Abstract
Thymic tumors (for example, thymomas, thymic carcinomas, and thymic neuroendocrine tumors) are rare tumors. Thymic carcinomas are aggressive thymic epithelial neoplasms with a poor prognosis. Cardiac tamponade as a presenting complaint of malignant thymic carcinoma is rare.A 64-year-old woman presented to the emergency department with complaints of progressive exertional dyspnea and chest discomfort. On physical examination, she had diminished breath sounds at the left lung base. The chest x-ray showed a mediastinal widening, significant cardiomegaly, and pleural effusion. CT scan of the chest revealed a dominant mediastinal mass, left-sided pleural effusion, and pericardial effusion. Transthoracic echocardiogram showed 3 cm circumferential pericardial effusion, with evidence of cardiac tamponade. An emergent pericardiocentesis and thoracentesis were done. A core needle biopsy of the mediastinal mass revealed a high-grade non-keratinizing squamous cell thymic carcinoma. Immunohistochemistry staining was positive for pan-cytokeratin, high molecular weight cytokeratin, CK 5/6, E-cadherin, p63, epithelial membrane antigen (EMA), and BerEp4. The patient had repeated hospital admissions due to recurrent malignant pericardial effusion and left pleural effusion. The patient was planned for radiation and chemotherapy with oncology.In our review of literature, the primary squamous cell thymic carcinoma presenting initially as a cardiac tamponade was found to be a rare event. Early diagnosis and treatment are of utmost importance given the aggressive clinical course culminating in to poor outcome.
Highlights
Thymic neoplasms are exceedingly rare tumors with an estimated incidence of less than 1% of all the adult cancers
We present a case of a 64-year-old with a cardiac tamponade of unknown origin and found to have high-grade malignant thymic carcinomas (TCs)
TCs tend to be more aggressive and are known for cellular atypia as well as lymphatic and hematogenous metastatic spread resulting in a poor prognosis [2]
Summary
Thymic neoplasms are exceedingly rare tumors with an estimated incidence of less than 1% of all the adult cancers. A Rare Case of Malignant Thymic Carcinoma Presenting as Recurrent Pericardial Effusion and Tamponade. How to cite this article Rai M, Keogh A (July 24, 2020) A Rare Case of a High-Grade Thymic Squamous Cell Carcinoma Presenting as Cardiac Tamponade. The patient was discharged and had an outpatient mediastinal mass core biopsy It revealed high-grade non-keratinizing squamous cell TC (Figure 4). A PET-CT scan showed an increased size of the hypermetabolic anterior mediastinal mass (11.5 cm transverse and 6.1 cm anteroposterior dimension), with a maximum standardized uptake value (SUV) 16.9. It revealed a new hypermetabolic (maximum SUV 16.9), marked pleural thickening throughout the left hemithorax periphery consistent with the pleural extension of disease (Figure 9). The patient succumbed to the disease before the therapy could be instituted
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