Rarity among the rare-large and invasive thymoma, a case report and review

Figures & data

Table

Lab	Result	Normal Range
WBC	13,260/μL	4,000–11,000/μL
Hemoglobin	11.7 g/dL	12.5–15 g/dL
Hematocrit	35.8%	38.0%-47.0%
Platelets	570,000/μL	150,000–450,000/μL
Erythrocyte Sedimentation Rate	110 mm/hr	=/<30 mm/hr
C-Reactive Protein	22.23	=/< 0.5 mg/dL
Beta-type Natriuretic Peptide	665.7 pg/mL	=/<125.0 pg/mL

Figure 1. (a) Chest radiograph showing diffuse bilateral hilar adenopathy with questionable calcified granuloma at the hila (black arrows) noted in Figure 1 (a) and (b). This adenopathy obscures the hilum and the cardiac silhouette. There are bilateral pleural effusions, left greater than right, also appreciated. (b) The lateral view shows a large mass obscuring cardiac silhouette (black arrows) in the anterior compartment of the mediastinum.

Figure 2. CT chest angiogram in figures 2 (a) and (b) showing mildly lobulated, mildly heterogeneously enhancing anterior mediastinal mass measuring approximately 9.5 × 6.7 x 10.0 cm. The mass label ‘M’ in figures 2 (a) and (b) appears to be compressing a portion of the left pulmonary artery and concerning for massive, compressive thymoma. In figure 2 (c) The thickened pericardium is seen (double-headed arrow) as well as moderate-sized pericardial effusion (single-headed arrows). A mild pleural effusion (*) is seen on the right and a moderate pleural effusion (**) is seen on the left.

TABLE A1. The Masaoka-Koga staging system [10,13].

Stage	Definition
I	Macroscopically and microscopically completely encapsulated
IIA	Microscopic trans capsular invasion
IIB	Macroscopic invasion into surrounding fatty tissue or grossly adherent to but not through mediastinal pleura or pericardium
III	Macroscopic invasion into neighboring organs (pericardium, great vessels, lung)
IVA	Pleural or pericardial dissemination
IVB	Lymphogenous or hematogenous metastasis

Table A2. Thymoma prognosis by Masaoka-Koga staging system [6,10].

Stage	Prognosis
I	Has a 84% 10-year survival rate
II	Has 83% 10-year survival rate
III	Has a 70% 10-year survival rate and 29% recurrence rate for thymoma and 59% recurrence rate for thymic carcinoma
IVa	Has a 42% 10-year survival rate and a 71% recurrence rate for thymoma and 76% for thymic carcinoma
IVb	Has a 53% 10-year survival and 57% recurrence for thymoma and 54% recurrence rate for thymic carcinoma

Table A3. Thymoma treatment options according to Masaoka-Koga staging system [11].

Stage	Treatment
I	Complete surgical resection
II	Complete surgical resection; if resection is incomplete, post-operative radiation therapy
III	Neoadjuvant chemotherapy followed by complete surgical resection; if resection is incomplete, postoperative radiation therapy
IVa	Neoadjuvant chemotherapy followed by complete surgical resection; if resection is incomplete, postoperative radiation therapy
IVb	Palliative chemotherapy

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