report presents a case of PIT in a 59-year old Chinese woman with a type A thymoma (including its pathogenesis, clinical pathological characteristics, immunological phenotype, treatment and prognosis), in the context of a review of the current literature. The origin of thymomas in this unusual location remains unknown. In this case, immunohistochemical analysis demonstrated that the epithelial component was strongly positive for cytokeratin and focally reactive for epithelial membrane antigen. It is concluded that PIT should be considered when the histopathological appearance of a lung tumour is not typical of other pulmonary neoplasms. Complete resection appears sufficient in non-malignant tumours, while in cases of partial resection or malignancy, adjuvant radiotherapy should be considered. Long-term regular clinical follow-up is also warranted, due to the risk of late local recurrence.

Primary intrapulmonary thymoma: A systematic review

AIM

This article reviews the literature on the clinical features, diagnosis and management of primary intrapulmonary thymoma.

METHODS

Medline, Embase and Cochrane Library searches were performed on all relevant Anglo-Saxon language articles. The search words included "primary pulmonary thymoma" and "intrapulmonary thymoma". Secondary references were obtained from key articles. Prognostic and treatment strategies were analyzed by the Kaplan-Meier method, comparisons between curves were made using log rank test.

RESULTS

The searches yielded 25 cases of primary intrapulmonary thymoma. Median follow-up was 9 months (1 day to 13 years). At follow-up, 14 patients were tumor free, one patient had a local recurrence 8 years after radiotherapy, one patient responded favorably to radiotherapy, six patients died and three patients were lost to follow-up. The presence of a paraneoplastic syndrome decreased survival (P=0.02), however, histological subgroup (P=0.216), clinical stage (P=0.63) and tumor size (P=0.288) did not affect survival. Survival in surgically managed patients was significantly better than in conservatively managed patients (P=0.039). Adjuvant radiotherapy did not provide any benefit (P=0.4).

CONCLUSION

Complete resection of primary intrapulmonary thymomas appears sufficient in non-malignant tumors. Because of the risk of late local recurrence, long-term regular clinical follow-up is warranted.

Primary intrapulmonary thymoma successfully resected with vascular reconstruction

Primary intrapulmonary thymomas are defined as intrapulmonary tumors without an associated mediastinal component and are very rare. We report a resected case of primary intrapulmonary thymoma with dissection of mediastinal lymph nodes and vascular reconstruction. Because the tumor directly invaded the right brachiocephalic vein, the vein was reconstructed with a graft, and then adjuvant radiation was performed postoperatively. The tumor was diagnosed as a lymphocyte dominant thymoma and B2 type thymoma in the WHO classification. There has been no evidence of recurrence in 6 years. Complete resection of the tumor with vascular reconstruction and adjuvant radiation should be considered in invasive intrapulmonary thymoma.

Cystic sclerosing haemangioma of the lung

AIMS

To present three cases of sclerosing haemangioma of the lung (SHL) with prominent cystic changes.

METHODS AND RESULTS

The patients were three women, 27, 35, and 64 years of age. In two cases, the lesion was found on routine chest X-ray and in both instances the diagnosis of SHL was not entertained in the radiological differential diagnosis. In one case, the finding was discovered on post mortem examination. Grossly, the lesions were well-circumscribed and cystic. Histologically, the tumours were characterized by a dual population of small and large bland-appearing neoplastic cells growing in a predominantly cystic pattern. Immunohistochemical staining for epithelial membrane antigen by tumour cells was consistently positive in all three cases. All tumours were negative for keratin, CD34, factor VIII, and S100. The two patients in whom the lesion was identified ante-mortem are alive and free of disease 4 and 7 years after surgical excision.

CONCLUSIONS

The present cases indicate that sclerosing haemangioma may present as a cystic pulmonary neoplasm; such a presentation should be taken into consideration when assessing cystic pulmonary lesions.

[Thymoma. A retrospective study]

We review cases of thymic cell tumor treated between January 1991 and March 1998. Nineteen of the 23 cases studied involved thymoma. Eight (42%) were asymptomatic, 4 (21%) were associated with myasthenia gravis and 7 (37%) were symptomatic. The most common symptom was non-specific chest pain, reported by 4 (47%) patients with symptoms. Classifying the cases of thymoma by Masaoka's system, we found that 12 were cases of thymoma in stage I (63.2%), 4 in stage II (21.1%) and 3 in stage III (15.8%). No stage IV patients were treated. Treatment consisted of full exeresis of the tumor in 17 (89.5%) cases, partial resection in one case (5.2%) and biopsy of the tumor in one non-resectable, case. Adjuvant radiotherapy was applied in seven cases. Chemotherapy was not prescribed. With follow-up ranging from 9 to 96 months, half the patients survived 21 months after surgery. Among the surviving patients, mortality was nil at the end of the study. The results of microscopic, cytologic and blood analyses were of scarce value in differentiating between benign and malignant tumors, even though p53 and bcl2 antigen positivity and clinical stage have been related to poor prognosis in recent years.