This is a 46 year old male who is working as a policeman. Through a routine medical checkup, X-ray chest showed left anterior mediastinal rounded mass. (CXR-P-A) - (CXR- Lateral)
CT scan chest showed homogeniously opaque single rounded mass closely related to the chest wall ( CT image). The mass has a clear line of cleavage from the surroundings. CT guided true cut biopsy was tried twice but it was conclusive.
The lesion was removed on 8/9/1998. Operative specimen: (image1) - (image2)
The histopathology report: THYMOMA
One year later, he start to feel weakness while getting up and praying at night. He was referred to Neurologist who put him put on
1- Mestinon tab 60 mg t.d.s.
2- Azathoprine tab 50 mg b.d.
He improved a lot and was back to almost full duties
On 136/2004 He was readmitted to respiratory unit because of severe dry cough.
Chest x-ray showed left antero-medial and postero-lateral lesions. CT chest confirmed the mass and showed that The postero-lateral lesion has a wide base towards the outside denoting an extra-pulmonary lesion. ( image1) - (image2)
The antero-medial lesion is an irregular lobulated mediasitnal mass invading the aortic arch, descending aorta, left pulmonary trunk and left ventricle. (image1) - (image2)
CT guided true-cut biopsy was taken and needle aspiration was performed.
Histopathology report: LYMPHOMA . patient was referred to oncologist for further management.
Evidence that cell-mediated immunity is important:
The majority of patients with Burkett's lymphoma ( a tumor caused by Epstein-Barr virus) have inhibited cell mediated responses.
Among the few reports of thymoma and concomitant thymic T-cell lymphoma, only Macon et al. described a
case similar to ours. Both presented a benign encapsulated epithelial thymoma intermingled with blast-like lymphocytes,
without the widely infiltrative growth typical of the T-lymphoblastic lymphoma. Nevertheless, the involvement
of mediastinal lymph nodes by T-lymphoblasts in Maconís case, and the subsequent development of T-lymphoblast
metastases in our case, prove the malignant nature of the lymphoid cells.
Interact CardioVasc Thorac Surg 2003;2:537-540
Francesca Rovera, Paola Billo, Carlo Capella and Lorenzo Dominioni
Concurrent epithelial thymoma and T-cell lymphoblastic lymphoma