Wide en-bloc thymectomy and venous axis reconstruction in Masaoka stage IIIB thymoma: a case report and literature review

TL;DR

A 36-year-old man with advanced thymoma underwent complex surgery involving thymectomy and venous reconstruction, followed by chemotherapy with no recurrence after 3 months.

Contribution

This case report presents a successful surgical and chemotherapeutic approach for Masaoka stage IIIB thymoma with venous axis reconstruction.

Findings

En-bloc thymectomy and venous bypass using a Dacron graft were successfully performed.

Neoadjuvant chemotherapy followed by surgery led to no recurrence after 3 months of follow-up.

Pericardiectomy and diaphragm metastasis resection were part of the comprehensive treatment strategy.

Abstract

Thymomas are rare tumors originating from thymic tissue and rarely metastasize. They can be diagnosed either incidentally or symptomatically when compressing or invading nearby structure. A 36-year-old man presented with significant high-grade fever, chest pain that worsens upon lying down, and dyspnea. A chest X-Ray and computed tomography followed by biopsy confirmed the diagnosis of thymoma. The management included chemotherapy cycles, followed by surgery. Pericardiectomy was performed with en-bloc thymectomy and partial resection of the infiltrating lung. Venous drainage was restored by 8/16 mm inverted bifurcated brachiocephalic-superior vena cava Dacron bypass. The pericardium was reconstructed by a synthetic Dacron patch, and the right diaphragm metastasis was resected. Neoadjuvant chemotherapy was initiated. After 3 months of follow-up, no recurrence was evidenced by computed tomography.

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