Case reportPeritoneal recurrence of thymoma treated by surgery and hyperthermic intraperitoneal chemotherapy
Introduction
Thymomas are rare cancers (1,5 cases/million) and typically occur in adults with a median age of 50 years old. Concomitant myasthenia gravis (MG) is diagnosed among 30% to 50% of cases. The current histological classification of thymomas includes five types (types A, AB, B1, B2, B3), and thymomas are indolent cancers with a 10-year overall survival (OS) for resected stage II thymomas of 70%. Late relapses occur in 20% of the cases, and local recurrence is more common [1]. Distant metastases from thymoma are rare, but have been described in lung, diaphragm, pleura, liver, kidney, retroperitoneum and bones [2]. Peritoneal recurrence of thymoma treated with surgery associated with hyperthermic intraperitoneal chemotherapy (HIPEC) has not been previously described in the literature. We describe herein the first report of a 54-year-old man presenting with peritoneal metastasis of his thymoma, 21 years after initial treatment, and treated with HIPEC.
Section snippets
Case report
54 years-old man with MG presented with a recurrent liver and peritoneal disease from stage II by Masaoka (T1b N0 M0 according 8th TNM classification) [3] epithelial B3 thymoma 21 years after initial resection (Fig. 1). Complete cytoreductive surgery was performed upfront with the removal of two liver metastases of 60 mm and 30 mm and one peritoneal metastasis of 27 mm, all pathologically proven as metastases from B3 thymoma. Two new peritoneal lesions were detected 29 months after surgery,
Discussion
Peritoneal relapses from thymomas are distinctly rare and only a few cases have been reported previously [5]. Three potential causes for transdiaphragmatic spread have been proposed: through the retrocrural space, through the openings in the anteromedial diaphragmatic origin or direct invasion of muscular diaphragm [6]. Peritoneal relapses described in the literature are commonly treated with surgery, as complete as possible, with or without peri-operative chemotherapy [2]. One study reported a
Conflict of interest
The authors have no conflict of interest to declare.
References (9)
- et al.
The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors
J. Thorac. Oncol.
(2014) - et al.
Cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy in patients with malignant pleural mesothelioma or pleural metastases of thymoma
Chest
(2002) - et al.
Peritoneal carcinomatosis from unusual cancer origins: is there a role for hyperthermic intraperitoneal chemotherapy?
J. Visc. Surg.
(2016) - et al.
Thymomas and thymic carcinomas: Clinical Practice Guidelines in Oncology
J. Natl. Compr. Cancer Netw. JNCCN
(2013)