Thymic carcinoma recurring 11 years post-extended surgery: a case report

Thymic carcinoma is a rare type of tumor originating in the thymus, making up about 15-20% of all thymic epithelial tumors. It typically has a poor prognosis, especially in advanced stages, with low 5-year survival rates. Cases where the cancer recurs more than 10 years after surgery are extremely uncommon. Additionally, there are very few reports about the outcomes of patients who undergo aortic resection as part of their treatment for thymic carcinoma.

A 68-year-old male was diagnosed with thymic squamous cell carcinoma classified as Masaoka stage III following the detection of an anterior mediastinal mass during a routine health examination. The patient underwent preoperative treatment, which included two cycles of chemotherapy (cisplatin and docetaxel) and 60 Gy of mediastinal radiotherapy, followed by an extensive surgical procedure comprising extended thymectomy, resection of the ascending aorta and superior vena cava, and wedge resection of the right upper lobe. Postoperative pathological examination revealed ypT3N0M0 disease, corresponding to ypStage IIIa disease, and the patient remained disease-free for 10 years. However, at 11 years after surgery, imaging revealed new nodules in the left lung. Surgical resection confirmed these nodules as metastatic lesions originating from the thymic carcinoma.

This case highlights the critical need for long-term monitoring of thymic carcinoma patients, extending beyond the standard 5-year follow-up due to the potential for late recurrence, even in initially disease-free patients. Furthermore, our findings indicate that aortic resection, when carefully selected, can contribute to favorable long-term outcomes in advanced cases. This report enhances the limited literature on the long-term prognosis of thymic carcinoma, particularly following major vascular resection, and underscores the importance of a multidisciplinary approach to optimize patient management and improve outcomes.