Invasive thymoma extending to the right atrium with superior vena cava syndrome presenting massive intracardiac thrombosis immediately after the start of chemotherapy: an autopsy case report
Invasive thymoma extending to the right atrium with superior vena cava syndrome presenting massive intracardiac thrombosis immediately after the start of chemotherapy: an autopsy case report
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DOI：
10.1007/s13691-022-00541-2
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发表时间：
2022-02-28
影响因子：
0.7
通讯作者：
Matsunaga, Kazuto
中科院分区：
文献类型：
--
作者：
Asami-Noyama, Maki;Furuya-Kondo, Tomoko;Matsunaga, Kazuto
浸润性胸腺瘤合并腔内肿瘤血栓是罕见的。切除胸腺瘤和浸润上腔静脉（SVC）是一种治疗选择。我们报告一个解剖病例浸润性胸腺瘤与腔内生长到心内右心房延伸。此外，患者在化疗开始5天后死于大量心内血栓形成。一位66岁的SVC综合征患者被转介到我院。他感到脸部肿胀已有6个月了。通过ct引导下对前纵隔肿块进行穿刺活检，诊断为浸润性胸腺瘤。增强胸部计算机断层扫描显示前纵隔有肿块，延伸至SVC和右心房。经过与外科医生和放疗师的讨论，我们计划采用多学科治疗方案，通过新辅助化疗缩小肿瘤大小，手术和术后放疗后再进行化疗。给予CBDCA + PTX新辅助化疗（卡铂，曲线下面积= 6，紫杉醇，200 mg/m(2)）。化疗第4天，因右心室心内血栓形成，突然出现梗阻性休克。我们认为化疗可能会引发血栓快速形成。如果浸润性胸腺瘤扩散到大血管或右心房，则应考虑手术治疗。然而，如果手术是不可能的，在化疗前应考虑使用抗凝剂以防止血栓形成。
Invasive thymomas with intraluminal tumor thrombi are rare. Removal of the thymoma and infiltration of the superior vena cava (SVC) is a curative alternative. We report an autopsy case of invasive thymoma with intraluminal growth into the intracardiac right atrium extension. Furthermore, the patient died of massive intracardiac thrombosis 5 days after the start of chemotherapy. A 66-year-old man with SVC syndrome was referred to our hospital. He had been aware of swelling of the face for 6 months. The patient was diagnosed with invasive thymoma by a CT-guided needle biopsy of the anterior mediastinal mass. Contrast-enhanced chest computed tomography showed a mass in the anterior mediastinum extending to the SVC and right atrium. As a result of discussion with surgeons and radiotherapists, we planned a multidisciplinary treatment in which neoadjuvant chemotherapy would reduce the tumor size, and surgery and postoperative radiotherapy were followed by chemotherapy. He was administered neo-adjuvant chemotherapy with CBDCA + PTX (carboplatin, area under the curve = 6, and paclitaxel, 200 mg/m(2)). On the 4th day of chemotherapy, he suddenly developed obstructive shock due to intracardiac thrombosis in the right ventricle. We believe that chemotherapy may trigger rapid thrombus formation. If an invasive thymoma spreads into a large vessel or the right atrium, surgical treatment should be considered if possible. However, if surgery is impossible, administration of anticoagulants should be considered to prevent thrombus formation before chemotherapy.