Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan.
Pathol Int. 2013 Jan;63(1):56-62. doi: 10.1111/pin.12023. Epub 2012 Dec 25.
We present a case of an aged male with invasive thymoma that extended into the right atrium and led to superior and inferior vena cava syndrome. The patient initially presented with edema of the face and bilateral lower extremities. Echocardiography revealed a mass within the right atrium. Imaging studies demonstrated an anterior mediastinal tumor that continuously occupied the bilateral brachiocephalic veins, superior vena cava, and right atrium. Pathological diagnosis of the tumor biopsy was highly suspicious of thymoma. Due to the high risk of wide spread of the tumor, treatments including resection of the tumor were impossible. Several days later he died, and an autopsy was performed. The tumor was type B2 thymoma invading bilateral brachiocephalic veins, superior vena cava and right atrium. Multiple tumor emboli within the pulmonary arteries were identified. Direct cause of death was deemed to be tumor strangulation at the tricuspid orifice. In addition to the superior vena cava syndrome, inferior vena cava syndrome including ectasia of the intrahepatic vessels was confirmed along with pericarditis. To our knowledge, this is the first English report of an autopsy case of intracardiac thymoma extension, and a detailed literature review of similar cases is also presented.
我们报告了一例老年男性侵袭性胸腺瘤，该肿瘤延伸至右心房，导致上腔静脉和下腔静脉综合征。患者最初表现为面部和双侧下肢水肿。超声心动图显示右心房内有一肿块。影像学研究显示前纵隔肿瘤连续占据双侧头臂静脉、上腔静脉和右心房。肿瘤活检的病理诊断高度怀疑为胸腺瘤。由于肿瘤广泛扩散的风险较高，包括肿瘤切除在内的治疗方法都不可行。几天后，他去世了，并进行了尸检。肿瘤为 B2 型胸腺瘤，侵犯双侧头臂静脉、上腔静脉和右心房。肺动脉内有多个肿瘤栓子。死亡的直接原因被认为是三尖瓣口的肿瘤绞窄。除了上腔静脉综合征，还证实了下腔静脉综合征包括肝内血管扩张，并伴有心包炎。据我们所知，这是首例心脏内胸腺瘤延伸的英文尸检报告，同时还对类似病例进行了详细的文献复习。
