Ketata W, Fouzi S, Msaad S, Ben Amira S, Yangui I, Ayoub A
Service de pneumo-allergologie, CHU Hédi Chaker, Sfax, Tunisie.
Rev Mal Respir. 2009 Jan;26(1):78-82. doi: 10.1016/s0761-8425(09)70139-1.
Thymoma is a rare tumor which represents about 20% of mediastinal tumors. It is associated with several parathymic conditions. A second cancer frequently occurs during long term follow up.
We report the case of a 59 year-old woman who presented with a two month history of a dry cough. Thoracic imaging revealed a soft tissue mass in the anterior mediastinum with associated bilateral pleural effusion and mediastinal lymphadenopathy. Fibreoptic bronchoscopy was normal. CT guided-biopsy was not contributive. A diagnostic mediastinoscopy was carried out. Histological examination confirmed the diagnosis of thymoma. The patient was treated with 4 cycles of chemotherapy which led to a partial regression of the mass. The course was marked by the occurrence of a pure red cell aplasia requiring corticosteroid therapy which caused the disappearance of the anemia. However, bluish nodules appeared on the patients legs which when biopsied were found to represent Kaposi's sarcoma. The patient was treated with chemotherapy (vinblastine) without any improvement of the cutaneous lesions.
Our case describes the association of a thymoma, pure red cell aplasia and Kaposi's sarcoma. Immunologic disorders seem to be in the origin of this association.
胸腺瘤是一种罕见肿瘤,约占纵隔肿瘤的20%。它与多种胸腺旁疾病相关。在长期随访中常发生第二种癌症。
我们报告一例59岁女性,有两个月干咳病史。胸部影像学检查显示前纵隔有一软组织肿块,伴有双侧胸腔积液和纵隔淋巴结肿大。纤维支气管镜检查正常。CT引导下活检无诊断价值。进行了诊断性纵隔镜检查。组织学检查确诊为胸腺瘤。患者接受了4个周期的化疗,肿块部分消退。病程中出现了纯红细胞再生障碍,需要皮质类固醇治疗,贫血消失。然而,患者腿部出现蓝色结节,活检发现为卡波西肉瘤。患者接受化疗(长春碱),皮肤病变无改善。
我们的病例描述了胸腺瘤、纯红细胞再生障碍和卡波西肉瘤的关联。免疫紊乱似乎是这种关联的根源。