Two Invasive Thymomas Incidentally Found during Coronary Artery Bypass Graft Surgery

Abstract

Thymoma, the most common neoplasm of the anterior mediastinum, is a rare tumor of thymic epithelium that can be locally invasive. We reported 2 cases of invasive thymoma incidentally found during routine coronary artery bypass graft (CABG) surgery at Faghihee Hospital of Shiraz University of Medical Sciences of Iran in a period of about 6 months. The 2 patients were male and above 60 years old. They had no clinical symptoms and radiological evidence of mediastinal mass before detection of the tumor during operation. For both patients mass was completely excised and sent to the laboratory. The ultimate pathological diagnosis of both masses was invasive thymoma (stage 2). There are few reports in which thymomas were found incidentally during cardiac surgery. In spite of rare coincidence, due to being asymptomatic and possibly invasive, special attention to thymus gland during cardiac surgery or other mediastinal surgery and preoperative imaging studies seem to be reasonable approach.

A huge thymoma accidentally discovered during minimally invasive aortic valve surgery

“…In some patients, the first manifestation of the disease was cardiac tamponade produced by heart compression [ 3 ]. However, our patient did not experience the latter, despite having a tumour larger than those previously described in the literature [ 1 ]. Patients with thymoma, in most cases, are split into three groups depending on their symptoms.…”

“…The incidence of thymoma during elective cardiac surgery ranges from 0.2% to 0.7% [ 1 ]. These tumours have a broad spectrum of clinical presentation, including local and paraneoplastic global symptoms [ 2 ].…”

Surgery Resection of a Massive Thymic Carcinoma during Urgent Coronary Artery Bypass Grafting

“…There are rare cases reported with the coexistence of thymomas with cardiac surgery pathologies and the simultaneous surgical treatment of thymus tumours during a cardiac surgery procedure. The incidence of the coexistence of the thymoma and CABG pathologies is referred 0.2-0.7 % [ 5 ] The most of the thymus tumors were incidental findings after the sternotomy is done [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 10 ] while a part of them was distinguished prior the cardiac intervention [ 3 ] [ 4 ] [ 9 ] [ 11 ]. All cases referred to the localisation of tumour in the anterior mediastinum.…”

“…Kouzu at al report simultaneous operations performed for angina pectoris, aortic regurgitation and thymoma [ 11 ]. In all of them, the tumour of thymus were thymomas [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 11 ] while Abdullah et al, [ 10 ] refer a very rare case of thymic carcinoid tumour encountered incidentally during a CABG procedure. The case we presented may be the first case of an incidental finding of thymic carcinoma and treated simultaneously during a CABG.…”

“…Thymic carcinomas are very rare and more aggressive than classical thymomas [ 2 ]. The simultaneous treatment of tumours of the thymus during a cardiac surgery procedure is referred to in some presentations, mostly during CABG [ 3 ] [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 10 ] [ 11 ]. We will present below a case of simultaneous surgical treatment of an incidentally detected thymic carcinoma during an urgent coronary artery bypass.…”