Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Case Rep. 2022 Jan 12;16(1):10. doi: 10.1186/s13256-021-03225-2.
Cervical thymoma is a rare thymic epithelial neoplasm. Evidence supports an increased risk of second primary malignancies in patients with thymoma. We report a rare case of a patient with synchronous cervical thymoma and diffuse large B-cell lymphoma.
An 81-year-old Thai woman was referred for further treatment of diffuse large B-cell lymphoma at Siriraj Hospital, Bangkok, Thailand. While waiting for a review of the original pathological examination of a mass in the left neck and a mass in the left arm, the attending physician noticed ptosis of the upper eyelids, which was proven to be caused by myasthenia gravis. The final pathology review confirmed that the arm mass was diffuse large B-cell lymphoma, but the neck mass was cervical thymoma, type B1, not diffuse large B-cell lymphoma. Interestingly, the patient reported that the arm mass had been present for 2 years, while the neck mass had grown rapidly in the past month. A diagnostic challenge had arisen when the initial morphological evaluation was not performed with care, causing the first pathologist to misinterpret that the neoplastic cells in both masses were the same.
Concurrent cervical thymoma and diffuse large B-cell lymphoma were proven after a careful pathology review, leading to better clinical management.
颈胸腺瘤是一种罕见的胸腺上皮肿瘤。有证据表明，胸腺瘤患者发生第二原发恶性肿瘤的风险增加。我们报告了一例同时患有颈胸腺瘤和弥漫性大 B 细胞淋巴瘤的罕见病例。
一位 81 岁的泰国女性因弥漫性大 B 细胞淋巴瘤在泰国曼谷的 Siriraj 医院接受进一步治疗。在等待对左颈部和左手臂肿块的原始病理检查进行复查期间，主治医生注意到上眼睑下垂，经证实是由重症肌无力引起的。最终的病理复查结果证实手臂肿块为弥漫性大 B 细胞淋巴瘤，但颈部肿块为 B1 型颈胸腺瘤，而非弥漫性大 B 细胞淋巴瘤。有趣的是，患者报告称手臂肿块已经存在 2 年，而颈部肿块在过去一个月内迅速生长。由于初始形态学评估不够仔细，导致第一位病理学家错误地认为两个肿块中的肿瘤细胞是相同的，从而带来了诊断上的挑战。
经过仔细的病理复查，证实同时患有颈胸腺瘤和弥漫性大 B 细胞淋巴瘤，从而改善了临床管理。
