Rahul Kumar Bhardwaj
Mt.Sinai Hospital, USA
Title: Presentation and Prognosis of Incomplete Resection in Thymic Carcinoma
Biography
Biography: Rahul Kumar Bhardwaj
Abstract
Thymic cancer is among one of the rarest malignancy found in humans and accounts for less than 1% of all neoplasms. A rare variant is the basaloid subtype which has approximately 12 reported cases in literature. Treatment of such a malignancy is aimed at complete resection, incomplete resection, or a combination of chemotherapy, radiotherapy and resection.
A 65 year old woman presented with shortness of breath. Initial chest x-ray revealed a marked elevation of the right hemidiaphragm vs subpulmonic effusion. Patient was started on antibiotics and placed on continuous BiPAP. A CT chest without contrast revealed an anterior mediastinal mass measuring approximately 3.6 x 4.5 x 5.8 cm. The patient underwent biopsy, which provided an inconclusive differential of: thymoma (type B), thymic carcinoma and lung squamous cell carcinoma. A repeat CT scan with contrast showed the anterior mediastinal mass measuring 4.2 x 4.9 x 5.2 cm. CT surgery performed a median sternotomy and was able to incompletely (85%) remove the mediastinal mass. The resection was limited due to the mass encasing right phrenic nerve and the pulmonary vein. Biopsy results of the mass showed: Thymic carcinoma-basaloid carcinoma subtype staging T4NxMx. Post-operatively patient had numerous complications requiring vasopressor support, going into A.fib with RVR, and having a cardiac arrest. Considering the patient’s poor prognosis, her family decided for full withdrawal of support after which patient passed away.
This case illustrates the poor prognosis observed in patients with incomplete resection of basaloid subtype of thymic cancer when other structures are involved