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Abstract：
BACKGROUND: A multidisciplinary treatment approach is recommended for patients with extensive, advanced, or recurrent thymomas. However, detailed treatment strategies, such as chemotherapy regimens and optimal surgical procedures, are still under debate.
METHODS: We report a case of gigantic locally advanced thymoma. A 70-year-old male was referred to our hospital following the detection of abnormal chest shadows. Chest X-ray and computed tomography (CT) scans revealed a 21-cm mass in the anterior mediastinum, encircling the pulmonary hilum and extending into the left thoracic cavity. PET/CT showed increased 18F-fluorodeoxyglucose uptake at the tumor site. Based on a trans-percutaneous CT-guided needle biopsy, the tumor was diagnosed as a Type B2 thymoma at the clinical IIIA stage. The patient underwent four cycles of preoperative induction chemotherapy, including cisplatin, doxorubicin, and methylprednisolone (CAMP), resulting in a partial response; the tumor shrank to 12 cm and FDG uptake decreased. Considering the patient\'s age and comorbidities, we performed total thymectomy, along with partial resections of the parietal, mediastinal and visceral pleura, pericardium, and left upper lobectomy. This approach achieved complete histological resection, mitigating the risk of recurrence. Pathological analysis confirmed a thymoma, ypT3 (lung) N0M0 stage IIIA, with no malignancy in the pericardial or pleural effusions. No recurrence was detected 9 months post-surgery.
CONCLUSIONS: We report a case of giant thymoma successfully treated with multidisciplinary strategy. Surgical treatment alone may not have achieved complete resection, but after inducing significant tumor shrinkage with preoperative CAMP therapy, we were able to achieve complete resection. This treatment strategy may be effective in large thymoma cases.
METHODS: We report a case of gigantic locally advanced thymoma. A 70-year-old male was referred to our hospital following the detection of abnormal chest shadows. Chest X-ray and computed tomography (CT) scans revealed a 21-cm mass in the anterior mediastinum, encircling the pulmonary hilum and extending into the left thoracic cavity. PET/CT showed increased 18F-fluorodeoxyglucose uptake at the tumor site. Based on a trans-percutaneous CT-guided needle biopsy, the tumor was diagnosed as a Type B2 thymoma at the clinical IIIA stage. The patient underwent four cycles of preoperative induction chemotherapy, including cisplatin, doxorubicin, and methylprednisolone (CAMP), resulting in a partial response; the tumor shrank to 12 cm and FDG uptake decreased. Considering the patient\'s age and comorbidities, we performed total thymectomy, along with partial resections of the parietal, mediastinal and visceral pleura, pericardium, and left upper lobectomy. This approach achieved complete histological resection, mitigating the risk of recurrence. Pathological analysis confirmed a thymoma, ypT3 (lung) N0M0 stage IIIA, with no malignancy in the pericardial or pleural effusions. No recurrence was detected 9 months post-surgery.
CONCLUSIONS: We report a case of giant thymoma successfully treated with multidisciplinary strategy. Surgical treatment alone may not have achieved complete resection, but after inducing significant tumor shrinkage with preoperative CAMP therapy, we were able to achieve complete resection. This treatment strategy may be effective in large thymoma cases.
摘要：
背景：对于广泛的患者，建议采用多学科治疗方法，先进,或复发性胸腺瘤.然而,详细的治疗策略，如化疗方案和最佳外科手术，仍在辩论中。
方法：我们报告一例巨大的局部晚期胸腺瘤。一名70岁的男性在检测到异常的胸部阴影后被转诊到我们医院。胸部X射线和计算机断层扫描（CT）扫描显示前纵隔有21厘米的肿块，环绕肺门并延伸到左胸腔。PET/CT显示肿瘤部位18F-氟代脱氧葡萄糖摄取增加。基于经皮CT引导穿刺活检，该肿瘤在临床IIIA期被诊断为B2型胸腺瘤。患者接受了四个周期的术前诱导化疗，包括顺铂,阿霉素,和甲基强的松龙（CAMP），导致部分反应；肿瘤缩小至12cm，FDG摄取减少。考虑到病人的年龄和合并症,我们做了全胸腺切除术,随着顶骨的部分切除，纵隔和内脏胸膜，心包,左上叶切除术.这种方法实现了完全的组织学切除，降低复发风险。病理分析证实是胸腺瘤,ypT3（肺）N0M0IIIA期，心包或胸腔积液无恶性肿瘤。术后9个月未发现复发。
结论：我们报告了一例巨大胸腺瘤的多学科治疗成功。单纯手术治疗可能无法实现完全切除，但是在术前CAMP治疗诱导显著的肿瘤缩小后，我们能够实现完全切除。这种治疗策略在大型胸腺瘤病例中可能有效。
方法：我们报告一例巨大的局部晚期胸腺瘤。一名70岁的男性在检测到异常的胸部阴影后被转诊到我们医院。胸部X射线和计算机断层扫描（CT）扫描显示前纵隔有21厘米的肿块，环绕肺门并延伸到左胸腔。PET/CT显示肿瘤部位18F-氟代脱氧葡萄糖摄取增加。基于经皮CT引导穿刺活检，该肿瘤在临床IIIA期被诊断为B2型胸腺瘤。患者接受了四个周期的术前诱导化疗，包括顺铂,阿霉素,和甲基强的松龙（CAMP），导致部分反应；肿瘤缩小至12cm，FDG摄取减少。考虑到病人的年龄和合并症,我们做了全胸腺切除术,随着顶骨的部分切除，纵隔和内脏胸膜，心包,左上叶切除术.这种方法实现了完全的组织学切除，降低复发风险。病理分析证实是胸腺瘤,ypT3（肺）N0M0IIIA期，心包或胸腔积液无恶性肿瘤。术后9个月未发现复发。
结论：我们报告了一例巨大胸腺瘤的多学科治疗成功。单纯手术治疗可能无法实现完全切除，但是在术前CAMP治疗诱导显著的肿瘤缩小后，我们能够实现完全切除。这种治疗策略在大型胸腺瘤病例中可能有效。
