HEPATIC METASTASIS OF THYMOMA: CASE REPORT OF A FAST-GROWING ABDOMINAL MASS IN A PREGNANT PATIENT

Miloš Raspopović; Dušan Micić; Zlatko Perišić; Vladimir Arsenijević; Dušan N Brkić; Pavle Gregorić

doi:10.5937/sanamed0-47954

Miloš Raspopović Clinic for Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
Dušan Micić ¹Clinic for Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia; ²School of Medicine, University of Belgrade, Belgrade, Serbia
Zlatko Perišić ¹Clinic for Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia ²School of Medicine, University of Belgrade, Belgrade, Serbia
Vladimir Arsenijević Clinic for Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
Dušan N Brkić Clinic for Emergency Surgery, University Clinical Centre of Serbia, Belgrade, Serbia
Pavle Gregorić ¹Clinic for Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia ²School of Medicine, University of Belgrade, Belgrade, Serbia

DOI: https://doi.org/10.5937/sanamed0-47954

Keywords: thymoma, metastasis, liver, pregnancy, surgery

Abstract

Introduction: Thymomas are the most common primary mediastinal tumors originating from epithelial cells of the thymus, demonstrating epithelial differentiation. Pathologically, thymomas exhibit relatively slow growth and typically spread directly, with extremely rare occurrences of distant dissemination to extrathoracic organs. The precise incidence of such dissemination remains unknown. Distant metastases, particularly to the liver, are exceptionally rare, with only a few cases documented in the literature.

Case Report: A 39-year-old woman, in her 31st week of gestation, presented with abdominal pain and discomfort. She underwent ultrasonography, followed by an urgent MRI of the abdomen due to a protruding tumor mass in the liver. Shortly after delivering a healthy baby via cesarean section, she was admitted to the hospital for a CT scan of the abdomen. The imaging revealed multiple focal changes in the liver parenchyma, exhibiting radiological characteristics consistent with focal nodular hyperplasia. Less likely differential diagnoses included adenomas or hemangiomas. Subsequently, she underwent staged hepatectomy, and the results of the pathological analysis confirmed the presence of type B thymoma metastases in the liver.

Conclusion: According to the available data in the literature, metastatic thymomas are often identified in patients who have previously undergone treatment for the primary disease. Our patient did not have a history of thymectomy, as confirmed by postoperative chest scans. Onset of symptoms during late pregnancy guided our diagnosis, relying on overall clinical and radiological findings of the detected tumor. Our treatment involved staged hepatectomy post-childbirth, followed by adjuvant chemotherapy. Further comprehensive studies are essential to precisely understand neoplasm behaviors like thymoma for timely detection and effective treatment.

Author Biographies

Dušan Micić, ¹Clinic for Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia; ²School of Medicine, University of Belgrade, Belgrade, Serbia

ORCID: 0000-0002-1461-7920

Dušan N Brkić, Clinic for Emergency Surgery, University Clinical Centre of Serbia, Belgrade, Serbia

ORCID: 0009-0008-1338-6922

Pavle Gregorić, ¹Clinic for Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia ²School of Medicine, University of Belgrade, Belgrade, Serbia

ORCID: 0000-0003-0656-7561

References

Mallick J, Peterson JM, Pina-Oviedo S, Patel N, Venkatesan R, Stevenson HL et al. Liver metastasis of thymoma: case report and review of the literature. Int J Surg Pathol. 2023;31(5):755-60. doi: 10.1177/10668969221115818.

Utsunomiya T, Sakamoto K, Tsukamoto D, Shine M, Nishi Y, Matsui T et al. Ruptured metastatic liver tumor secondary to a thymoma: a case report. J Surg Case Rep. 2021;2021(8):rjab341. doi: 10.1093/jscr/rjab341.

Dhahir Ali F, Kuebler S, Lakenberg N, Hermann L, Mall J, Fangmann J. A rare case of hepatic metastasis 20 years after surgical resection of a thymoma: A case report. Int J Surg Case Rep. 2021;87:106406. doi: 10.1016/j.ijscr.2021.106406.

Tachi H, Yoshimura T, Hosoda Y, Kiyochi H, Komoto I, Taki Y, et al. [A case of thymic carcinoma of postoperative liver and mediastinal lymph node metastases where long-term survival was achieved through multidisciplinary treatment]. Gan To Kagaku Ryoho. 2020;47(3):507-9. Japanese.

Dunphy L, Abbas SH, Patel A, Tebala G. Spontaneous splenic rupture: a rare first presentation of diffuse large B cell lymphoma. BMJ Case Rep. 2019;12(8):e231101. doi: 10.1136/bcr-2019-231101.

Oshita K, Itamoto T, Oshita A, Nakahara H, Nishisaka T. A rare case of a spontaneously ruptured secondary hepatic malignant lymphoma. Surg Case Rep. 2018;4(1):44. doi: 10.1186/s40792-018-0451-2.

Siliézar MM, Muñoz CC, Solano-Iturri JD, Ortega-Comunian L, Mollejo M, Montes-Moreno S et al.Spontaneously ruptured spleen samples in patients with infectious mononucleosis: analysis of histology and lymphoid subpopulations. Am J Clin Pathol. 2018;150(4):310-7. doi: 10.1093/ajcp/aqy056.

Speisky D, de Davila MT, Vigovich F, Mendez J, Maurette R, Ejarque MG et al. Hepatic metastasis of thymoma: case report and immunohistochemical study. Ecancermedicalscience. 2016;10:693. doi: 10.3332/ecancer.2016.693.

Scorsetti M, Leo F, Trama A, D'Angelillo R, Serpico D, Macerelli M et al. Thymoma and thymic carcinomas. Crit Rev Oncol Hematol. 2016;99:332-50. doi: 10.1016/j.critrevonc.2016.01.012.

Khandelwal A, Sholl LM, Araki T, Ramaiya NH, Hatabu H, Nishino M. Patterns of metastasis and recurrence in thymic epithelial tumours: longitudinal imaging review in correlation with histological subtypes. Clin Radiol. 2016;71(10):1010-7. doi: 10.1016/j.crad.2016.05.007.

Kim HJ, Park YE, Ki MS, Lee SJ, Beom SH, Han DH et al. Spontaneous rupture of hepatic metastasis from a thymoma: A case report. World J Gastroenterol. 2016 Nov 28;22(44):9860-4. doi: 10.3748/wjg.v22.i44.9860.