title: Development of combined thymic carcinoma and thymoma in an extrathymic lesion during long follow-up for recurrent thymoma.
abstract: The present study reported a rare case of combined thymic squamous cell carcinoma and thymoma exhibiting a mass on the left chest wall. The patient underwent thoracotomy for invasive thymoma 15 years previously, however, suffered a relapse in the left intrathoracic space. Radiotherapy, chemotherapy and partial resection, as secondary surgery for the intrathoracic mass, were performed. The histological findings in the resected specimens revealed type B3 thymoma. As the patient developed a left chest wall mass and pain in 2013, the mass was resected. The histological findings indicated two separate components composed of type B3 thymoma and squamous cell carcinoma. Immunohistological findings revealed that the thymoma cells were positive for CD5, while the thymic carcinoma cells were negative for CD5. Several reports have demonstrated the coexistence of thymic carcinoma and thymoma in the primary thymus, however, the development of a combined tumor in an extrathymic lesion is extremely rare. The present case had a long follow-up for recurrent thymoma. The present case indicated that the development and/or coexistence of malignant components in the thymoma must be taken into consideration for the treatment and/or management of patients with thymoma and that a pre-existence of CD5 expression in thymoma and the lost change may be associated with the process of malignant transformation.
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ohue
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Matsuoka
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Kumeda
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Agatsuma
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hyougotani
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Toishi
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shiina
authors.affiliation: Division of Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Laboratory Medicine, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Shingu
authors.affiliation: Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Toshirou
authors.initials: T
authors.lastname: Fukushima
authors.affiliation: Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Matsumoto, Nagano 390-8621, Japan.
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Koizumi
keywords: CD5; chemotherapy; invasive thymoma; tacrolimus; thymic tumor