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Journal of Cancer Research and Therapeutics
Medknow Publications on behalf of the Association of Radiation Oncologists of India (AROI)
ISSN: 0973-1482 EISSN: 1998-4138
Vol. 5, Num. 1, 2009, pp. 41-42

Journal of Cancer Research and Therapeutics, Vol. 5, No. 1, January-March, 2009, pp. 41-42

Case Report

Invasive thymoma with intraorbital metastases

Nirmala S, Janaki MG, Malavika K, Rishi KarthikS

Department of Radiotherapy and Ophthalmology, MS Ramaiah Medical College, Bangalore - 560 054, India.
Correspondence Address:Department of Radiotherapy, MS Ramaiah Medical College, Bangalore - 560 054, India. drknmrao@gmail.com

Code Number: cr09009

Abstract

Thymomas are epithelial neoplasm of thymus and most common primary neoplasm of anterior and superior mediastinum affecting males and females equally. It occurs usually in the fifth to seventh decade. Approximately one-third of thymomas are invasive. Metastases to distant extrathoracic sites such as the liver, lung, lymph node, kidneys, ovary and brain occur infrequently. This is more common with invasive thymomas. Although brain has been shown to be a site of infrequent metastases, intraorbital metastases has not yet been reported. Here we report one such case of invasive thymoma of anterior superior mediastinum, which later metastasized to orbit as well as the brain.

Keywords: Intraorbital metastases, invasive thymoma, brain metastases

Case Report

A 62-year-old male patient presented to the department of thoracic surgery with complaints of extreme weakness that lasted for three days. A chest X-ray [Figure - 1] done showed an anterior mediastinal mass.

CT scan of the thorax showed heterogeneously enhancing mass in the anterior mediastinum displacing the SVC and ascending aorta measuring 9.7 x 8.4 cms. A median sternotomy and tumour excision with partial pericardial excision was done for this patient.

Histopathology of the mass was reported as anterior mediastinum - mixed thymoma minimally invasive Stage T2 [Figure - 2]. Sections show encapsulated tumor made of admixture of epithelial cells and nonepithelial lymphocytes. Epithelial cells are plump to round with vesicular nuclei and abundant eosinophillic cytoplasm, some of the cells arranged around blood vessels. Tumor cells show invasion into surrounding fat.

Patient received postoperative radiotherapy to the anterior superior mediastinum to a dose of 50Gy/25Fr/5Fr/week on Co-60. He was on regular follow-up and was doing well.

One year and seven months later he came with H/O proptosis in Lt Eye with diminished vision.

CT scan of the brain revealed a retro orbital mass lesion in both the eyes with intracranial extensions [Figure - 3].

Fine needle aspiration cytology (FNAC) from the right orbital mass through the medial canthus of right eye was reported as epithelial type of malignant thymoma.

He was given palliative RT of 40 Gy/20Fr to the orbital metastases and brain. His vision improved from Perception of light to Counting fingers at 1 meter. He was lost for follow-up after completion of treatment.

Discussion

Thymoma is an epithelial neoplasm of the thymus and represents the most common primary neoplasm of the anterior superior mediastinum. The majority of thymomas are completely encapsulated lesions, but in a minority of the cases there may be invasion of the tumour capsule and / or surrounding structures. [1] The most common sites of metastases are liver, lung, lymph nodes including pelvic group, ovary, [2] kidney, [3] bone, [3] intestines, [4] spine, [5] retro vesicle soft tissue [6] and Brain, [7],[8],[9] and pelvis. [10] Until now about 17 cases of brain metastasis have been reported and as per our knowledge this is the first case of orbital metastases with intracranial extension. Radiotherapy has a role in the management of metastasis. Extrathoracic disease is associated with poor prognosis and the average time of survival after the diagnosis of metastases is 1.5 years. [2]

Acknowledgement

We acknowledge Late. Dr. Nithyananda Shetty, Professor and Head of department Cardiothoracic Surgery at our Hospital who was the treating Surgeon and also Dr. Manjunath. Pathologist of Metropolis, M.S. Ramaiah Memorial Hospital, who helped us in getting the microphotographs of the histopathology.

References

1.Frazier AA, Garcia G, Monge JG, Moran C. Extended review: thymoma. From The department of Radiologic Pathology, Armed Forces Institute of Pathology. Last revision 5/1/98.  Back to cited text no. 1    
2.Bott-Kothari T, Aron BS, Bejarno P. Malignant thymoma with metastases to the gastrointestinal tract and ovary: A case report and literature review. Am J Clin Oncol 2000;23:140-2.  Back to cited text no. 2    
3.Needles B, Kemeny N, Urmacher C. Malignant thymoma: Renal metastases responding to cis-platinum. Cancer 1981;48:223-6.  Back to cited text no. 3    
4.Huber O, Megevand R, Baud M. Malignant thymoma and intestinal metastasis: Report of a case and review of the literature. Helv Chir Acta 1980;47:209-11.  Back to cited text no. 4    
5.Emile J, Bertrand G, Truelle JL, Bastard J. Spinal paraplegia revealing metastatic malignant lymphoepithelial thymoma. Ann Med Interne (Paris) 1975;126:211-5.  Back to cited text no. 5  [PUBMED]  
6.Faruk T, Mehmet A, Nuri T, Erkan T. Retrovesical soft-tissue metastases of malignant thymoma: Case report. Am J Clin Oncol 2003;26:366-8.  Back to cited text no. 6    
7.Oda Y, Mori K, Watanabe H, Osaka K, Handa H. Malignant thymoma with cerebral metastasis. Rinsho Shinkeigaku 1982;22:501-6.  Back to cited text no. 7  [PUBMED]  
8.MacDonald J, Parker JC Jr, Brown S, Page LK, Wolfe DE. Cerebral metastasis from a malignant thymoma. Surg Neurol 1978;9:58-60.  Back to cited text no. 8  [PUBMED]  
9.Filiz K, Deniz Y, Filiz SK, Deniz Y, Yakup S. Myesthenia gravis and invasive thymoma with multiple intracranial metastases. J Clin Neuromusc Dis 2004;4:171-3.  Back to cited text no. 9    
10.Elliott KS, Borowsky ME, Bakdounes K, Huang J, Abulafia O, Lee YC. Malignant thymoma metastatic to the pelvis: A rare case and considerations for management. Gynecol Oncol 2005;99:228-31.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]

Copyright 2009 - Journal of Cancer Research and Therapeutics

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[cr09009f2.jpg] [cr09009f1.jpg] [cr09009f3.jpg]
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