A Case of Thymic Carcinoma with Bone and Cerebral Metastases Treated with Stereotactic Radiosurgery and Chemotherapy

Abstract

Unusual clinical course Background: Thymic carcinoma is a rare malignant neoplasm. High-grade thymic carcinoma has a high recurrence rate following surgery, and a low 5-year survival rate. Approximately 30% of patients with thymic carcinoma will be asymptomatic at the time of diagnosis. Extrathoracic metastasis on presentation is uncommon. Treatment of the primary tumor includes surgery, chemotherapy, and fractionated radiation. A rare case of thymic carcinoma that presented with bone and cerebral metastases is reported in a patient who responded well to stereotactic radiosurgery and chemotherapy. Case Report: A 63-year-old woman presented to the hospital for evaluation of hip pain. She was diagnosed with a lytic bone lesion of the right femur and brain metastasis. Biopsies from the mediastinal mass and right femur showed histological features consistent with carcinoma. Immunohistochemistry showed positive immunostaining of the tumor cells for the c-kit receptor (CD117) and CD5, supporting a diagnosis of stage IVb thymic carcinoma. Treatment included stereotactic radiosurgery, which delivered multiple radiation beams to the tumor tissue from different directions to target the tumor without affecting normal tissues. She was treated as an outpatient with carboplatin and taxol after stereotactic radiosurgery. The patient recovered well following treatment. Conclusions: A case of thymic carcinoma with bone and cerebral metastases was successfully treated with stereotactic radiosurgery and chemotherapy.

Advanced thymic lymphoepithelioma-like carcinoma with bone marrow metastases treated by immunotherapy combined with antiangiogenesis therapy: a case report

“…The patient was diagnosed with thymic LELC, a highgrade subtype of thymic cancer, and the thymic LELC accounts for 6% of all thymic carcinoma cases [4][5][6]. Patients with thymic LELC are mostly adult males and it rarely occurs in children [7,8]. Because tumor growth in the mediastinum can be asymptomatic, thymic carcinomas are often diagnosed in advanced or metastatic stages, conferring a poor prognosis.…”

“…Platinum- and anthracycline-based systemic chemotherapy are the first-line treatment plan. However, owing to the rarity and heterogeneity of thymic LELC, an appropriate second-line therapy has not been established for those patients with progressive disease after first or even multiline therapy [8,10]. Considering that the patient has bone marrow metastasis after first-line chemotherapy and cannot tolerate chemotherapy, it is a treatment with strong bone marrow suppression.…”

Thymic carcinoma metastasize to the small intestine: a case report

“…Previous studies reported lymph node metastasis was common and the anterior lymph nodes were first involved, with subsequent progression to the intrathoracic lymph nodes, and then the extrathoracic lymph nodes [ 6 ]. Bone metastasis were characterized by osteolytic bone destruction combined with soft tissue mass formation [ 8 ]. Pleural and lung metastasis was present as multiple small nodules.…”