Thymic Lymphoepithelioma-Like Carcinoma-Case Report

Abstract

Primary thymic carcinoma is a rare heterogeneous group of tumors of the anterior mediastinum with a poor overall prognosis. Lymphoepithelioma like carcinoma is an extremely rare subtype of thymic carcinoma. A 14-year-old boy who was presented with chest pain and dyspneae had a mass lesion in the anterior mediastinum. The patient underwent right thoracotomy with mediastinal mass resection and wedge resection of the middle lobe. Macroscopically the resected mass measured 8x7x4 cm and surrounded partially by a capsule. Microscopic examination showed a syncytial growth of carcinoma cells accompained by a lymphoplasmacyctic infiltration in the thymic tissue. Lung parenchyma was infiltrated by the tumor cells but the cut margins were safe. Following operation the patient had chemotherapy and radioterapy. Three years after operation, he is well without sign of recurrence. Because of its rarity we presented this case with literature. Key words: Thymus; Lymphoepithelioma Like Carcinoma; Differential Diagnosis.

Keywords

• Thymus; Lymphoepithelioma Like Carcinoma; Differential Diagnosis.

Timusun Lenfoepitelyoma Benzeri Karsinomu: Olgu Sunumu

Öz

Primer timik karsinomlar, ön mediastenin nadir görülen, kötü prognozlu heterojen tümörleridir. Lenfoepitelyoma benzeri karsinom ise timik karsinomun oldukça nadir görülen alt tipidir. Göğüs ağrısı ve nefes darlığı şikayetiyle kliniğe başvuran 14 yaşında erkek hastada çekilen bilgisayarlı tomografide ön mediastende kitle tesbit edildi. Hastaya sağ torakotomi ile mediastinal kitle eksizyonu ve sağ orta lobdan wedge rezeksiyon uygulandı. Makroskopik incelemede tümöral kitle 8x7x4 cm ölçülerinde olup, bazı alanlarda kapsül yapısı ile çevriliydi. Mikroskopik incelemede timus dokusu içinde sinsityal gelişim göstermiş karsinom hücrelerine eşlik eden lenfoplazmositik infiltrasyon izlendi. Akciğer parankimi tümör hücreleri ile infiltreydi ancak cerrahi sınırlarda tümör mevcut değildi. Hasta operasyon sonrası kemoterapi ve radyoterapi aldı. Üç yıllık takibinde hastada rekürrens bulgusu saptanmadı. Oldukça nadir olması nedeniyle bu olgu literatür bilgileri eşliğinde sunuldu. Anahtar kelimeler: Timus; Lenfoepitelyoma Benzeri Karsinom; Ayırıcı Tanı.

Anahtar Kelimeler

• Timus; Lenfoepitelyoma Benzeri Karsinom; Ayırıcı Tanı.

References

1. Rosai J. Histological typing of tumours of the thymus. In World Health Organization International Histological Classification of Tumours. 3rd ed. Heidelberg: Springer-Verlag, 2004.
2. Suster S, Rosai J. Thymic carcinoma A clinicopathologic study of 60 cases. Cancer 1991;67:1025-32.
3. Kuo T, Chang JP, Lin FJ, Wu WC, Chang CH. Thymic carcinomas: histopathologic varieties and immunohistochemical study. Am J Surg Pathol 1990; 14(1): 24-34.
4. Kilis-Pstrusinska K, Medynska A, Zwolinska D, Dobaczewski G. Lymphoepithelioma-like thymic carcinoma in a 16-year-old boy with nephrotic syndrome- a case report. Pediatr Nephrol 2008; 23: 1001-03.
5. Hsu NY, Lin JW, Hsieh MJ, Lai YF, Kao CL, Chang JP. Thymic lymphoepithelioma-like carcinoma associated with thymoma in a patient with ocular myasthenia. Scand Cardiovasc 1998; 31: 105-7.
6. Snover DC, Levine GD, Rosai J. Thymic carcinoma: five distinctive histological variants. Am J Surg Pathol 1982; 6: 451-70.
7. Chalabreysse L, Etienne-Mastroianni B, Adeleine P, Cordier J-F, Greenland T, Thivolet-Bejui F. Thymic carcinoma: a clinicopathological and immunohistological study of 19 cases. Histopathology 2004; 44: 367-74.
8. Koppula BR, Pipavath S, Lewis DH. Epstein-Barr virus (EBV) associated lymphoepithelioma-like thymic carcinoma associated with paraneoplastic syndrome of polimyositis: a rare tumor with rare association. Clin Nucl Med 2009; 34: 686-88.

9. Sadat K, Singh A, Rao S, Zdunek T, Malhotra R. Thymic lymphoepithelioma-like carcinoma mimicking primary tumor of the lung. Compr Ther 2009; 35: 115-9.
10. Thompson EM, Sather MD, Reyes CA, Long DJ. Intracranial leptomeningeal metastasis from thymic carcinoma: case report and review. Surg Neurol 2007; 68: 233-8.
11. Tseng YL, wang ST, Wu MH, Lin MY, Lai WW, Cheng FF. Thymic carcinoma: involvement of great vessels indicates poor prognosis. Ann Thor Surg 2003; 76: 1041-45.