title: Radical surgery in an unusual case of thymoma with intraluminal growth into the superior vena cava and right atrium.
abstract: We report a very rare case of malignant invasive thymoma with intraluminal growth through the thymic veins into the superior vena cava (SVC), with intracardiac right atrium extension. A 44-year old female with SVC syndrome underwent a radical thymectomy with pericardiectomy and complete removal of the endovascular and endocardiac neoplastic thrombus by a longitudinal incision starting from the atrium and extending along the SVC. The left anonymous vein was sacrificed, and the SVC and atrium were repaired with a continuous 5-0 Prolene suture. The hospital stay was uneventful. Postoperatively, the patient received adjuvant chemoradiotherapy (three cycles of cisplatin, doxorubicin and cyclophosphamide and subsequent mediastinal irradiation with 50 Gy). Nine months after surgery, no recurrences were seen and the patient is still well. This thymoma presentation with intravascular growth without direct vascular wall infiltration, although very rare, is possible and the management may be challenging. In our case, a primary radical operation was considered mandatory due to the clinical symptoms and the risk of neoplastic embolization. The collection of other similar cases could better clarify the role of adjuvant therapy.
authors.affiliation: Thoracic Surgery Unit, Humanitas Gavazzeni Hospital, Bergamo, Italy.
authors.forename: Giovanna
authors.initials: G
authors.lastname: Rizzardi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Arena
authors.forename: Eliseo
authors.initials: E
authors.lastname: Passera
authors.forename: Luigi
authors.initials: L
authors.lastname: Bortolotti
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology; D059186:Chemoradiotherapy, Adjuvant; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006801:Humans; D009361:Neoplasm Invasiveness; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery*; D010492:Pericardiectomy; D010690:Phlebography / Q000379:methods; D011879:Radiotherapy Dosage; D013934:Thymectomy; D013953:Thymus Neoplasms / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D014683:Vena Cava, Superior / Q000473:pathology / Q000601:surgery*
keywords: Neoplastic intravascular thrombus; Superior vena cava syndrome; Thymoma