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[Invasive thymoma in patient with pernicious anemia and pericardial effusion]
M Watanabe1, A Watanabe, M Noguchi
1Department of Respiratory Medicine, National Nagoya Hospital, Japan.
Insights
This case report details a rare instance of invasive thymoma complicated by pernicious anemia. The patient presented with symptoms of both conditions, highlighting the diagnostic challenges and rare co-occurrence.
Area of Science:
- Oncology
- Hematology
- Immunology
Background:
- Thymoma is a rare tumor arising from the thymus gland.
- Pernicious anemia is an autoimmune condition affecting vitamin B12 absorption.
- The co-occurrence of invasive thymoma and pernicious anemia is exceptionally rare.
Observation:
- A 69-year-old woman presented with symptoms including cough, dyspnea, fatigue, and edema.
- Imaging revealed cardiac enlargement, mediastinal mass, pericardial effusion, and lung nodules.
- Biopsy confirmed mixed-cell-type thymoma; lab tests indicated pernicious anemia.
Findings:
- The patient was diagnosed with stage IVb invasive thymoma and pernicious anemia.
- Chemotherapy led to tumor shrinkage, but surgical resection was impossible due to cardiac and vascular invasion.
- Post-operative radiation therapy was administered.
Implications:
- This case underscores the importance of considering rare autoimmune comorbidities in thymoma patients.
- The diagnostic and therapeutic challenges associated with advanced invasive thymoma are highlighted.
- Further research into the potential links between thymoma and autoimmune disorders like pernicious anemia is warranted.
Abstract:
A 69-year-old woman was admitted to the hospital because of coughing, dyspnea, generalized fatigue, and pretibial edema. A chest X-ray film revealed cardiac enlargement, a left hilar mass, and a small nodule in the right middle lung field. Echocardiography showed a massive pericardial effusion. A chest CT scan showed pericardial effusion, an anterior mediastinal mass, and a small nodule in the right upper lobe. Examination of a percutaneous biopsy specimen showed round and spindle-shaped tumor cells and lymphocyte infiltration, which was consistent with mixed-cell-type thymoma. Hematological examination showed macrocytic anemia, and the concentration of vitamin B12 was 65 pg/ml (249-938 pg/ml). A test for anti-parietal cell antibodies was positive. Our diagnosis was pernicious anemia and stage IVb invasive thymoma (by Masaoka's classification). Because of the intrapulmonary metastasis and pericardial effusion, the patient underwent chemotherapy. The tumor shrank, so a thoracotomy was done. However, the tumor was found to have invaded the heart and large vessels, and it could not be removed. After surgery the thorax was irradiated. Invasive thymoma complicated by pernicious anemia is rare.