Sapkota Ranjan, Luitel Prajjwol
Department of Cardio-Thoracic and Vascular Surgery, Manmohan Cardio-Thoracic Vascular and Transplant Center, Institute of Medicine, Tribhuvan University, Nepal.
Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Nepal.
Int J Surg Case Rep. 2025 Feb;127:110891. doi: 10.1016/j.ijscr.2025.110891. Epub 2025 Jan 13.
Thymoma is the most common primary anterior mediastinal tumor in adults. Invasive thymomas infiltrate organs adjacent to the mediastinal pleura, including the lungs, great vessels, heart, pericardium, and diaphragm. Complete resection of invasive thymoma leads to a better prognosis.
We report a case of protrusion of an invasive thymoma infiltrating the left upper lobe of the lung with intraluminal growth into the left brachiocephalic vein without direct invasion of the vessel wall. In this case, the thymic vein and the left brachiocephalic vein were thoroughly examined intraoperatively. A venotomy was performed to remove the tumor thrombus, and histopathological examination confirmed tumor protrusion via the thymic vein without direct invasion.
Preoperative identification of tumor protrusion into the thymic vein is challenging therefore a thorough intraoperative examination of the thymic vein is essential to ensure the removal of the residual tumor in an invasive thymoma. Our finding points towards the possibility of the thymic vein being one of the potential pathways of tumor spread to the brachiocephalic vein.
A thorough examination of the thymic vein is essential to confirm and ensure the removal of the residual tumor. Complete resection of invasive thymoma with adjuvant chemotherapy leads to a better prognosis.
胸腺瘤是成人最常见的原发性前纵隔肿瘤。侵袭性胸腺瘤会浸润纵隔胸膜附近的器官，包括肺、大血管、心脏、心包和膈肌。完整切除侵袭性胸腺瘤可带来更好的预后。
我们报告一例侵袭性胸腺瘤突出至肺左上叶并向腔内生长进入左头臂静脉但未直接侵犯血管壁的病例。在此病例中，术中对胸腺静脉和左头臂静脉进行了全面检查。进行了静脉切开术以清除肿瘤血栓，组织病理学检查证实肿瘤经胸腺静脉突出且无直接侵犯。
术前识别肿瘤向胸腺静脉内突出具有挑战性，因此术中对胸腺静脉进行全面检查对于确保切除侵袭性胸腺瘤中的残留肿瘤至关重要。我们的发现表明胸腺静脉有可能是肿瘤扩散至头臂静脉的潜在途径之一。
对胸腺静脉进行全面检查对于确认并确保切除残留肿瘤至关重要。完整切除侵袭性胸腺瘤并辅以化疗可带来更好的预后。
