Hülya BAYİZ, Deniz KÖKSAL, Ebru ÇAKIR, Bahadır BERKTAŞ, Mine BERKOĞLU, Neslihan MUTLUAY, Mahmut GÜLGÖSTEREN, Ebru BOYACI, Nihal BAŞAY

Recurrence of thymoma after 11 years presenting as diffuse pleural thickening

Elli yaşında erkek hasta bir aydır olan nefes darlığı, kilo kaybı ve plöretik göğüs ağrısı yakınmasıyla başvurdu. Doğumdan sonra 12 yaşına kadar çevresel asbest maruziyeti vardı. Öz geçmişinde hastanın 11 yıl önce minimal invaziv lenfositik timoma tanısıyla maksimal timektomi operasyonu geçirdiği ve adjuvant radyoterapi aldığı öğrenildi. Toraks bilgisayarlı tomografide sol akciğeri tümüyle çepeçevre saran plevral kalınlaşma ve efüzyon izlendi. VATS-plevral biyopsi ile invaziv timoma, Tip B1, evre IVA tanısı konuldu. Sonuç olarak, difüz plevral lezyonların ayırıcı tanısında invaziv timoma da akılda tutulmalıdır. Tam rezeksiyon sonrası olan timoma nüksleri 10 yıl kadar uzun olabilmektedir.

Difüz plevral kalınlaşma ile prezente olan 11 yıl sonra nüks eden timoma olgusu

A 50-year-old man presented with a 1-month history of dyspnea, weight loss, and pleuritic chest pain. He had environmental asbest exposure from birth to 12 years-old. Past medical history revealed maximal thymectomy operation and adjuvant radiotherapy with the diagnosis of minimally invasive lymphocytic thymoma 11 years ago. Thorax computerized tomography demonstrated a circumferential pleural thickening encasing the entire left lung and pleural effusion. VATS-pleural biopsy revealed the diagnosis invasive tymoma, Type B1, stage IVA. In conclusion, the diagnosis of invasive thymoma must be kept in mind in the differential diagnosis of diffuse pleural lesions. The recurrence of thymomas may be as long as 10 years after complete resection.

PDF

___

1. Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer 2003; 105: 546-51.
2. Lewis JE, Wick MR, Scheithauer BW, Bernatz PE, Taylor WF. Thymoma. A clinicopathologic review. Cancer 1987; 60: 2727- 43.
3. Verstandig AG, Epstein DM, Miller WT Jr, Aronchik JA, Gefter WB, Miller WT. Thymoma-report of 71 cases and a review. Crit Rev Diagn Imaging 1992; 33: 201-30.
4. Zerhouni EA, Scott WW Jr, Baker RR, Wharam MD, Siegelman SS. Invasive thymomas: diagnosis and evaluation by computed tomography. J Comput Assist Tomogr 1982; 6: 92-100.
5. Moran CA, Travis WD, Rosado-de-Christenson M, Koss MN, Rosai J. Thymomas presenting as pleural tumors. Report of eight cases. Am J Surg Pathol 1992; 16: 138-44.
6. Vural M, Abali H, Oksuzoglu B, Akbulut M. An atypical presentation of thymoma with diffuse pleural dissemination mimicking mesothelioma. Cancer Invest 2006; 24: 615-20.
7. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981; 48: 2485-92.
8. Sahn SA. Malignant pleural effusions. In: Fishman AP, Elias JA, Fishman JA, Grippi MA, Kaiser LR, Senior EM (eds). Pulmonary Diseases and Disorders. 3rd ed. New York: McGrawHill, 1998: 1429-38.
9. Senyigit A, Dalgic A, Kavak O, Tanrikulu AC. Determination of environmental exposure to asbestos (tremolite) and mesothelioma risks in the southeastern region of Turkey. Arch Environ Health 2004; 59: 658-62.
10. Metintas M, Metintas S, Ak G, Erginel S, Alatas F, Kurt E, et al. Epidemiology of pleural mesothelioma in a population with non-occupational asbestos exposure. Respirology 2008; 13: 117-21.
11. Ruffini E, Mancuso M, Oliaro A, Casadio C, Cavallo A, Cianci R, et al. Recurrence of thymoma: analysis of clinicopathologic features, treatment, and outcome. J Thorac Cardiovasc Surg 1997; 113: 55-63.
12. Reddy RH, Shah R, Kumar B, Thorpe JA. Recurrence of stage I thymoma in sternum, 13 years after "complete" excision. Eur J Cardiothorac Surg 2003; 23: 134-5.
13. Hansel DM, Armstrong P, Lynch DA, McAdams HP. Imaging of diseases of the chest. 4th ed. Philadelphia: Elsevier Mosby, 2005: 785-899.
14. Strollo DC, Rosado-de Christenson ML. Tumors of the thymus. J Thorac Imaging 1999; 14: 152-71.
15. Hansel DM, Armstrong P, Lynch DA, McAdams HP. Imaging of diseases of the chest. 4th ed. Philadelphia: Elsevier Mosby, 2005: 901-1021.
16. Rosai J. Histologic typing of tumors of the thymus. In: Sobin LH (ed). WHO international classification of tumors. Berlin and Heidelberg, Germany: Springer-Verlag, 1999.
17. Attanoos RL, Galateau-Salle F, Gibbs AR, Muller S, Ghandour F, Dojcinov SD. Primary thymic epithelial tumours of the pleura mimicking malignant mesothelioma. Histopathology 2002; 41: 42-9.
18. Fushimi H, Tanio Y, Kotoh K. Ectopic thymoma mimicking diffuse pleural mesothelioma: a case report. Hum Pathol 1998; 29: 409-10.
19. Fukayama M, Maeda Y, Funata N, Koike M, Saito K, Sakai T, et al. Pulmonary and pleural thymoma. Diagnostic application of lymphocyte markers to the thymoma of unusual site. Am J Clin Pathol 1988; 89: 617-21.