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Benitez JC, Boucher MÈ, Dansin E, Kerjouan M, Bigay-Game L, Pichon E, Thillays F, Falcoz PE, Lyubimova S, Oulkhouir Y, Calcagno F, Thiberville L, Clément-Duchêne C, Westeel V, Missy P, Thomas PA, Maury JM, Molina T, Girard N, Besse B. Central Nervous System Metastases in Thymic Epithelial Tumors: A Brief Report of Real-World Insight From RYTHMIC. J Thorac Oncol 2021; 16:2144-2149. [PMID: 34455064 DOI: 10.1016/j.jtho.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/15/2021] [Accepted: 08/06/2021] [Indexed: 01/04/2023]
Abstract
Thymic epithelial tumors (TETs) are rare malignancies ranging from indolent thymoma A to aggressive thymic carcinomas (TCs). Brain metastases are extremely infrequent for TETs and have only been described in case reports or small single-center series. RYTHMIC (Réseau tumeurs THYMiques et Cancer) is a French nationwide network mandated to systematically review every TET case and prospectively includes all consecutive patients discussed by national or regional tumor boards. We analyzed patients with TETs and central nervous system (CNS) metastasis during their cancer history from this large French registry. In an 8-year period, 2909 patients were included in the database, including 248 TCs (8.5%). A total of 14 patients had CNS metastases, five (36%) at diagnosis and nine (64%) at relapse. Among them, 12 patients (86%) had a diagnosis of TC and two (14%) had thymoma A and B3. Surgical biopsies were performed, and the histologic subtype for non-TC tumors was centrally confirmed. Median overall survival was 22 months (95% confidence interval [CI]: 9.8-34.2), with longer, albeit not significant, overall survival when CNS metastases were present at diagnosis versus relapse (not reached versus 17 mo; p = 0.29); median progression-free survival was 13 versus 8 months (p = 0.06), respectively. A higher risk of death (hazard ratio = 5.34, 95% CI: 1.3-21.9, p = 0.02) and relapse (hazard ratio = 1.89, 95% CI: 0.9-3.7, p = 0.06) was observed for patients suffering from TC with brain metastases compared with those without CNS extension. CNS disease was extremely rare in our TET cohort (0.48%), reported at both diagnosis and progression, present primarily in TC, with prevalence rising to 4.9%.
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Affiliation(s)
| | | | | | | | - L Bigay-Game
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | | | | | | | | | | | - Fabien Calcagno
- Centre Hospitalier Universitaire de Besançon, Besançon, France
| | | | | | - Virginie Westeel
- Intergroupe Francophone de Cancérologie Thoracique, Paris, France
| | - Pascale Missy
- Intergroupe Francophone de Cancérologie Thoracique, Paris, France
| | | | | | - Thierry Molina
- Hôpital Universitaire Necker Enfants Malades, Paris, France
| | | | - Benjamin Besse
- Thoracic Cancer Unit, Gustave Roussy, Villejuif, France; Paris-Saclay University, Orsay, France.
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Kouitcheu R, Appay R, Diallo M, Troude L, Melot A. A case of brain metastasis of a thymic carcinoma with a review of the literature. Neurochirurgie 2019; 65:43-48. [PMID: 30711259 DOI: 10.1016/j.neuchi.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 08/25/2018] [Accepted: 09/23/2018] [Indexed: 10/27/2022]
Abstract
Thymic epithelial tumors (TET) are rare lesions. The brain metastases of these tumors are even rarer. We report a case of brain metastases in a known patient with a thymic carcinoma diagnosed in October 2016. She was a 73-year-old woman who presented with headache, nausea, and right hemiplegia. Brain MRI revealed five lesions (1 insular, 1 frontal and 2 left temporal, 1 right parafalcine). These lesions were initially treated using two stereotactic radiosurgery gamma knives. A macroscopically complete excision of the left frontal lesion was subsequently performed without any complications with a good evolution of the neurological symptoms postoperatively. Immunohistochemical examination was compatible with metastatic thymic carcinoma. The patient died 14 months after the initial diagnosis. A review of the literature in English has reported another 45 TET cases with brain metastases.
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Affiliation(s)
- R Kouitcheu
- Department of neurosurgery, CHU-hôpital Nord, Marseille, France.
| | - R Appay
- Department of pathology and neuropathology, CHU-Timone, Marseille, France
| | - M Diallo
- Department of neurosurgery, CHU-hôpital Nord, Marseille, France
| | - L Troude
- Department of neurosurgery, CHU-hôpital Nord, Marseille, France
| | - A Melot
- Department of neurosurgery, CHU-hôpital Nord, Marseille, France
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Gharwan H, Kim C, Thomas A, Berman A, Kim SA, Biassou N, Steinberg SM, Rajan A. Thymic epithelial tumors and metastasis to the brain: a case series and systematic review. Transl Lung Cancer Res 2017; 6:588-599. [PMID: 29114474 DOI: 10.21037/tlcr.2017.08.06] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Thymic epithelial tumors (TETs) rarely metastasize to the brain. Clinico-pathologic features of TET patients with brain metastasis are not well described. Methods TET patients referred for consultation or screening for clinical trials are included. Imaging to evaluate for brain metastases was performed when clinically indicated or if required for screening. Tumor tissue from brain metastases was obtained for analysis, when available. Clinical characteristics and survival was evaluated and a systematic review of the literature on brain metastases associated with TETs was performed. Results Fourteen TET patients with brain metastasis were identified. Median age at TET diagnosis was 53 years (range: 31-71 years). Twelve patients had thymic carcinoma and two patients had World Health Organization B3 thymoma. Median time from TET diagnosis to discovery of brain metastases was 2.5 years (range: 9 months-8.3 years). Eleven patients had extracranial, extrathoracic metastases during presentation with brain metastases. Three patients underwent surgery and radiation therapy, eight patients received radiation therapy alone, and one patient had surgery alone. One patient with thymoma died 11 months after diagnosis of brain metastases and another patient died but with unknown date of diagnosis of brain metastases. Among 12 patients with thymic carcinoma, 11 of whom had a known date of brain metastases diagnosis, the median potential follow-up is 35.8 months, and median overall survival (OS) from diagnosis of brain metastases is 13.1 months. Conclusions Although uncommon, patients with advanced thymic carcinoma can develop brain metastases. Appropriate imaging and aggressive treatment should be considered for these patients.
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Affiliation(s)
- Helen Gharwan
- Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Chul Kim
- Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Anish Thomas
- Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Arlene Berman
- Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Sun A Kim
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Nadia Biassou
- Division of Neuroradiology, Department of Imaging Sciences, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Arun Rajan
- Thoracic and Gastrointestinal Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Sinclair G, Martin H, Fagerlund M, Samadi A, Benmakhlouf H, Doodo E. Adaptive hypofractionated gamma knife radiosurgery in the acute management of large thymic carcinoma brain metastases. Surg Neurol Int 2017; 8:95. [PMID: 28607829 PMCID: PMC5461566 DOI: 10.4103/sni.sni_391_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 03/09/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Brain metastases often lead to serious neurological impairment and life threatening states. Their acute management remains complex, particularly in the case of rare malignancies with aggressive evolution. In large single lesions, open surgery followed by radiation to the surgical cavity is widely regarded as the best approach; yet in many cases, microsurgery is not feasible due to the lesion's critical location and/or the number of brain metastases present. We report the effects of adaptive hypofractionated gamma knife radiosurgery in the acute management of critically located thymic carcinoma metastases. CASE DESCRIPTION A 50-year-old male with metastatic thymic carcinoma was treated with radiosurgery for two large supratentorial brain metastases (M3 and M4) adjacent to eloquent areas and one smaller cerebellar metastasis (M2). M3 and M4 were treated with adaptive hypofractionated gamma knife radiosurgery, showing a dramatic volume reduction 4 weeks after treatment completion without radiation-induced side effects. Thirteen months later, two new small, threatening supratentorial lesions (M5-M6) were treated with the same technique. Interestingly, M2 (treated with standard single fraction) and M5-M6 developed local adverse radiation events. The patient's general and neurological status remained next to normal by the time of paper submission. CONCLUSION The application of adaptive hypofractionated radiosurgery in this acute setting proved effective in terms of rapid tumor ablation, with salvage of neurological functionality and limited toxicity. We have called the overall procedure rapid rescue radiosurgery (RRR). A systematic study of past and ongoing RRR-treatments is warranted and in progress.
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Affiliation(s)
- Georges Sinclair
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Heather Martin
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Fagerlund
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Amir Samadi
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Hamza Benmakhlouf
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Ernest Doodo
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
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Kosty JA, Andaluz N. Metastatic Thymic Carcinoma Presenting as a Posterior Fossa Mass: Case Report and Review of the Literature. World Neurosurg 2016; 93:486.e1-6. [PMID: 27418532 DOI: 10.1016/j.wneu.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 07/02/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Thymic epithelial tumors (TETs) are uncommon lesions, and cerebral metastases from these tumors are even rarer. We report a case of a posterior fossa metastasis in a patient with a known history of thymic carcinoma. CASE DESCRIPTION A 47-year-old man with a history of Hodgkin lymphoma and thymic carcinoma presented with headache, nausea, and ataxia. Imaging revealed a large posterior fossa mass. This lesion was completely resected without complications. Pathologic examination was consistent with metastatic thymic carcinoma. The patient's symptoms were relieved postoperatively. We reviewed the literature and identified an additional 44 cases of TETs with metastases to the brain. Although brain metastases are generally associated with a poor prognosis in patients with TETs, survival of more than 1 year may be accomplished with surgical resection and multimodality treatment. CONCLUSIONS Metastasis should be considered in the differential of a patient with a TET and an intracranial mass lesion.
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Affiliation(s)
- Jennifer A Kosty
- Department of Neurosurgery, University of Cincinnati College of Medicine, Brain Tumor Center at the University of Cincinnati Neuroscience Institute; and Mayfield Clinic, Cincinnati, Ohio, USA
| | - Norberto Andaluz
- Department of Neurosurgery, University of Cincinnati College of Medicine, Brain Tumor Center at the University of Cincinnati Neuroscience Institute; and Mayfield Clinic, Cincinnati, Ohio, USA.
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HARYU S, SAITO A, INOUE M, SANNOHE S, KUROTAKI H, KON H, SASAKI T, NISHIJIMA M. Brain Metastasis from Invasive Thymoma Mimicking Intracerebral Hemorrhage: Case Report. Neurol Med Chir (Tokyo) 2014; 54:673-6. [DOI: 10.2176/nmc.cr2012-0430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Shinya HARYU
- Department of Neurosurgery, Aomori Prefectural Central Hospital
| | - Atsushi SAITO
- Department of Neurosurgery, Aomori Prefectural Central Hospital
| | - Mizuho INOUE
- Department of Neurosurgery, Aomori Prefectural Central Hospital
| | - Seiya SANNOHE
- Department of Pathology, Aomori Prefectural Central Hospital
| | | | - Hiroyuki KON
- Department of Neurosurgery, Aomori Prefectural Central Hospital
| | - Tatsuya SASAKI
- Department of Neurosurgery, Aomori Prefectural Central Hospital
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Nassiri F, Scheithauer BW, Corwin DJ, Kaplan HG, Mayberg M, Cusimano MD, Rotondo F, Kovacs K. Invasive thymoma metastatic to the cavernous sinus. Surg Neurol Int 2013; 4:74. [PMID: 23776760 PMCID: PMC3683174 DOI: 10.4103/2152-7806.112824] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/24/2013] [Indexed: 11/15/2022] Open
Abstract
Background: Thymomas are typically benign tumors of thymic epithelium. Metastases to distal sites, particularly intracranial locations, are extremely rare. Herein, we present the third case of thymoma and the second invasive thymoma to metastasize to the cavernous sinus, adjacent to the pituitary. Case Description: A 41-year-old female patient presented with headaches, stuffy nose, and drooping of the right face. A magnetic resonance imaging scan revealed a complex, multilobulated mass centered upon the right cavernous sinus. The mass was removed via transsphenoidal surgery, and histopathological investigation confirmed the diagnosis of metastatic thymoma. A positron emission tomography-computed tomography scan demonstrated a large anterior mediastinal mass. A biopsy confirmed the diagnosis of invasive thymoma morphologically identical to the World Health Organization type B2 sellar region metastasis. Conclusion: Although rare, thymomas can metastasize to the central nervous system. Our case is the second invasive thymoma to metastasize to the cavernous sinus, adjacent to the pituitary.
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Affiliation(s)
- F Nassiri
- Divisions of Pathology, St. Michael's Hospital, Toronto, Ontario, Canada ; Department of Neurosurgery, St. Michael's Hospital, Toronto, Ontario, Canada
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McLaughlin SS, Peckham SJ, Enis JA, Koebbe C, Smith BD. Young woman with thymoma metastatic to the brain controlled with gross total resection and stereotactic radiosurgery, with a subsequent uncomplicated pregnancy. J Clin Oncol 2011; 29:e30-3. [PMID: 20940185 DOI: 10.1200/jco.2010.31.0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tsutsumi S, Abe Y, Yasumoto Y, Shiono S, Ito M. Metastatic skull base tumor from thymic carcinoma mimicking Tolosa-Hunt syndrome. Neurol Med Chir (Tokyo) 2010; 50:499-502. [PMID: 20587979 DOI: 10.2176/nmc.50.499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 39-year-old male without contributory medical history had sustained progressive double vision, ptosis, and trigeminal pain for 2 weeks. Physical examination revealed total ophthalmoplegia and visual field defect with normal blood examination and chest radiography. Cranial computed tomography revealed a hyperdense mass in the left frontotemporal fossae with bony erosion. Magnetic resonance imaging confirmed a broad-based, intensely enhanced extraaxial tumor of 4x4x4 cm diameter with dural tail sign. Cerebral angiography demonstrated insignificant blood supply both from the internal carotid and middle meningeal arteries. Nearly total tumor resection was achieved via orbitofrontotemporal craniotomy. Intraoperative findings revealed the extraaxial tumor with broad attachment to the dura mater and invasion to the optic and oculomotor nerves. Histological examination revealed hypercellular tumor with significant cell atypism, mitotic activity, and focal necrosis. Immunohistochemical staining was positive for AE1/3 and c-kit, but negative for glial fibrillary acidic protein. Systemic examination performed postoperatively revealed a thymic tumor without additional remote lesions. The final diagnosis was metastatic brain tumor from thymic carcinoma. Rapid progression of neurological impairment inconsistent with a benign extraaxial tumor needs prompt surgical intervention.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
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10
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Brain metastasis from thymic carcinoma in association with SIADH and pituitary enlargement: a case report. South Med J 2009; 101:764-6. [PMID: 18580715 DOI: 10.1097/smj.0b013e31817a8bb7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 49-year-old white female presented to the emergency room complaining of severe headaches. A brain computed tomography (CT) showed a large right temporal mass that measured 2.9 x 5 cm. Sodium was low at admission, which indicated syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Her pituitary gland was enlarged. Thorax CT revealed a large anterior mediastinal mass measuring 6.3 x 3.6 cm. Pathology revealed a poorly differentiated carcinoma arising from the thymus. This case is unique because thymic cancer rarely results in brain metastases and very rarely causes SIADH with changes in pituitary volume and signal quality.
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Ersahin M, Kilic K, Gögüsgeren MA, Bakirci A, Vardar Aker F, Berkman Z. Multiple brain metastases from malignant thymoma. J Clin Neurosci 2007; 14:1116-20. [PMID: 17276689 DOI: 10.1016/j.jocn.2005.12.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 12/11/2005] [Accepted: 12/12/2005] [Indexed: 10/23/2022]
Abstract
A rare case of thymic carcinoma with multiple brain metastasis is reported. In our extensive review of the literature only six of 30 reports of intracranial thymoma metastasis describe multiple metastases. A 38-year-old man presented with signs of raised intracranial pressure that had began 15 days previously. Cranial MRI revealed over 70 cystic lesions in the supra and infratentorial regions. Stereotactic biopsy was planned. On the second day of his admission he deteriorated and died the following day. The autopsy revealed a mass in the mediastinum. In the brain parenchyma were multiple cystic lesions between 0.5 and 3 cm in diameter. Histopathologically they were diagnosed as metastases from the thymic carcinoma. The mean survival with a single brain metastasis is approximately 256 days, whereas with multiple brain metastases it is only 64 days, thus treatment of this tumor demands prompt surgery whenever possible and optimal adjuvant therapy.
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Affiliation(s)
- M Ersahin
- Department of Neurosurgery, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
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Thompson EM, Sather MD, Reyes CA, Long DJ. Intracranial leptomeningeal metastasis from thymic carcinoma: case report and review. ACTA ACUST UNITED AC 2007; 68:233-8. [PMID: 17537485 DOI: 10.1016/j.surneu.2006.08.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Accepted: 08/21/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thymic carcinoma is an uncommon malignant tumor of the anterior mediastinum. Meningeal metastasis from this type of neoplasm is extraordinarily rare and the prognosis is abysmal. CASE DESCRIPTION This article presents the case of a 45-year-old man with known metastatic thymic carcinoma who presented with intractable headaches. An MRI scan was highly suggestive of a meningioma, and it was initially suspected that this patient had 2 primary tumors. Surgical resection of the mass both demonstrated a metastatic thymic lesion and ameliorated the patient's quality of life. CONCLUSION The authors report a case of intracranial meningeal metastasis from a lymphoepithelioma-like poorly differentiated metastatic thymic carcinoma, which was treated by resection and WBRT. A review of the current literature revealed no other cases of this uncommon alhistologic subtype of thymic carcinoma metastatic to the cranium. The incidence, histologic classification of subtypes, and treatment are discussed. This case also illustrates the importance of maintaining a high degree of suspicion for a metastasis in patients with known primary malignancy who present with an MRI highly suspicious for meningioma.
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Affiliation(s)
- Eric M Thompson
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE 68198-2035, USA.
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Abstract
The authors report the clinical presentations, radiological findings, and treatment outcome of thymic carcinoma patients with cerebral metastasis. The authors retrospectively reviewed the medical records of 49 patients with thymic carcinoma and 6 of them (12.2%) developed brain metastasis. There were 4 men and 2 women with a mean age of 48 years (ranging from 33 to 56 years). The pathological types of thymic carcinoma which developed brain metastasis were thymic carcinoma type C of the WHO classification in three patients, type B3 in one and carcinoid tumor in two patients. Surgical resection was performed as an initial treatment for brain lesions in three patients. Five patients received whole brain radiation therapy (WBRT) and radiosurgery was performed in one of them. The survival time was from 2 months in a patient with no treatment for brain lesions to 9 months in a patient who is still alive after surgical resection combined with WBRT and radiosurgery. There is high probability of metastasis particularly in thymic carcinoma type C or carcinoid tumor. Frequent surveillance and aggressive therapeutic approach are necessary to improve survival in these patients with cerebral involvement.
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Affiliation(s)
- Doo-Sik Kong
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong Kangnam-gu, Seoul 135-710, Korea.
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