Thymic Carcinoma: 30 Cases at a Single Institution

IntroductionThymic carcinoma is a rare and invasive mediastinal neoplasm that often metastasizes. It constitutes a heterogeneous group of tumors that displays different biologic behavior and prognosis. The clinical prognostic factors and treatment of thymic carcinoma are not yet standardized.MethodsThirty patients with thymic carcinoma have been treated at Nagoya City University Hospital since 1983. The clinical and pathologic data of these patients were retrospectively reviewed. Thirteen cases were considered to be unresectable or inoperable and received chemotherapy or chemoradiotherapy. Seventeen cases underwent resection; total in 7 cases and subtotal in 10 cases. Postoperative irradiation was added as adjuvant therapy in the tolerable cases. The most recent five cases received induction chemotherapy.ResultsIn 17 of the 30 cases, the patients died. The survival periods in the death cases were from 2.4 to 78.1 months (mean, 32.4 months; median, 21.0 months). The observation periods in the 13 live cases were 6.3 to 232 months (average follow-up, 64.6 months). The 5-year survival rate was 47.5%, and median survival time (MST) was 49.0 months. Cases that underwent total resection showed significantly better prognosis than cases with subtotal resection (p = 0.011) and inoperable cases (p = 0.002). The cases that underwent subtotal resection showed significantly better prognosis than the inoperable cases (p = 0.050). The cases with hematogenous metastasis demonstrated significantly poorer prognosis (p = 0.021), but lymphogenous metastasis was not a significant predictor of poor prognosis. Only resectability was a significant prognostic factor in multivariate Cox regression analysis, and the hazard ratio was 5.123.ConclusionsResectability was the only prognostic factor in thymic carcinoma. We suggest the importance of preoperative precise evaluation to exclude unresectable Masaoka stage IVb disease and expect preoperative chemotherapy or chemoradiotherapy to improve the respectability

Micronodular thymoma with lymphoid stroma diagnosed 10 years after the first operation: a case report

Abstract Introduction Micronodular thymoma with lymphoid stroma is a rare subtype of thymoma. Here we report a case of micronodular thymoma with lymphoid stroma that was completely resected after incomplete resection 10 years earlier. Case presentation A 70-year-old Japanese woman who had undergone resection for a thymic cyst 10 years earlier was found to have a solid nodule with a multilocular lesion at the site of the previous operation. We suspected that the tumor was a malignant tumor and performed trans-sternal radical thymectomy and diagnosed the lesion as micronodular thymoma with lymphoid stroma pathologically. When we reassessed the thymic cyst that had been resected 10 years earlier, a few lesions of micronodular thymoma with lymphoid stroma were found in the cyst wall. Based on these findings, we concluded that only the cystic component of micronodular thymoma with lymphoid stroma had been removed, and that the residual lesion grew locally over the next 10 years before being completely resected by reoperation. Conclusion We experienced an unusual case of micronodular thymoma with lymphoid stroma, which is a rare subtype of thymoma. Greater care should be taken to exclude a thymoma with a cystic lesion, even if a thymic cyst is strongly suspected on computed tomography and magnetic resonance imaging

A new approach to left sleeve pneumonectomy: complete VATS left pneumonectomy followed by right thoracotomy for carinal resection and reconstruction

Abstract Background Left sleeve pneumonectomy is a challenging operation that requires individualized approaches. Here, we present a new minimally invasive combined thoracoscopic approach. Case presentation A 61-year-old woman was diagnosed with tracheobronchial adenoid cystic carcinoma. The tumor originated from the left main stem bronchus, and tumor with carinal involvement was observed. We judged that complete resection would be possible via left sleeve pneumonectomy. However, because tumor involvement with the esophagus and descending aorta was suspected, evaluation of resectability in advance was necessary. After confirmation via examination thoracoscopy of no involvement with the surrounding organs, complete VATS left pneumonectomy was performed and followed by right thoracotomy for carinal resection and reconstruction. Conclusions When thoracoscopic surgery becomes mainstream, this minimally invasive combined thoracoscopic approach might be an optimal option for patients who require left sleeve pneumonectomy