Multiple pleuropericardial implants of thymoma after videothoracoscopic resection

Abstract

The case of a 49-year-old man with multiple pleuropericardial implants of B2 thymoma is reported. Two years earlier, the patient had undergone left videothoracoscopic (VATS) resection of a 6-cm thymoma in another hospital. The operative report describes a technically correct procedure with morcellation of the lesion within a retrieval thoracoscopic bag. Through a standard thoracotomy, 11 implants were resected with macroscopically complete tumor removal. The origin of cell spillage was ascribed to manipulation of the thymoma during VATS resection.

Stage-related outcome for thymic epithelial tumours

“…Sternotomy approach remains the most common technique to be employed but, along with thoracotomy, there are several series describing the minimally invasive surgery as a valuable therapeutic option in the removal of a mediastinal mass suggesting a low-stage thymoma [ 13 – 15 ]. The recurrence seems to be frequently related to spillage, malignant residue after suboptimal surgery or possible multifocal malignancy within the mediastinal fat [ 1 , 5 , 12 , 16 ]. A careful surgery can safely remove all the neoplastic tissue but must be respectful of the primary lesion integrity [ 17 ].…”

“…Encouraging results have been reported in large series from high volume centers [ 13 , 15 , 17 ]. Tumor manipulation during minimally invasive procedures can result in additional risk of drop metastasis that would forward the stage from I-II to IVa with a significant worsening of prognosis [ 16 – 18 ]. Therefore, the indication to such operations needs to be balanced against its hazards [ 15 , 17 , 18 ].…”

“…Once decided to submit the patient to surgery for stage IV thymoma, diagnostic and staging information must satisfy technical conditions for a possible macroscopically complete resection; if it is absolutely not achievable, any surgical plan should be abandoned [25,28]. Redo-surgery is not self-limiting and cases of indolent disease can develop multiple metachronous metastasis that can undergo surgery time by time [16,29].…”

Could thymomectomy be a reasonable option for non-myasthenic thymoma patients?

“…(I) It is widely known that the risk of recurrence is correlated to Masaoka stage, tumor size, WHO histological classification and completeness of resection (3,(18)(19)(20)27). Few studies have investigated on how the extent of resection on the healthy thymus may affect the prognosis.…”

Pretreatment biopsy for thymic epithelial tumors—does histology subtype matter for treatment strategy?

“…In the available literature, tumor seeding is reported at exceedingly low rates (7)(8)(9). However, biopsies violating the pleural space, such as VATS biopsy of an anterior mediastinal mass, should be avoided due to potential pleural seeding which has been reported (10,11). Thoracoscopic approaches were reported in ChART but it is unclear how many were performed since they were analyzed in conjunction with mediastinoscopy and EBUS.…”