Pleural “drop metastases” 21 years after resection of a thymoma

ABSTRACT Introduction: We describe an unusual case of pleural drop metastases 21 years after complete resection of an encapsulated thymoma in a Southeast Asian patient with myasthenia gravis (MG). Methods: This investigation includes a case report and brief review of the literature. Results: The pat...

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Bibliographic Details
Published in:Muscle & nerve 2017-07, Vol.56 (1), p.171-175
Main Authors: Chiang, Chia‐Chun, Parsons, Angela M., Kriegshauser, J. Scott, Paripati, Harshita R., Zarka, Matthew A., Leis, A. Arturo
Format: Article
Language:English
Subjects:
Adult
Biopsy
Chest
Computation
Computed tomography
disease surveillance
disease‐free survival
drop metastases
Dysphagia
Encapsulation
Fatigue
Humans
Literature reviews
Male
Metastases
Metastasis
Muscular fatigue
Myasthenia
Myasthenia gravis
Neuromuscular junctions
Nodules
Pleural Neoplasms - etiology
Pleural Neoplasms - secondary
Positron-Emission Tomography
Postoperative Complications - diagnostic imaging
recurrence
Surveillance
Thymectomy - adverse effects
Thymoma
Thymoma - diagnostic imaging
Thymoma - pathology
Thymoma - surgery
Thymus Neoplasms - diagnostic imaging
Thymus Neoplasms - pathology
Thymus Neoplasms - surgery
Tomography, X-Ray Computed
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Summary:ABSTRACT Introduction: We describe an unusual case of pleural drop metastases 21 years after complete resection of an encapsulated thymoma in a Southeast Asian patient with myasthenia gravis (MG). Methods: This investigation includes a case report and brief review of the literature. Results: The patient presented in 2015 with generalized weakness, fatigue, and shortness of breath, but no diplopia, ptosis, dysphagia, or dysarthria. Because these symptoms were atypical for an MG exacerbation, a de‐novo work‐up was performed. Chest computed tomography (CT) showed numerous pleural nodules (“drop metastases”), and CT‐guided biopsy revealed metastatic thymoma. Conclusions: The average disease‐free interval for thymoma ranges from 68 to 86 months. Pleural and mediastinal recurrence are more common than distant hematogenous recurrence. Adverse prognostic factors include an initial higher Masaoka stage, incomplete resection, older age, and pleural or pericardial involvement. Despite apparent complete resection of thymoma, clinicians should remain vigilant for recurrence for as long as 20 years after initial management. Long‐term follow‐up with radiologic surveillance is recommended. Muscle Nerve 56: 171–175, 2017
ISSN:0148-639X
1097-4598
DOI:10.1002/mus.25479