Huge thymoma combined with pure red cell aplasia: a case report and literature review

Thymoma is the most common tumor of the anterior mediastinum, especially in adults, and accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal tumors. Thymomas originating from thymus epithelial cells or lymphocytes are the most common, and account for 95% of thymomas. Thymoma is a relatively rare and inert disease of the chest, and many thymoma patients have a long survival period despite disease progression. Surgery is the first choice of treatment for thymoma, but controversy remains as to the best approach for treating giant thymoma. The incidence of large tumors in the thorax is low, surgical treatment is difficult, and surgical risk is high. A thymoma with myasthenia gravis is common, but a huge thymoma with pure red cell aplasia is rare.

Our hospital (Liupanshui People's Hospital) admitted a patient with a large thymoma. The 37-year-old female patient had chest pain without obvious cause, accompanied by chest tightness and shortness of breath for 3 days. The patient appeared to have severe anemia. The patient's initial hemoglobin level was 51 g/L. A computed tomography (CT) scan after hospitalization revealed a large soft tissue mass in the left thoracic cavity, about 22.0 cm × 18.0 cm × 15.0 cm in size, of mixed density, with an intact boundary envelope, partial pulmonary atelectasis of the left lung, and pleural fluid on the left. The tumor was successfully removed by left anterolateral incision, and postoperatively, the patient s compression and anemia improved significantly, and a pathologic diagnosis of type A thymoma.

Through a literature review and case analysis, we extend understandings of thymoma. Clinical differential diagnosis should be made before surgery, which is very important for making treatment plan. Our results can provide a reference for the clinical treatment of thymoma, and strive to provide the best treatment for patients.