Abstract
BackgroundAlthough complete surgical resection of thymic carcinoma is a prognostic factor, it is not always an option for advanced tumors because of locoregional invasion. Extended surgery combined with a major blood vessel procedure remains controversial because of the increased risk of mortality.Case presentationChest computed tomography (CT) uncovered an abnormal shadow in the mediastinum of a 74-year-old man. An irregularly shaped tumor obstructed the left innominate vein, and invasion of the aortic arch was suspected. A CT-guided percutaneous needle biopsy revealed squamous cell carcinoma of the thymus, which was considered unresectable. The patient underwent chemotherapy elsewhere, then was referred to us for surgical resection. We combined extended surgery with total aortic arch replacement under a cardiopulmonary bypass. Complete resection was achieved, and the patient remains alive without recurrence at 3 years after surgeryConclusionResection including aortic arch replacement might be an option that can achieve complete resection of local advanced thymic carcinoma.
Highlights
Complete surgical resection of thymic carcinoma is a prognostic factor, it is not always an option for advanced tumors because of locoregional invasion
Since PET-computed tomography (CT) and brain MRI ruled out metastatic lesions, such as mediastinal lymph node and brain metastases, the tumor was diagnosed as local advanced thymic carcinoma, Masaoka stage III, cT4N0M0 stage IIIB
We previously reported that multimodal treatment offered encouraging results and complete resection increases the survival rate of patients with advanced thymic carcinoma [5]
Summary
Thymic carcinoma is a relatively rare tumor that accounts for 20% of all thymic epithelial neoplasms [1]. Thymic carcinoma tends to be aggressive, with the features of local invasion, intrathoracic lymphadenopathy, and distant metastases. Complete surgical resection is generally a significant prognostic factor for survival. Complete surgical resection is not always an option for treating advanced thymic carcinoma because of locoregional invasion [2]. Case presentation Chest X-rays revealed an abnormal shadow without symptoms such as hoarseness, in a 74-year-old man with a history of rheumatoid arthritis. Chest CT and MRI revealed an irregularly shaped mediastinal tumor measuring 60 × 60 × 55 mm that obstructed the left innominate vein and suspected invasion of the aortic arch. Since PET-CT and brain MRI ruled out metastatic lesions, such as mediastinal lymph node and brain metastases, the tumor was diagnosed as local advanced thymic carcinoma, Masaoka stage III, cT4N0M0 stage IIIB. The patient underwent six cycles of chemotherapy (three cycles each of ADOC and carboplatin/paclitaxel), Kuno et al Surgical Case Reports (2019) 5:198
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