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Case Reports
. 2017 Jun 20;9(6):e1374.
doi: 10.7759/cureus.1374.

Polyparaneoplastic Manifestations of Malignant Thymoma: A Unique Case of Myasthenia, Autoimmune Hepatitis, Pure Red Cell Aplasia, and Keratoconjunctivitis Sicca

Doron Feinsilber  1 , Katrina A Mears  2 , Brian L Pettiford  3
Affiliations
Case Reports

Polyparaneoplastic Manifestations of Malignant Thymoma: A Unique Case of Myasthenia, Autoimmune Hepatitis, Pure Red Cell Aplasia, and Keratoconjunctivitis Sicca

Doron Feinsilber et al. Cureus. .

Abstract

Thymomas are relatively uncommon malignancies of the anterior mediastinum and present with four distinct histological types based on the specific epithelial to lymphocyte ratio: spindle cell, epithelial predominant, lymphocyte predominant, or mixed. Each histologic type of thymoma has a propensity for local invasion and metastasis and can have a wide variety of paraneoplastic manifestations, myasthenia being the most common. We present a unique case of a 34-year-old African-American female who initially presented with a history of profound weakness with repetitive motion, shortness of breath, horizontal nystagmus, persistent anemia, keratoconjunctivitis sicca, and what was initially thought to be azithromycin-induced hepatitis. Upon left anterior thoracotomy with biopsy of the mediastinal mass, pathology yielded a lymphocyte-predominant (B1), Masaoka stage IVA invasive thymoma with pericardial extension. This case illustrates the clinical significance of considering a multitude of extrathymic paraneoplastic manifestations, each with a unique physiological mechanism.

Keywords: autoimmune hepatitis; keratoconjuncivitis sicca; myasthenia; plasmapharesis; pure red cell aplasia; thymoma.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Computed tomography (CT) of the chest.
A CT of the chest with contrast revealed a 7.69 cm x 9.25 cm anterior mediastinal mass with central calcification and extension into the anterior left chest abutting the pleura (yellow arrow).
Figure 2
Figure 2. Intraoperative findings.
Intraoperative findings demonstrated involvement of the pericardium (green arrow) and phrenic nerve (white arrow) as well as invasion into the adjacent left upper lobe (yellow arrow).
Figure 3
Figure 3. Surgical histopathology of thymic mass.
Sections from the tumor showed a lymphocyte-predominant population with scattered starry sky-appearing cells representing macrophages (yellow arrow). Admixed with these lymphocytes were cells with vesicular chromatin and prominent nucleoli representing epithelial cells. Dense fibrous tissue traversed throughout the tumor and was extensively invaded by the tumor cells (white arrow).
See this image and copyright information in PMC

References

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