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Thymoma of the middle mediastinum.
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MedLine Citation:
PMID:  22880176     Owner:  NLM     Status:  PubMed-not-MEDLINE    
Abstract/OtherAbstract:
Thymoma is a common anterior mediastinal mass, although thymomas have occasionally been found in the neck, pulmonary hillus, or posterior mediastinum. But a thymoma within the middle mediastinum has rarely been reported. We report a thymoma arising in the middle mediastinum with a review of the literature.
Authors:
Su Ryeun Chung; In Sook Kim; Jhingook Kim
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Publication Detail:
Type:  Journal Article     Date:  2012-08-03
Journal Detail:
Title:  The Korean journal of thoracic and cardiovascular surgery     Volume:  45     ISSN:  2093-6516     ISO Abbreviation:  Korean J Thorac Cardiovasc Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-10     Completed Date:  2012-08-23     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101563922     Medline TA:  Korean J Thorac Cardiovasc Surg     Country:  Korea (South)    
Other Details:
Languages:  eng     Pagination:  267-8     Citation Subset:  -    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
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Full Text
Journal Information
Journal ID (nlm-ta): Korean J Thorac Cardiovasc Surg
Journal ID (iso-abbrev): Korean J Thorac Cardiovasc Surg
Journal ID (publisher-id): KJTCS
ISSN: 2233-601X
ISSN: 2093-6516
Publisher: Korean Society for Thoracic and Cardiovascular Surgery
Article Information
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© The Korean Society for Thoracic and Cardiovascular Surgery. 2012. All right reserved.
open-access:
Received Day: 20 Month: 10 Year: 2011
Revision Received Day: 28 Month: 11 Year: 2011
Accepted Day: 01 Month: 12 Year: 2011
Print publication date: Month: 8 Year: 2012
Electronic publication date: Day: 03 Month: 8 Year: 2012
Volume: 45 Issue: 4
First Page: 267 Last Page: 268
ID: 3413836
PubMed Id: 22880176
DOI: 10.5090/kjtcs.2012.45.4.267

Thymoma of the Middle Mediastinum
Su Ryeun Chung, M.D.A1
In Sook Kim, M.D.A1
Jhingook Kim, M.D.A1
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
Correspondence: Corresponding author: Jhingook Kim, Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. (Tel) 82-2-3410-3483, (Fax) 82-2-3410-0089, jkim@smc.samsung.co.kr

CASE REPORT

A 59-year-old womon presented with an abnormal mass on chest X-ray that was discovered during a routine check-up. She had lost body weight during the previous 3 months. No family history of tumors or other medical diseases was identified. We obtained a biopsy though endobronchial ultrasound and pathologically diagnosed a thymoma (type A). A systemic examination was performed, and all tests were negative. Contrast-enhanced computed tomography showed a smooth, solitary homogeneously enhanced mass measuring 3×3.5×2 cm in the right paratracheal area, which had no calcification (Fig. 1). We initially suspected Castleman disease due to the mass location. She underwent mass excision by video-assisted thoracic surgery. The resected specimen was a firm light-gray tumor with a smooth capsule that measured 4.5×3×2.5 cm. The tumor was solid and was partially composed of adipose tissue. The tumor had not invaded any other mediastinal structures and was easily extracted.

Postoperative follow-up proceeded without any problems, and the patient was discharged after 5 days. Microscopy revealed that the tumor was a thymoma (World Health Organization type A+B2, Masaoka staging I) (Fig. 2).


DISCUSSION

The majority of thymomas are found in the anterior mediastinum. Only a few thymic masses arising out of the anterior mediastinum have been described in the literature, and these have been found in an ectopic thymus location such as the neck, pulmonary hilus, or posterior mediastinum [1,2]. A thymoma occurring in the middle mediastinum is extremely rare. The thymus arises embryologically from the third pharyngeal pouch and branchail cleft on each side. The thymic masses from each side then move toward each other and migrate from the midline to the anterior mediastinum and their final position. Failure of the thymic gland to migrate during embryogenesis leads to ectopic thymic tissue. The incidence of ectopic thymic tissue is 3% to 5% in the retroinnomiate vein (i.e., a paratracheal site) [3].

Surgical resection has been used for both a firm diagnosis and treatment in previously reported cases of a middle mediastinum thymoma [4]. Endobronchial ultrasound-guided biopsy may be useful, as in this case. Sakurai et al. [5] reported that 18F-fluorodeoxyglucose positron emission tomography (PET) scan and 11C-acetate PET are useful for diagnosing a thymoma from the middle mediastinum as ectopic thymic tissue.

Castleman disease is an atypical lymphoproliferative disorder, and masses are commonly located in the chest. Most patients are asymptomatic and lesions are accidentally found on chest X-ray as rounded mediastinal masses, often mistaken for a thymoma [6]. The most effective treatment for Castleman disease is surgical resection.

Because of malignant changes, patients with unicentric Castleman disease may need more postoperative immunosuppressive therapy or radiation. Thus, it is important to pathologically confirm the diagnosis [7].

Thymomas rarely arise in the middle mediastinum, and thymoma is not considered in the differential diagnosis of middle mediastinum masses. But thymomas appear to have malignant potential, and the overall rate of thymoma recurrence is approximately 20%. So a thymoma should be considered in the differential diagnosis of a mediastinal mass [2,8]. A complete resection of a thymoma is useful for both treatment and diagnosis.


References
1. Shimosato Y,Mukai K. Rosai JTumors of the thymus and related lesionAtlas of tumor pathology: fascicle 21, third seriesYear: 1995WashingtonArmed Force Institute of Pathology33247
2. Kojima K,Yokoi K,Matsuguma H,et al. Middle mediastinal thymomaJ Thorac Cardiovasc SurgYear: 200212463964012202887
3. Ashour M. Prevalence of ectopic thymic tissue in myasthenia gravis and its clinical significanceJ Thorac Cardiovasc SurgYear: 19951096326357715209
4. Nakamura H,Adachi Y,Fujioka S,Miwa K,Haruki T,Taniguchi Y. Thoracoscopic resection of middle mediastinal noninvasive thymoma: report of a caseSurg TodayYear: 20073778778917713734
5. Sakurai H,Kaji M,Suemasu K. Thymoma of the middle mediastinum: 11C-acetate positron emission tomography imagingAnn Thorac SurgYear: 2009871271127419324170
6. Keller AR,Hochholzer L,Castleman B. Hyaline-vascular and plasma-cell types of giant lymph node hyperplasia of the mediastinum and other locationsCancerYear: 1972296706834551306
7. Jongsma TE,Verburg RJ,Geelhoed-Duijvestijn PH. Castleman's disease: A rare lymphoproliferative disorderEur J Intern MedYear: 200718878917338958
8. Monden Y,Nakahara K,Iioka S,et al. Recurrence of thymoma: clinicopathological features, therapy, and prognosisAnn Thorac SurgYear: 1985391651693970610

Article Categories:
  • Case Report

Keywords: Thymoma, Mediastinal neoplasms.

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