Minimally invasive extended thymectomy for thymoma associated with pure red cell aplasia

Anaemia characterised by near absence of red cell precursors in the bone marrow is referred to as "pure red cell aplasia (PRCA)." It has an unusual and intriguing association with thymoma and auto-immunity. Here, we report such a case which was successfully treated with extended thymectomy by minimally invasive approach. A 68-year-old anaemic lady presented to our institute with weakness and exertional dyspnoea for almost a year. She was transfused with blood for the same periodically but remained transfusion dependent. Apart from pallor, her systemic examination was unremarkable. Peripheral smear showed reduced haemoglobin (Hb) mass and reduced reticulocytes. Bone marrow biopsy implied PRCA. High-resolution computed tomography (HRCT) of thorax revealed a well-defined soft tissue lesion in the anterior mediastinum suggesting thymoma. Biopsy showed lymphocyte-rich type thymoma. Thymus along with fibrofatty tissue was resected completely using video-assisted thoracoscopic surgery (VATS) approach. Histopathological examination of the resected specimen revealed World Health Organisation (WHO) type B1-thymoma. Immediate post-operative period was uneventful. However, a fall in Hb which required blood transfusions necessitated initiation of immunosuppression with corticosteroids. Patient was given 6 weeks of adjuvant immunosuppression with corticosteroids. After 8 months post-thymectomy, she was leading a symptom-free life and no longer in need for blood transfusions. VATS thymectomy is a safe and feasible approach for the treatment of thymoma-induced PRCA with added advantage of minimal invasive approach. Long-term complete remission is possible with adjuvant immunosuppression.