Makita Ayaka, Nakamura Shota, Setogawa Tomohiro, Imamura Yoshito, Okado Shoji, Nomata Yuji, Watanabe Hiroki, Kawasumi Yuta, Kadomatsu Yuka, Ueno Harushi, Kato Taketo, Mizuno Tetsuya, Chen-Yoshikawa Toyofumi Fengshi
Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-Cho, Showa-Ku, Nagoya, 466-8550, Japan.
Surg Case Rep. 2024 Jul 12;10(1):170. doi: 10.1186/s40792-024-01970-2.
A multidisciplinary treatment approach is recommended for patients with extensive, advanced, or recurrent thymomas. However, detailed treatment strategies, such as chemotherapy regimens and optimal surgical procedures, are still under debate.
We report a case of gigantic locally advanced thymoma. A 70-year-old male was referred to our hospital following the detection of abnormal chest shadows. Chest X-ray and computed tomography (CT) scans revealed a 21-cm mass in the anterior mediastinum, encircling the pulmonary hilum and extending into the left thoracic cavity. PET/CT showed increased F-fluorodeoxyglucose uptake at the tumor site. Based on a trans-percutaneous CT-guided needle biopsy, the tumor was diagnosed as a Type B2 thymoma at the clinical IIIA stage. The patient underwent four cycles of preoperative induction chemotherapy, including cisplatin, doxorubicin, and methylprednisolone (CAMP), resulting in a partial response; the tumor shrank to 12 cm and FDG uptake decreased. Considering the patient's age and comorbidities, we performed total thymectomy, along with partial resections of the parietal, mediastinal and visceral pleura, pericardium, and left upper lobectomy. This approach achieved complete histological resection, mitigating the risk of recurrence. Pathological analysis confirmed a thymoma, ypT3 (lung) N0M0 stage IIIA, with no malignancy in the pericardial or pleural effusions. No recurrence was detected 9 months post-surgery.
We report a case of giant thymoma successfully treated with multidisciplinary strategy. Surgical treatment alone may not have achieved complete resection, but after inducing significant tumor shrinkage with preoperative CAMP therapy, we were able to achieve complete resection. This treatment strategy may be effective in large thymoma cases.
对于广泛、晚期或复发性胸腺瘤患者，推荐采用多学科治疗方法。然而，详细的治疗策略，如化疗方案和最佳手术程序，仍存在争议。
我们报告一例巨大局部晚期胸腺瘤病例。一名70岁男性在发现胸部阴影异常后被转诊至我院。胸部X线和计算机断层扫描（CT）显示前纵隔有一个21厘米的肿块，环绕肺门并延伸至左胸腔。PET/CT显示肿瘤部位氟脱氧葡萄糖摄取增加。经皮CT引导下针吸活检显示，该肿瘤在临床IIIA期被诊断为B2型胸腺瘤。患者接受了四个周期的术前诱导化疗，包括顺铂、阿霉素和甲泼尼龙（CAMP），结果为部分缓解；肿瘤缩小至12厘米，FDG摄取减少。考虑到患者的年龄和合并症，我们进行了全胸腺切除术，同时部分切除壁层、纵隔和脏层胸膜、心包以及左上肺叶切除术。这种方法实现了完整的组织学切除，降低了复发风险。病理分析证实为胸腺瘤，ypT3（肺）N0M0 IIIA期，心包或胸腔积液无恶性肿瘤。术后9个月未检测到复发。
我们报告一例成功采用多学科策略治疗的巨大胸腺瘤病例。单独手术治疗可能无法实现完整切除，但术前CAMP治疗使肿瘤显著缩小后，我们能够实现完整切除。这种治疗策略可能对大型胸腺瘤病例有效。
