Thymic tumors are uncommon but may be seen relatively often in the Far East and particularly in China.Survival of patients with thymoma and invasive tumors is fairly good, if properly managed. Cases of noninvasive thymoma may be cured by surgery. Those with invasive lesions can be treated with additional radiotherapy. In cases with either unresectable lesions or metastatic disease, chemotherapy may be useful.
We have seen one patient with invasive thymoma which invaded the right upper lung and the superior vena cava. We treated him with en-bloc resection of the tumor and superior vena cava followed by Gore-Tex vascular grafting and obtained good results. This report describes the treatment and results of this surgery.
Figure 1. Chest x-ray film in posterior-anterior view showed widening and prominence of superior mediastinum.
This 50-year-old man was hospitalized for assessment of progressive dyspnea and pressure sensation over his head and neck of three months’ duration. Pertinent findings showed venous distension over the neck and upper chest, swelling of his face, and a mass in the upper anterior mediastinum (Fig 1). Computerized tomography of the chest and a superior vena cavagram revealed a mediastinal tumor with superior vena caval obstruction. A thoracotomy was performed and the mediastinum was explored through a median sternotomy. A hard but movable tumor, measuring 8 x 10 cm in size and with irregular margins, was found to occupy the superior anterior mediastinum and abut the anterior segment of the right upper lung and the pericardium. The tumor invaded the superior vena cava and left innominate vein, causing obstruction of these vessels. The left innominate vein was ligated. The right lung was separated from the tumor by sharp and blunt dissection. Both the tumor and the superior vena cava from the bifurcation of the right and left innominate vein were resected. A segment of Gore-Tex vascular graft, 12 cm long by 14 mm wide, was bridged between the lower end of the right innominate vein and lower end of the superior vena cava with an end-to-end anastomosis to reconstruct the resected cava (Fig 2). Microscopic examination of the tumor showed a thymoma with prominent epithelial cells and lymphocytes with capsular invasion.
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FIGURE 2. Schematic drawing of the location of invasive thymoma and reconstruction of the superior vena cava with Gore-Tex graft.
He was treated with radiotherapy to the mediastinum and is asymptomatic and free of disease 14 months after surgery.