Myasthenic crisis appearing after resection of intracardiac ectopic thymoma with superior vena cava syndrome

Background We describe herein an extremely rare case of intracardiac ectopic thymoma—only two pure cases have been reported to date—associated with myasthenia gravis, an infrequent complication of ectopic thymoma. Case presentation A 71-year-old woman with superior vena cava syndrome was found to have a large mass mainly located in the right atrium. Tumor resection under cardiopulmonary bypass was performed. The pathological diagnosis was type AB ectopic thymoma. The postoperative course was complicated by progressive respiratory failure, and she was diagnosed with myasthenic crisis based on clinical signs and the edrophonium test. The patient recovered and was weaned from prolonged mechanical ventilation after receiving intravenous immunoglobulin, and was subsequently discharged uneventfully. Conclusions This is the first report of myasthenic crisis due to intracardiac ectopic thymoma. Residual thymoma is a risk factor for the development of post-thymectomy myasthenia gravis, and long-term follow-up is required.

Endovideosurgical removal of ectopic thymoma

A clinical case of endovascular surgical removal of ectopic thymoma in the hospital surgery clinic of S. M. Kirov Military Medical Academy performed a planned surgical intervention - thymomtectomy from left-side thoracoscopic access. 4 thoracoports used. The time of surgical intervention was 125 minutes, the volume of intraoperative blood loss was less than 50 ml. The postoperative period was uneventful. Drainage removed the next day. There were no postoperative complications. Discharged on the 5th day of the postoperative period in satisfactory condition. It is believed that ectopic thymomas arise from scattered ectopic thymus tissue, which could not migrate to the anteroposterior mediastinum. Currently, the surgical method is the «gold standard» in the treatment of patients with thymus neoplasms. Complete surgical removal of the thymus gland is a prerequisite for the effective treatment of thymic tumors. The basic principle of radicalism is the complete excision of the tumor surrounding the tissue with the lymph nodes. Particular care should be exercised when removing the spurs of the gland, which often go high on the neck, as the left tissue can cause a relapse of the disease. To remove the thymus, various «open» (transcervical, full, partial and oblique partial transsternal, right-, left- and bilateral transpleural), video-assisted (thoracoscopic, transcervical and subciphoidal, transoral) and robot-assisted surgical approaches are proposed. In this case, the choice of surgical access should be approached individually in each case.

An Unusual Ectopic Thymoma in the Lung and Anterior Mediastinum: A Case Report

Background: Ectopic thymoma, a subtype of thymomas, is a rare clinical entity. Understanding the pathogenesis and evolution of Ectopic thymoma may lead to greater insight into tumor initiation and maintenance and may guide therapeutic interventions. We report a case of a multiple thymoma in the lung and anterior mediastinum.Case presentation: we presented a case of 62-year-old man with type A ectopic pulmonary thymoma and thymoma in the anterior mediastinum, which were diagnosed postoperatively. Mediastinal lesion resection and thoracoscopic pulmonary wedge resection were performed. The tumors were completely resected, and the patient was disease-free and without recurrence. we performed whole-exome sequencing (WES), and found eight gene mutations that was co-mutated in both lesions. Consistent with a previous exome sequencing analysis of Thymoma and Thymic Carcinoma, HRAS was also observed in mediastinal lesion and lung lesion tissues. We also evaluated the intratumor heterogeneity of nonsilent mutations, and the mediastinal lesion tissue has higher degree of heterogeneity in detected variants, and the pulmonary tissue has a relatively low amount of variant heterogeneity. Conclusions: Ectopic thymoma is a highly rare clinical entity. Full recognition of its Molecular characteristics will help to better diagnose this disease.