Thymoma masquerading as transfusion dependent anemia

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Pure red cell aplasia (PRCA) is a rare hematologic disorder characterized by the selective destruction of erythroid precursors.
• Identifying the underlying etiology of PRCA is crucial for effective management, as patients often require lifelong blood transfusions.
• Thymoma, a tumor of the thymus gland, is an infrequently identified cause of PRCA.

Observation:

• A transfusion-dependent patient with PRCA was evaluated.
• The patient was diagnosed with thymoma, a neoplastic condition of the thymus.
• The specific WHO histopathological classification of the thymoma was Type B, which typically correlates with myasthenia gravis rather than PRCA.

Findings:

• This case presents a Type B thymoma associated with PRCA, diverging from the typical association of Type A thymoma with PRCA.
• While surgical resection of the thymus improves PRCA in approximately 30% of cases, this patient was not a surgical candidate.
• Chemotherapy was initiated as the treatment strategy for this patient's PRCA secondary to thymoma.

Implications:

• This case underscores the importance of investigating thymoma in patients with PRCA, even in the presence of atypical histopathological findings.
• It highlights that PRCA can be associated with various thymoma subtypes, necessitating a thorough etiological workup.
• For patients unsuitable for surgery, chemotherapy offers an alternative treatment modality for thymoma-associated PRCA, potentially improving outcomes.