Thymomas presenting as pleural tumors. Report of eight cases

Eight cases of thymomas presenting as pleural-based lesions are presented. The patients are five men and three women between the ages of 38 and 71 years (mean 54.5). Histologically, six tumors showed morphologic features indistinguishable from classical mediastinal thymomas, namely lobulation produced by fibrous bands and a biphasic cell population composed of epithelial cells admixed with small lymphocytes. One case showed prominent spindle cell configuration and marked vascularization resulting in a hemangiopericytomalike appearance; in another case, the epithelial component was associated with cystic structures. The radiographic findings were diffuse pleural thickening with encasement of the lung in four cases; an ill defined mass involving the right diaphragmatic pleura with engulfment of the left lower lobe in one case; diffuse pleural thickening along the mid lateral axillary line in one case; and left-sided pleural masses involving the diaphragmatic and chest wall pleural surfaces in another. In the remaining case, a massive unilateral left pleural effusion obscured the underlying lesion. Clinically, the patients presented with varied symptoms, including shortness of breath, fever, and weight loss. Follow-up information was obtained in four patients. One patient died 1 month after initial diagnosis, but no details of the cause of death were available. Another had metastasis to the groin 1 year after diagnosis. The other two patients were alive and well 2-10 years after the initial diagnosis.