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Zhang X, Chen L, Zhou W, Wang Z, Wang C, Shi J, Yao F. Case report: Complete resection of invasive thymoma invading the superior vena cava and right atrium under cardiopulmonary bypass support. Front Oncol 2022; 12:1026524. [PMID: 36338675 PMCID: PMC9631927 DOI: 10.3389/fonc.2022.1026524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/03/2022] [Indexed: 11/26/2022] Open
Abstract
Here we describe an uncommon case of a 48-year-old male patient with an invasive thymoma invading the superior vena cava, bilateral innominate veins, right internal jugular vein, right subclavian vein, right atrium, azygos vein, and part of the lung tissues. The tumor was resected entirely under cardiopulmonary bypass support, and the venous bypass using a vascular graft was successfully established between the left innominate vein and the right atrium. The postoperative course was uneventful, and the patient was discharged 15 days after surgery without complications.
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Affiliation(s)
- Xiangxin Zhang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China
- Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center; Qilu Hospital of Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary Cerebral Resuscitation Research of Shandong Province, Shandong Provincial Engineering Laboratory for Emergency and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Liang Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenyong Zhou
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhexin Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chong Wang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianxin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Feng Yao, ; Jianxin Shi,
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Feng Yao, ; Jianxin Shi,
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Arrossi AV, Dermawan JK, Bolen M, Raymond D. Thymomas With Intravascular and Intracardiac Growth. Front Oncol 2022; 12:881553. [PMID: 35814455 PMCID: PMC9268891 DOI: 10.3389/fonc.2022.881553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022] Open
Abstract
Thymomas are derived from the epithelial component of the thymus and constitute the most common tumor of the anterior mediastinum. These neoplasms are considered malignant for their potential for invasion and metastases. Several histopathologic subclassification schemes have been proposed over the years, however, correlation of histotypes with prognosis remains controversial. In contrast, studies invariably have shown that staging and resection status correlate with oncologic behavior and disease outcomes. In this regard, several staging systems have been presented, though transcapsular invasion and degree of involvement of adjacent anatomic structures are common denominators of all schemes. Involvement of the great vessels and heart most commonly results from direct invasion, which may lead to unusual clinical presentations such as superior vena cava syndrome. Moreover, intravascular and intracardiac growth with or without direct mural invasion rarely occurs. We provide an overview of thymomas with intravascular and intracardiac involvement.
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Affiliation(s)
- Andrea Valeria Arrossi
- Department of Pathology, Robert J. (R.J) Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, United States
- *Correspondence: Andrea Valeria Arrossi,
| | - Josephine K. Dermawan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Michael Bolen
- Imaging Institute, Cardiovascular and Thoracic Radiology, Cleveland Clinic, Cleveland, OH, United States
| | - Daniel Raymond
- Department of Thoracic Surgery, Cleveland Clinic, Cleveland, OH, United States
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Kumar A, Pulle MV, Asaf BB, Shivnani G, Maheshwari A, Kodaganur SG, Puri HV, Bishnoi S. Superior Vena Cava Resection in Locally Advanced Thymoma-Surgical and Survival Outcomes. Indian J Surg Oncol 2020; 11:711-719. [PMID: 33299285 DOI: 10.1007/s13193-020-01204-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
This study was aimed at reporting the surgical management of superior vena cava invasion in patients with locally advanced thymoma and to evaluate surgical and survival outcomes. This is a retrospective analysis of 12 patients operated for superior vena cava resection for locally advanced thymoma over 8 years in a thoracic surgery centre in India. An analysis of peri-operative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Intra-operatively, superior vena cava (SVC) alone was involved in 3 (25%) cases, SVC with BCV involvement was there in 8 cases (66.7%) and in 1 patient, the SVC involvement extended into the right atrium also. In all cases, the tumour was resected en bloc with the involved part of SVC. Repair with primary closure was sufficient in 2 cases (16.6%) in view of < 1/3rd of circumferential involvement. However, in remaining 10 cases, SVC was replaced with PTFE graft (single graft in 6 cases, Y-graft in 2 cases and twin grafts in 2 cases). No peri-operative deaths. Overall survival (OS) at 1, 3 and 5 years was 100%, 91.6% and 83.3%, respectively. Myasthenia gravis and higher Masaoka stage (IV A) of the disease were poor predictors of survival. Superior vena cava resection and reconstruction is a feasible and oncologically superior option in invasive thymoma with SVC involvement. This challenging surgical procedure should only be attempted by an experienced team of thoracic and cardiac surgeons at high-volume centre to achieve best outcomes.
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Affiliation(s)
- Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Ganesh Shivnani
- Department of Cardiac Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Arun Maheshwari
- Department of Cardiac Anaesthesia, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | | | - Harsh Vardhan Puri
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, 110060 India
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Fang C, Pan H, Li Z, Lin S, Ma L, Han W. Invasive thymoma leading to pulmonary artery embolism during operation: A case report. Medicine (Baltimore) 2019; 98:e16385. [PMID: 31305442 PMCID: PMC6641840 DOI: 10.1097/md.0000000000016385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Invasive thymoma with intraluminal tumor thrombus may cause pulmonary artery thrombus if the tumor thrombus shed off during operation. However, there is no clinical case report focused on such complication. PATIENT CONCERNS A 40-year-old woman presented with repeated chest pain. DIAGNOSIS Chest computer tomography showed huge mediastinal mass. Postoperative pathology revealed type B2 and B3 thymoma, with B3 as the main type. INTERVENTIONS The patient underwent tumor resection through midline sternotomy in our hospital on September 17, 2018. She received emergent pulmonary artery exploration because the tumor thrombus in superior vena cava shed off unexpectedly during operation. Postoperative pulmonary computer tomography angiography showed right pulmonary artery embolism. Then emergent right pulmonary artery embolectomy was performed through lateral thoracic incision on September 29, 2018. OUTCOMES The patient recovered well after surgery. D-dimer reduced rapidly and returned to normal 1 month after the second operation. LESSONS Intraluminal tumor thrombus in invasive thymoma patients has a risk of shedding off during operation. Prevention strategy should be made beforehand. Pulmonary artery exploration is necessary once happened.
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Affiliation(s)
| | - Hui Pan
- Department of Lung Transplantation
| | | | | | - Liang Ma
- Department of Cardiothoracic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Sun Y, Gu C, Shi J, Fang W, Luo Q, Hu D, Fu S, Pan X, Chen Y, Yang Y, Yang H, Zhao H, Chen H. Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases. J Thorac Dis 2017; 9:725-733. [PMID: 28449480 DOI: 10.21037/jtd.2017.03.03] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Discuss an appropriate strategy for treatment of invasive thymoma invading adjacent great vessels. METHODS A retrospective study on 25 patients with invasive thymoma invading neighboring great vessels was performed. The corresponding data including clinical presentation, operation procedure, adjuvant radio-chemotherapy and follow-up were reviewed. RESULTS Twenty of 25 (80%) patients with invasive thymoma underwent complete resection of the tumor along with vessel reconstruction. Intraoperatively, different types of operation were conducted, namely, brachiocephalic vein (BCV)-right atrial appendage (RAA) reconstruction in 11 cases, complex vessel reconstruction (more than one graft) in 1 case and superior vena cava (SVC)-SVC reconstruction in the remaining cases. Ringed polytetrafluoroethylene (PTFE) grafts were used for vessel reconstruction. Postoperatively, three cases suffered from pulmonary infection, and three cases had haemothorax, chylothorax and atelectasis, respectively. Two patients died due to acute respiratory distress syndrome within 90 days after the surgery. Within the remaining patients, 11 cases (44%) experienced a relapse and finally 8 (32%) patients died. Compared to R1 resection group, R0 resection group had a better prognosis (Log-rank P=0.0196). The 3- and 5-year survival rates were 79.6% and 59.1%, with median survival time of 84 months. CONCLUSIONS Reconstruction of mediastinal vessels for invasive thymoma is a feasible technology method. Radical resection of the tumor with involved neighboring structures is the key to prolong overall survival for patients suffered from invasive thymoma.
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Affiliation(s)
- Yifeng Sun
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Chang Gu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Jianxin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Qingquan Luo
- Shanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Dingzhong Hu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Shijie Fu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xufeng Pan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yong Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Yu Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Haitang Yang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.,Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
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Panda PK, Wig N, Kumar S, Arava S. Invasive thymoma presenting as classic superior vena cava syndrome: a case of venous spread metastasis. BMJ Case Rep 2016; 2016:bcr-2016-217695. [PMID: 27797848 DOI: 10.1136/bcr-2016-217695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The approach to an intrinsic cause of superior vena cava syndrome (SVCS) is usually difficult but rewarding. We report a case of a middle-aged man who presented with progressive oedema of the upper half of the body, dyspnoea, cough and weight loss for a 1-year duration. He was a non-smoker without prior hospitalisation. Chest radiography showed right-sided pleural effusion with an apparent normal superior mediastinum. Contrast-enhanced CT of the chest revealed a right atrial mass extending and completely obliterating to superior vena cava. The differentials were tuberculosis, invasive fungal granuloma, sarcoidosis, primary vasculitis, chronic venous thrombosis, cardiac sarcoma/lymphoma and metastatic thyroid tumour or thymoma. He underwent transvenous (femoral approach) biopsy of the mass and then cardiothoracic surgery after haemodynamic instability. Pathology showed invasive thymoma type B3. This case highlights the approach to an intrinsic cause of SVCS, a complication of the transvenous approach, and importantly a noble finding of venous spread metastasis.
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Affiliation(s)
- Prasan Kumar Panda
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardio-Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudheer Arava
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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El Batti S, Mercier O, Rohnean A, Besse B, Nottin R, Dartevelle P. Recurrence of thymoma in the right atrium arising from the coronary sinus. Ann Thorac Surg 2013; 95:e71-2. [PMID: 23438569 DOI: 10.1016/j.athoracsur.2012.08.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 08/25/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022]
Abstract
Invasive thymoma is a malignant tumor of the anterior mediastinum that could have intravenous affinity associated with a high recurrence rate. This report highlights the need of coronary sinus exploration when intraatrial thymoma recurrence is diagnosed. Surgical resection of invaded coronary sinus can be achieved safely with a good result.
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Affiliation(s)
- Salma El Batti
- Centre Chirurgical Marie Lannelongue, Service de Chirurgie Thoracique, Vasculaire et Transplantation cardio-pulmonaire, Université Paris Sud Le Plessis Robinson, France.
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Kurata A, Saji H, Ikeda N, Kuroda M. Intracaval and intracardiac extension of invasive thymoma complicated by superior and inferior vena cava syndrome. Pathol Int 2013; 63:56-62. [PMID: 23356226 DOI: 10.1111/pin.12023] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 11/24/2012] [Indexed: 11/28/2022]
Abstract
We present a case of an aged male with invasive thymoma that extended into the right atrium and led to superior and inferior vena cava syndrome. The patient initially presented with edema of the face and bilateral lower extremities. Echocardiography revealed a mass within the right atrium. Imaging studies demonstrated an anterior mediastinal tumor that continuously occupied the bilateral brachiocephalic veins, superior vena cava, and right atrium. Pathological diagnosis of the tumor biopsy was highly suspicious of thymoma. Due to the high risk of wide spread of the tumor, treatments including resection of the tumor were impossible. Several days later he died, and an autopsy was performed. The tumor was type B2 thymoma invading bilateral brachiocephalic veins, superior vena cava and right atrium. Multiple tumor emboli within the pulmonary arteries were identified. Direct cause of death was deemed to be tumor strangulation at the tricuspid orifice. In addition to the superior vena cava syndrome, inferior vena cava syndrome including ectasia of the intrahepatic vessels was confirmed along with pericarditis. To our knowledge, this is the first English report of an autopsy case of intracardiac thymoma extension, and a detailed literature review of similar cases is also presented.
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Affiliation(s)
- Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University, Tokyo, Japan.
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Toker A, Tireli E, Tanju S, Kaya S. Transcaval invasion of right atrium by thymoma: resection via transient cava-pulmonary shunt. Eur J Cardiothorac Surg 2012; 41:1175-7. [DOI: 10.1093/ejcts/ezr261] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Shih YJ, Lin YC, Tsai YT, Lin CY, Lee CY, Yang HY, Tsai CK, Tsai CS. Letter to the editor: concomitant off-pump coronary artery bypass grafting and thymectomy. Heart Surg Forum 2011; 14:E212-3. [PMID: 21859637 DOI: 10.1532/hsf98.20111019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Thymoma in patients with coronary disease is rare. Although simultaneously performing a cardiac procedure and thymectomy for patients with combined thymoma and cardiac disease has been reported, a clear consensus regard- ing the optimal surgical treatment is lacking. Moreover, in all of the previously reported cases, the surgical intervention and standard cardiopulmonary bypass were performed simul- taneously. We present the case of a patient who underwent combined off-pump coronary artery bypass grafting (CABG) and thymectomy. We show that this combined procedure is the treatment of choice for patients with a severely ischemic myocardium and a malignant thymoma.
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Venuta F, Rendina EA, Klepetko W, Rocco G. Surgical management of stage III thymic tumors. Thorac Surg Clin 2011; 21:85-91, vii. [PMID: 21070989 DOI: 10.1016/j.thorsurg.2010.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thymic tumors are classified as stage III when they clearly invade the surrounding structures: pericardium, great vessels (superior vena cava, innominate veins, ascending aorta, and main pulmonary artery), lung parenchyma, phrenic nerves, and chest wall. Surgical treatment with or without induction therapy should always aim to complete resection removing en bloc all the involved structures. Also, extended procedures are justified because only R0 resection allows long-term survival.
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Affiliation(s)
- Federico Venuta
- Department of Thoracic Surgery, Policlinico Umberto I, University of Rome Sapienza, Cattedra di Chirurgia Toracica, Viale del Policlinico, 00166 Rome, Italy.
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