A Surgical Case of Heterotopic Thymic Carcinoma Coexisting With Hepatocellular Carcinoma

Yasumichi Yamamoto, Toshiya Toyazaki, Shinji Kosaka


Although thymomas arising in ectopic regions other than the upper anterior mediastinum are well known, thymic carcinomas in ectopic locations are very rare. On the other hand, the therapeutic strategies for synchronous double primary cancers arising from different organs are still controversial. We have experienced a case of thymic carcinoma in an ectopic location with a coexisting hepatocellular carcinoma (HCC) for which management presented a number of difficulties. A 67-year-old man with HCC presented with a slow-growing nodular shadow in the left lower anterior mediastinum, i.e. the left cardiophrenic angle. During 7 years of intensive treatment for the HCC, the mediastinal nodule, which had been suspected clinically to be a lymph node metastasis from the HCC, grew to 4 cm in diameter. Surgical intervention for the mediastinal nodule was carried out for treatment and definitive diagnosis using a mediastinoscope inserted via a transverse xyphoid incision. Intraoperative pathological diagnosis from frozen sections of the mediastinal nodule revealed thymic carcinoma, and therefore the procedure was converted to thymothymectomy via a median sternotomy. Despite postoperative multimodality treatment, the patient died due to multifocal metastasis and pleuritis carcinomatosa from the thymic carcinoma within 7 months after the thymothymectomy. The unusual location of the thymic carcinoma in this case and the synchronous nature of the coexisting primary HCC resulted in delay of surgical resection for the former. More intensive observation and early intervention in the form of diagnostic or therapeutic resection should be performed for any mediastinal nodule that appears during the course of treatment for HCC.

J Med Cases. 2015;6(9):433-436
doi: http://dx.doi.org/10.14740/jmc2267w


Thymic carcinoma; Ectopic location; Mediastinoscopy; Synchronous double primary cancer; Therapeutic management

Full Text: HTML PDF

Browse  Journals  


Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics


World Journal of Oncology

Gastroenterology Research

Journal of Hematology


Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity


Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research


Journal of Neurology Research

International Journal of Clinical Pediatrics



Journal of Medical Cases, monthly, ISSN 1923-4155 (print), 1923-4163 (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)

This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.journalmc.org   editorial contact: editor@journalmc.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.

Disclaimer: The views and opinions expressed in the published articles are those of the authors and do not necessarily reflect the views or opinions of the editors and Elmer Press Inc. This website is provided for medical research and informational purposes only and does not constitute any medical advice or professional services. The information provided in this journal should not be used for diagnosis and treatment, those seeking medical advice should always consult with a licensed physician.