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Cardiac tamponade from a giant thymoma: case report.

Fazlıoğulları O, Atalan N, Gürer O, Akgün S, Arsan S - J Cardiothorac Surg (2012)

Bottom Line: Thymoma, the most common neoplasm of the anterior mediastinum especially in adults, accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal masses.These tumors are routinely asymptomatic for prolonged periods of time.This report presents a patient who had hemorrhagic pericardial tamponade that likely resulted from the largest symptomatic mixed type (type AB) thymoma described in the literature.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular Surgery, Medicana Hospitals Camlica, Istanbul, Turkey.

ABSTRACT
Thymoma, the most common neoplasm of the anterior mediastinum especially in adults, accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal masses. These tumors are routinely asymptomatic for prolonged periods of time. Pericardial tamponade is a very rare initial manifestation of a thymoma. This report presents a patient who had hemorrhagic pericardial tamponade that likely resulted from the largest symptomatic mixed type (type AB) thymoma described in the literature.

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Histopathological evaluation: A. Massive lymphoid infiltration creating a nodular pattern with fibrous septae. B. Epithelial thymic components in massive lymphoid infiltration.
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Figure 2: Histopathological evaluation: A. Massive lymphoid infiltration creating a nodular pattern with fibrous septae. B. Epithelial thymic components in massive lymphoid infiltration.

Mentions: A 28-year-old man was admitted with sudden onset and severe complaints of orthopnea and palpitations because of a pericardial tamponade resulting from a massive pericardial effusion. He didn't complain any myasthenic symtom like muscular weakness, fatigability, diplopia etc. and trauma in his previous history. The pulse was rapid and weak (142 beats/min), and the neck veins were distended. The electrocardiogram showed sinus tachycardia and low voltage. The blood pressure was 80/60 mmHg. Chest x-ray showed that slightly widened cardio-thoracic index (0.62) and mildly expanded superior mediastinum. Laboratory findings were normal. Echocardiography showed biventricular collapse because of the widespread 4,5-cm pericardial effusion with anterior mediastinal mass. After the evacuation of pericardial hemorrhagic fluid (550 cc), the collapse disappeared, and the patient's symptoms were relieved entirely. The hematocrit value of the pericardial fluid was 36,1%. Cytological and bacterial evaluations were unremarkable. Recurrent pericardial effusion was observed twelve hours later without collapse. Computed tomography (CT) scans showed a huge antero-superior mediastinal mass with rough and longest dimensions of 17 × 12 × 7 cm; the exact dimensions could not be calculated because of the possible invasion into the pericardium, the innominate vein, the superior caval vein (VCS) and the sternum (Figure 1). Surgery was performed via median sternotomy as used frequently for thymic surgical aspects. The tumor's extension into the spaces between pericard, pleura and sternum was seen. Pericardial, pleural and at the superior segment innominate vein were invaded. Approximately 95% of tumor was resected with some parts of pleura and pericard. The superior part of the tumor couldn't resect because of the innominate vein adhesion. The biggest piece of the five pieces which resected has shown in Figure 1. Adhesions and the initial pathological diagnosis, the frozen, was lymphoma did not necessitate a total resection. The mass was off-white in color, solid, hard, and lobulated, and it weighed 640 g. Even the frozen evaluation was lymphoma, the late histopathological evaluation revealed that the mass was type AB according to the World Health Organization (WHO) classification and Stage II according to the Masaoka Staging System (Figure 2). The patient was discharged on the fifth postoperative day. Combined chemotherapy (cisplatin and ifosfamide) and radiation therapy (5000 cGy) was started one month later. CT scan did not reveal any metastasis at the first postoperative month.


Cardiac tamponade from a giant thymoma: case report.

Fazlıoğulları O, Atalan N, Gürer O, Akgün S, Arsan S - J Cardiothorac Surg (2012)

Histopathological evaluation: A. Massive lymphoid infiltration creating a nodular pattern with fibrous septae. B. Epithelial thymic components in massive lymphoid infiltration.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298781&req=5

Figure 2: Histopathological evaluation: A. Massive lymphoid infiltration creating a nodular pattern with fibrous septae. B. Epithelial thymic components in massive lymphoid infiltration.
Mentions: A 28-year-old man was admitted with sudden onset and severe complaints of orthopnea and palpitations because of a pericardial tamponade resulting from a massive pericardial effusion. He didn't complain any myasthenic symtom like muscular weakness, fatigability, diplopia etc. and trauma in his previous history. The pulse was rapid and weak (142 beats/min), and the neck veins were distended. The electrocardiogram showed sinus tachycardia and low voltage. The blood pressure was 80/60 mmHg. Chest x-ray showed that slightly widened cardio-thoracic index (0.62) and mildly expanded superior mediastinum. Laboratory findings were normal. Echocardiography showed biventricular collapse because of the widespread 4,5-cm pericardial effusion with anterior mediastinal mass. After the evacuation of pericardial hemorrhagic fluid (550 cc), the collapse disappeared, and the patient's symptoms were relieved entirely. The hematocrit value of the pericardial fluid was 36,1%. Cytological and bacterial evaluations were unremarkable. Recurrent pericardial effusion was observed twelve hours later without collapse. Computed tomography (CT) scans showed a huge antero-superior mediastinal mass with rough and longest dimensions of 17 × 12 × 7 cm; the exact dimensions could not be calculated because of the possible invasion into the pericardium, the innominate vein, the superior caval vein (VCS) and the sternum (Figure 1). Surgery was performed via median sternotomy as used frequently for thymic surgical aspects. The tumor's extension into the spaces between pericard, pleura and sternum was seen. Pericardial, pleural and at the superior segment innominate vein were invaded. Approximately 95% of tumor was resected with some parts of pleura and pericard. The superior part of the tumor couldn't resect because of the innominate vein adhesion. The biggest piece of the five pieces which resected has shown in Figure 1. Adhesions and the initial pathological diagnosis, the frozen, was lymphoma did not necessitate a total resection. The mass was off-white in color, solid, hard, and lobulated, and it weighed 640 g. Even the frozen evaluation was lymphoma, the late histopathological evaluation revealed that the mass was type AB according to the World Health Organization (WHO) classification and Stage II according to the Masaoka Staging System (Figure 2). The patient was discharged on the fifth postoperative day. Combined chemotherapy (cisplatin and ifosfamide) and radiation therapy (5000 cGy) was started one month later. CT scan did not reveal any metastasis at the first postoperative month.

Bottom Line: Thymoma, the most common neoplasm of the anterior mediastinum especially in adults, accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal masses.These tumors are routinely asymptomatic for prolonged periods of time.This report presents a patient who had hemorrhagic pericardial tamponade that likely resulted from the largest symptomatic mixed type (type AB) thymoma described in the literature.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiovascular Surgery, Medicana Hospitals Camlica, Istanbul, Turkey.

ABSTRACT
Thymoma, the most common neoplasm of the anterior mediastinum especially in adults, accounts for 20-25% of all mediastinal tumors and 50% of anterior mediastinal masses. These tumors are routinely asymptomatic for prolonged periods of time. Pericardial tamponade is a very rare initial manifestation of a thymoma. This report presents a patient who had hemorrhagic pericardial tamponade that likely resulted from the largest symptomatic mixed type (type AB) thymoma described in the literature.

Show MeSH
Related in: MedlinePlus