Chia-Chun Chiang
Mayo Clinic, USA
Title: Pleural ‘drop’ metastasis 21 years after resection of a thymoma: A case report and review of the literature
Biography
Biography: Chia-Chun Chiang
Abstract
We present an unusual case of multiple pleural drop metastasis 21 years after complete resection of an encapsulated thymoma in a Southeast Asian man with myasthenia gravis (MG). To the best of our knowledge, this is the longest reported disease-freeinterval of thymoma recurrence. A 43 year-old man with history of MG presented with a 9-month history of generalized weakness, fatigue and shortness of breath. After the initial diagnosis of MG 21 years ago, the patient underwent a complete resection of an encapsulated thymoma. His MG has reportedly been stable with cyclosporine, mycophenolate mofetil, and pyridostigmine. Due to his new symptoms, CT scan of the chest with contrast was done and revealed numerous pleural nodules surrounding the left lung
with basilar predominance and pleural thickening. The findings were concerning for “drop metastases”. CT-guided biopsy of a pleural nodule was done and the pathologic diagnosis was WHO type B1 thymoma. In the literature review, the average disease-free-interval for thymoma ranged from 68 to 86 months. Pleural and mediastinal recurrence are more common than distant hematogenous recurrence, although various presentations of thymoma recurrence have been reported. Adverse prognostic factors include an nitial higher Masaoka stage, incomplete resection, elderly age, and pleural or pericardial involvement. In patients with apparent complete resection of a thymoma, clinicians should remain vigilant for the possibility of thymoma recurrence for up to 20 years after initial management. Greater awareness