Chronic shoulder pain referred from thymic carcinoma: a case report and review of literature

Abstract

We report a case of thymic carcinoma presenting as unilateral shoulder pain for 13 months. Before an accurate diagnosis was made, the patient received conservative treatment, cervical discectomies, and myofascial trigger point injection, none of which relieved his pain. When thymic carcinoma was eventually diagnosed, he received total resection of the tumor and the shoulder pain subsided completely. Thymic carcinoma is a rare carcinoma, and our review of the literature did not show shoulder pain as its initial presentation except for one case report. The purpose of this report is to document our clinical experience so that other physiatrists can include thymic carcinoma in their differential diagnosis of shoulder pain.

Keywords: referred pain; shoulder pain; thymic carcinoma.

Figure 1

Chest X-ray indicating enlargement of the right hilar area and suspicious mass in the right heart border.

Figure 2

Chest CT showing an anterior mediastinal tumor, approximately 69 ×55 ×68 mm in size. Abbreviation: CT, computed tomography.

Figure 3

Pathology slides from total thymus resection showed thymic carcinoma composed of epitheloid tumor cells with nuclear pleomorphism, apparent nucleoli, and mitotic features (H&E, 400×) in solid nest or sheet arrangement (H&E, 100×). Abbreviation: H&E, hematoxylin and eosin.

Figure 4

Several possible etiologies in the diagnosis of chronic shoulder pain.