Thymoma metastatic to liver and pancreas: case report and review of the literature

Abstract

A 71-year-old man presented with a thymic mass involving the superior vena cava. A mediastinoscopical biopsy initially suggested a diagnosis of type A thymoma. After neoadjuvant chemotherapy, the patient underwent en-bloc thymectomy and vascular resection for a pathology-confirmed type B3 thymoma involving the superior vena cava, the left brachiocephalic vein and the distal part of the right brachiocephalic vein. Adjuvant radiotherapy was administered. Two years after the primary surgery, abdominal computed tomography (CT) and whole body fluorodeoxyglucose (18-FDG) positron emission tomography (PET) scans showed a single hepatic lesion that was treated with wedge liver resection. Pathological examination confirmed metastatic type B3 thymoma. Almost 4 years later, abdominal CT and 18-FDG PET revealed a 2.9-cm solid mass involving the body of the pancreas. Distal pancreatectomy with lymph node dissection was performed. Pathological examination showed a pancreatic metastasis from a type B3 thymoma, without lymph node involvement. The patient is alive and free of disease 6 months after the pancreatectomy (68 months after the initial thymectomy surgery). Intra-abdominal recurrence and pancreatic metastases are very uncommon manifestations of thymoma, but this event should be kept in mind when an abdominal mass is seen during follow-up.

Keywords: Pancreas; pancreatectomy; secondary tumours; survival; thymoma.

Figure 1.

Abdominal computed tomography images of a 71-year-old man showing a solid mass involving the body of the pancreas (arrow).

Figure 2.

Fluorodeoxyglucose (18-FDG) positron emission tomography/computed tomography of a 71-year-old man showing pathological uptake of the 18-FDG radiotracer in the peripancreatic area with a standardized uptake volume of 14.72. The colour version of this figure is available at: http://imr.sagepub.com.

Figure 3.

A representative high magnification photomicrograph of the tumour showing the spindle/oval shape of the neoplastic cells having slightly elongated nuclei, with finely dispersed chromatin and inconspicuous nucleoli (haematoxylin and eosin). Scale bar, 200 µm. The colour version of this figure is available at: http://imr.sagepub.com.