多学科治疗巨型胸腺瘤,为彻底手术切除铺平道路:病例报告。

IF 0.7 Q4 SURGERY Surgical Case Reports Pub Date : 2024-07-12 DOI:10.1186/s40792-024-01970-2
Ayaka Makita, Shota Nakamura, Tomohiro Setogawa, Yoshito Imamura, Shoji Okado, Yuji Nomata, Hiroki Watanabe, Yuta Kawasumi, Yuka Kadomatsu, Harushi Ueno, Taketo Kato, Tetsuya Mizuno, Toyofumi Fengshi Chen-Yoshikawa
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引用次数: 0

摘要

背景:对于广泛、晚期或复发性胸腺瘤患者,建议采用多学科治疗方法。然而,详细的治疗策略,如化疗方案和最佳手术方法,仍在争论之中:我们报告了一例巨大局部晚期胸腺瘤病例。一名 70 岁的男性因发现胸部异常阴影而被转诊至我院。胸部 X 光和计算机断层扫描(CT)显示,前纵隔有一个 21 厘米的肿块,环绕肺门并延伸至左胸腔。PET/CT 显示肿瘤部位的 18F- 氟脱氧葡萄糖摄取增加。根据经皮 CT 引导的针刺活检,该肿瘤被诊断为 B2 型胸腺瘤,临床分期为 IIIA 期。患者接受了四个周期的术前诱导化疗,包括顺铂、多柔比星和甲基强的松龙(CAMP),结果出现了部分反应;肿瘤缩小到 12 厘米,FDG 摄取下降。考虑到患者的年龄和合并症,我们对其进行了全胸腺切除术,同时部分切除了顶叶、纵隔和内脏胸膜、心包,并进行了左上肺叶切除术。这种方法实现了完全的组织学切除,降低了复发风险。病理分析证实为胸腺瘤,ypT3(肺)N0M0 IIIA 期,心包或胸腔积液中无恶性肿瘤。术后 9 个月未发现复发:我们报告了一例采用多学科策略成功治疗的巨大胸腺瘤病例。结论:我们报告了一例采用多学科策略成功治疗巨胸腺瘤的病例。单纯手术治疗可能无法实现完全切除,但通过术前 CAMP 治疗诱导肿瘤显著缩小后,我们实现了完全切除。这种治疗策略可能对巨大胸腺瘤病例有效。
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Multidisciplinary treatment of giant thymoma, paving the way to complete surgical resection: a case report.

Background: A multidisciplinary treatment approach is recommended for patients with extensive, advanced, or recurrent thymomas. However, detailed treatment strategies, such as chemotherapy regimens and optimal surgical procedures, are still under debate.

Case presentation: We report a case of gigantic locally advanced thymoma. A 70-year-old male was referred to our hospital following the detection of abnormal chest shadows. Chest X-ray and computed tomography (CT) scans revealed a 21-cm mass in the anterior mediastinum, encircling the pulmonary hilum and extending into the left thoracic cavity. PET/CT showed increased 18F-fluorodeoxyglucose uptake at the tumor site. Based on a trans-percutaneous CT-guided needle biopsy, the tumor was diagnosed as a Type B2 thymoma at the clinical IIIA stage. The patient underwent four cycles of preoperative induction chemotherapy, including cisplatin, doxorubicin, and methylprednisolone (CAMP), resulting in a partial response; the tumor shrank to 12 cm and FDG uptake decreased. Considering the patient's age and comorbidities, we performed total thymectomy, along with partial resections of the parietal, mediastinal and visceral pleura, pericardium, and left upper lobectomy. This approach achieved complete histological resection, mitigating the risk of recurrence. Pathological analysis confirmed a thymoma, ypT3 (lung) N0M0 stage IIIA, with no malignancy in the pericardial or pleural effusions. No recurrence was detected 9 months post-surgery.

Conclusions: We report a case of giant thymoma successfully treated with multidisciplinary strategy. Surgical treatment alone may not have achieved complete resection, but after inducing significant tumor shrinkage with preoperative CAMP therapy, we were able to achieve complete resection. This treatment strategy may be effective in large thymoma cases.

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