Type A thymoma: a rare cause of neoplastic cardiac tamponade with long-term survival

Abstract

Background The prognosis of thymoma with cardiac tamponade is generally poor. Most of the reported thymomas with cardiac tamponade were type B or type AB (mixed thymoma), and cardiac tamponade due to type A thymoma, which has a better prognosis compared to type B thymoma, is extremely rare. Case presentation We encountered a case of cardiac tamponade in a 71-year-old male. He visited our emergency department due to exacerbation of fatigue and dyspnea on exertion that lasted for two weeks. Chest imaging revealed a large amount of pericardial fluid and a contrast-enhanced tumor with calcification in the anterior mediastinum. The patient underwent thoracoscopic tumor biopsy and pathological examinations revealed type A thymoma. In this case, long-term disease-free survival (7.5 years) was achieved by multidisciplinary treatment (preoperative chemotherapy, surgical excision, and postoperative radiation therapy), in accordance with the histological type. Conclusions This case indicates that neoplastic cardiac tamponade, even in elderly patients, should not necessarily be regarded as a terminal cancer and requires a systematic investigation for underlying causes.

Disseminated thymoma in pleural fluid: An unusual case

“…The reasons behind the rarity of this finding are not completely understood. Although the incidence is unknown, multiple case reports exist of pleural effusion 4,8,9 or, rarely, pericardial effusion 8,10,11 occurring in thymoma patients with serosal dissemination. In many of these case reports the effusion cytology is described as negative.…”

Think Outside the Heart: An Unusual Cause of Large Hemopericardium

“…Usually seen in adults aged 45 to 50 years, the tumor has variable clinical presentation ranging from being incidentally detected during chest imaging to causing symptoms (cough, chest pain, dyspnea) due to direct invasion into surrounding organs like pleural, pericardial space or lungs, or mass effect. [6][7][8] Pericardial effusion is an established complication of malignancy, which can occur as a direct consequence of malignancy itself or as an adverse effect of treatment. 1,9 Pericardial tamponade complicating thymoma is rare, with only a few published case reports over the years.…”

“…1,9 Pericardial tamponade complicating thymoma is rare, with only a few published case reports over the years. 6,[10][11][12] Despite a higher yield of fluid cytology in malignant cases (50-80%), prior reports of thymoma invading pericardial space have shown nondiagnostic fluid analysis. 6,10 Video 2 Noncontrast, axial bright blood imaging showing large heterogenous intrapericardial mass extending superiorly to the arch and encasing the aorta; see also at https://youtu.be/pnJ-g_lxM0c.…”