Rizzardi Giovanna, Arena Vincenzo, Passera Eliseo, Bortolotti Luigi
Thoracic Surgery Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy.
Interact Cardiovasc Thorac Surg. 2013 Dec;17(6):1054-5. doi: 10.1093/icvts/ivt397. Epub 2013 Aug 30.
We report a very rare case of malignant invasive thymoma with intraluminal growth through the thymic veins into the superior vena cava (SVC), with intracardiac right atrium extension. A 44-year old female with SVC syndrome underwent a radical thymectomy with pericardiectomy and complete removal of the endovascular and endocardiac neoplastic thrombus by a longitudinal incision starting from the atrium and extending along the SVC. The left anonymous vein was sacrificed, and the SVC and atrium were repaired with a continuous 5-0 Prolene suture. The hospital stay was uneventful. Postoperatively, the patient received adjuvant chemoradiotherapy (three cycles of cisplatin, doxorubicin and cyclophosphamide and subsequent mediastinal irradiation with 50 Gy). Nine months after surgery, no recurrences were seen and the patient is still well. This thymoma presentation with intravascular growth without direct vascular wall infiltration, although very rare, is possible and the management may be challenging. In our case, a primary radical operation was considered mandatory due to the clinical symptoms and the risk of neoplastic embolization. The collection of other similar cases could better clarify the role of adjuvant therapy.
我们报告了一例极为罕见的恶性侵袭性胸腺瘤，其通过胸腺静脉腔内生长至 superior vena cava（上腔静脉，SVC），并向心腔内右心房延伸。一名患有上腔静脉综合征的44岁女性接受了根治性胸腺切除术，同时进行了心包切除术，并通过从心房开始沿上腔静脉延伸的纵向切口完整切除血管内和心内膜肿瘤血栓。牺牲了左无名静脉，用上5-0普理灵缝线连续缝合修复上腔静脉和心房。住院期间无异常情况。术后，患者接受了辅助放化疗（三个周期的顺铂、阿霉素和环磷酰胺，随后进行50 Gy的纵隔照射）。手术后九个月，未见复发，患者情况仍然良好。这种胸腺瘤呈现血管内生长且无直接血管壁浸润的情况，虽然极为罕见，但却是可能的，其治疗可能具有挑战性。在我们的病例中，由于临床症状和肿瘤栓塞风险，认为进行一期根治性手术是必要的。收集其他类似病例可以更好地阐明辅助治疗的作用。
