Report of a Case of Thymoma

Abstract

Primary tumors of the thymus are rare. Thymoma or lymphosarcoma is the most frequent and in all probability no neoplasm is so susceptible to radiation. The response is so dramatic that radiation should be always employed in the differential diagnosis of tumors of doubtful nature. Case History Mr. A. T. (Case No. A-16,643), age 42, came to the clinic September 19, 1924, complaining of “heart trouble.” A few days prior to that date he had received in another city a diagnosis of thoracic aneurysm. The family history and past history were unimportant. He felt perfectly well until September, 1923, at which time he began to be troubled with “a cold on the chest” which recurred at frequent intervals for approximately six months. In April, 1924, he noticed that he tired easily, and th er e was a slight loss of weight. Two months later he noticed dyspnea on slight exertion. This was accompanied by wheezing and a feeling of oppression in the chest and by precordial pain radiating down the left arm. In August, 1924, one month before consulting us, he became extremely nervous and the left arm felt numb. He had frequent attacks of vertigo and headache, was able to sleep only in an upright position, and was greatly distressed when lying down. Physical examination revealed many prominent veins over the upper thorax. There was modera te cyanosis. The pupils were equal and reaction was normal. There was marked increase of mediastinal dullness. Bronchial breathing was present in the upper half of the left chest posteriorly. There were no palpable glands. Wassermann reaction on the blood was negative. Complete blood count and urinalysis were normal. Roentgen-ray examination of the chest September 16, 1924 (Fig. 1) , showed a large non-pulsating flattened mass in the mediastinum. A diagnosis of media stinal tumor, probably lymphosarcoma, was made and roentgen-ray therapy advised. The first series of treatments was begun September 21, 1924. Six hundred milliampere minutes at 145,000 volts, 16 inch distance with 0.25 mm. copper on 1 mm. aluminum filtration was administered in the course of four successive days. Half of this dose was given through the front of the chest and half through the back. The patient was requested to return in a month for re-examination. He returned October 21, 1924, one month from the beginning of his first course of treatments, and stated that he “felt like a new man.” The precordial pain, fullness in the chest, numbness in the left arm, dyspnea, wheezing and cough, had completely disappeared. He was able to lie in bed and sleep all night. The enlarged thoracic veins formerly present were no longer visible. A roentgenogram of his chest taken on October 21, 1924 (Fig. 2), showed that in one month the tumor had been reduced to approximately one-sixth of its original size. A second series of roentgen-ray treatments was then given, using the same factors. He returned November 24, 1924.