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Yıldız Ç, Türkcan BT, Vural Ö, Gezgin Yıldırım D, İnan MA, Poyraz A, Pınarlı FG, Taştepe İ, Demir E, Sunar Yayla EN, Esmeray Şenol P, Karaçayır N, Bakkaloğlu SA. Thymic carcinoma presenting with overlap polyarthritis and myositis: A rare paraneoplastic syndrome in childhood. Int J Rheum Dis 2024; 27:e15187. [PMID: 38742741 DOI: 10.1111/1756-185x.15187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 04/18/2024] [Accepted: 04/28/2024] [Indexed: 05/16/2024]
Abstract
Thymic tumors are very rare neoplasms in children and account for less than 1% of mediastinal tumors in pediatric patients. One-third of the pediatric patients present with symptoms related to the compression of the tumor mass on the surrounding anatomic structures, and paraneoplastic syndromes such as myasthenia gravis, pure red cell aplasia, acquired hypogammaglobulinemia, and connective tissue disorders, which rarely occur in children with thymic tumors. Herein, we report a case of thymic carcinoma mimicking the symptoms of a connective tissue disease with symmetrical polyarthritis accompanying myositis, fever, weight loss, and malaise in a 15-year-old male patient. To our knowledge, this is the first case pediatric thymic carcinoma accompany with severe polyarthritis and myopathy, thus we have reviewed the current literature regarding the cases of thymic malignancies coexisting with paraneoplastic syndromes in children.
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Affiliation(s)
- Çisem Yıldız
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Büşra Topuz Türkcan
- Department of Pediatric Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Özge Vural
- Department of Pediatric Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Deniz Gezgin Yıldırım
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Mehmet Arda İnan
- Department of Medical Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Aylar Poyraz
- Department of Medical Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Faruk Güçlü Pınarlı
- Department of Pediatric Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - İrfan Taştepe
- Department of Thoracic Surgery, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ercan Demir
- Department of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emine Nur Sunar Yayla
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Pelin Esmeray Şenol
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nihal Karaçayır
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Pediatric Rheumatology, Gazi University Faculty of Medicine, Ankara, Turkey
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Rossi C, Zanelli M, Sanguedolce F, Zizzo M, Palicelli A, Ricci L, Corsi M, Caprera C, Cresta C, Sollitto F, Broggi G, Caltabiano R, Cavazza A, Lococo F, Loizzi D, Ascani S. Pediatric Thymoma: A Review and Update of the Literature. Diagnostics (Basel) 2022; 12:2205. [PMID: 36140606 PMCID: PMC9497562 DOI: 10.3390/diagnostics12092205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/04/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022] Open
Abstract
Pediatric thymomas are extremely rare and slow-growing malignant tumors. The recent publication of the first Union for International Cancer Control (UICC)/American Joint Committee on Cancer (AJCC) Tumor-Node-Metastasis (TNM) stage classification and updated treatment guidelines for thymomas has prompted us to perform a review of the literature on pediatric thymomas. A search of English-language articles in the PubMed, Cochrane, Web of Science, and Embase databases was conducted. Additional articles were identified through reference lists of retrieved publications. Thirty-two articles involving 82 pediatric thymomas were included. Males comprised 60% of patients, and 13% manifested myasthenia gravis (MG). Histotype B1 (45%) and stage I (52% Masaoka-Koga and 71% UICC/AJCC TNM) were the most frequent. Of note is the possibility that the lack of cases with mixed histologies in the reviewed publications might be related to a sampling issue, as it is well known that the more sections are available for review, the more likely it is that the majority of these neoplasms will show mixed histologies. Both staging systems showed a gradual increase in the percentage of cases, with more advanced stages of disease moving from type A to B3 thymomas. Complete surgical resection (R0) was the main therapeutic approach in Masaoka-Koga stage I (89%) and UICC/AJCC TNM stage I (70%) thymomas. Advanced stages of disease and incomplete surgical resection were most often associated with recurrence and death. An association between stage and outcome, and completeness of resection and outcome, was found. Interestingly, though an association between histotype and staging was found, this does not take into account the possibility of mixed histologies which would reduce the clinical impact of histologic subtyping over staging.
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Affiliation(s)
- Cristiana Rossi
- Pathology Unit, Azienda Unità Sanitaria Locale ASL5, 19124 La Spezia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, 71122 Foggia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Linda Ricci
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Matteo Corsi
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Cecilia Caprera
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Camilla Cresta
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy
| | - Francesco Sollitto
- Institute of Thoracic Surgery, University of Foggia, 71122 Foggia, Italy
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Rosario Caltabiano
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Alberto Cavazza
- Pathology Unit, Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Filippo Lococo
- Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore Roma, 00168 Roma, Italy
| | - Domenico Loizzi
- Institute of Thoracic Surgery, University of Foggia, 71122 Foggia, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy
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Kakamad FH, Abdullah AM, Salih AM, Baba HO, Mohammed SH, Salih RQ, Abdulla BA, Hassan MN, Muhialdeen AS. Thymoma with osseous metaplasia; a case report with a brief literature review. Int J Surg Case Rep 2021; 85:106149. [PMID: 34280875 PMCID: PMC8318848 DOI: 10.1016/j.ijscr.2021.106149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/11/2021] [Accepted: 06/26/2021] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE The thymus is a primary lymphatic organ within the mediastinum that plays an essential role in developing and maintaining cell-mediated immunity. The current study aims to report a case of intra-tumoral osseous metaplasia of the thymus gland, which is an infrequent phenomenon. CASE PRESENTATION A 43-year-old male presented with weakness and easy fatigability for 2 months. The patient had an elevated anti-acetylcholinesterase antibody (19.5 nmole/L). Magnetic resonance imaging showed a round, capsulated, enhanced mass in the anterior mediastinum measuring 5.5 × 3.5 cm, suspecting thymoma. The patient underwent plasmapheresis three times in one week, under general anesthesia, in a supine position, sternotomy was performed, and the thymoma was totally resected. DISCUSSION Thymomas are known to occur in all age groups with the peak of nearly between 35 and 70 years with the median age of 54 years. The sex distribution of thymoma is approximately equal with slight predilection of women in old age groups. However, among all reported cases of thymomas with osseous metaplasia, the majorities are female. The significance of this ossification is still to be clarified. CONCLUSION Although it is rare, secondary changes in thymoma may occur including calcification and ossification.
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Affiliation(s)
- Fahmi H Kakamad
- Faculty of Medical Sciences, School of Medicine, Department Cardiothoracic and Vascular Surgery, University of Sulaimani, Sulaimani, Kurdistan, Iraq; Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq.
| | - Ari M Abdullah
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Sulaimani Teaching Hospital, Sulaimani, Kurdistan, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Faculty of Medical Sciences, School of Medicine, University of Sulaimani, Sulaimani, Kurdistan, Iraq
| | - Hiwa O Baba
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | | | - Rawezh Q Salih
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | - Berwn A Abdulla
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | - Marwan N Hassan
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
| | - Aso S Muhialdeen
- Smart Health Tower, Madam Mitterrand Str, Sulaimani, Kurdistan, Iraq; Kscien Organization, Hamid Str, Azadi Mall, Sulaimani, Iraq
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Rod J, Orbach D, Verité C, Coze C, Stephan JL, Varlet F, Thomas-de-Montpreville V, Reguerre Y, Besse B, Sarnacki S. Surgical management of thymic epithelial tumors in children: lessons from the French Society of Pediatric Oncology and review of the literature. Pediatr Blood Cancer 2014; 61:1910-5. [PMID: 25130986 DOI: 10.1002/pbc.25159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/28/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE We report the results of a French multicenter retrospective study based on a period of more than 30 years and a review of the literature in order to more clearly define the surgical approach and specific pediatric risk factors. METHODS Clinical data of children comprising all histologic subtypes of thymic epithelial tumors (TET) treated between 1979 and 2009 in French pediatric oncology centers were retrospectively analyzed and discussed in the light of a review of all pediatric cases reported in the literature. RESULTS Nine cases were identified, corresponding to five females and four males with a median age of 13 years (range: 7.5-17). Histologic subtypes were type AB (n = 1), type B (n = 5) and type C (n = 3). Treatment consisted of tumor resection (4 R0, 4 R1, 1 R2) via right anterior thoracotomy, posterolateral thoracotomy, left thoracoscopy, sternotomy and cervicosternotomy, and/or chemotherapy, mainly cyclophosphamide-doxorubicin-cisplatin (CAP; n = 5), and/or radiotherapy (n = 4). Two patients with TET type C died. All other patients are alive with a median follow-up of 4 years (range: 1.5-20). Review of a total of 93 pediatric cases reported in the literature showed statistically significant associations between less favorable histologic subtypes and male gender (P = 0.012), advanced Masaoka stage (P < 0.001) and quality of resection (P < 0.001) respectively. CONCLUSIONS A review of the literature and our series identified several risk factors to take into account in the therapeutically decision. Complete resection through a sternotomy is highly recommended.
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Affiliation(s)
- J Rod
- Department of Pediatric Surgery, University of Caen Hospital, France
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Fonseca AL, Ozgediz DE, Christison-Lagay ER, Detterbeck FC, Caty MG. Pediatric thymomas: report of two cases and comprehensive review of the literature. Pediatr Surg Int 2014; 30:275-86. [PMID: 24322668 DOI: 10.1007/s00383-013-3438-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Thymomas are rare pediatric malignancies with indolent behavior. There are fewer than 50 reported cases and no comprehensive review. We sought to evaluate our recent experience with pediatric thymomas, and comprehensively review the extant literature. METHODS A systematic search of the PubMed database was performed using keywords: "thymoma", "pediatric", "juvenile", "childhood", and "child". Additional studies were identified by a manual search of the reference list. RESULTS We report two patients with thymomas. We identified 22 case reports or series that described 48 patients; 62 % were male, 15 % presented with myasthenia gravis. Fifty percent were Masaoka Stage I, 15 % were Stage II, 13 % were Stage III, and 23 % were Stage IV. Four patients with early stage (I or II) disease were treated with adjuvant therapies in addition to surgical excision, while five patients with late stage (III or IV) disease treated with surgical excision alone. Of studies reporting at least 2-year follow-up, survival was 71 %. CONCLUSION Pediatric thymomas are rare tumors with a slight male predominance. Wide variations were observed in the treatment of thymomas across all stages. Our review indicates a need for large database and multi-institutional studies to clearly elucidate clinical course, prognostic factors and outcome.
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Affiliation(s)
- Annabelle L Fonseca
- Department of Pediatric Surgery, Yale School of Medicine, FMB 107, 333 Cedar Street, New Haven, CT, 06511, USA,
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Chaturvedi M, Kalgutkar AD, Khandekar JV. Extensive Ossification of Thymoma in a Child. Ann Thorac Surg 2013; 95:e139-41. [DOI: 10.1016/j.athoracsur.2012.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 11/01/2012] [Accepted: 11/06/2012] [Indexed: 10/26/2022]
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