A Rare Case of Dual Malignancy: Recurrent Thymoma With Metastasis and Squamous Transformation
Recommended Citation
Worku DK, Virk HR, Gelaye AE. A Rare Case of Dual Malignancy: Recurrent Thymoma With Metastasis and Squamous Transformation. Am J Respir Crit Care Med 2025; 211.
Document Type
Conference Proceeding
Publication Date
5-1-2025
Publication Title
Am J Respir Crit Care Med
Keywords
D dimer, troponin, abdominal mass, adult, bilevel positive airway pressure, bronchoscopy, case report, clinical article, conference abstract, coughing, cytology, dyspnea, elevated blood pressure, female, human, human tissue, hypertension, lung embolism, main bronchus, metastasis, radiation exposure, radiotherapy, respiratory distress, squamous cell carcinoma, tachycardia, tachypnea, thymoma, thymus carcinoma, wheezing
Abstract
Introduction: Thymoma, a rare tumor originating in the thymus gland, is often indolent but can become invasive or recurrent, presenting significant management challenges. Recurrence may lead to metastasis in distant sites such as the lungs, liver, and bones. A unique feature of thymoma is its potential to transform histologically into more aggressive forms, including thymic carcinoma, which worsens the prognosis. Here, we present a rare case of a patient with recurrent thymoma that manifested both as metastatic disease and a separate squamous cell carcinoma in the bronchus, illustrating the complexity of dual malignancy in thymic tumors. Case Presentation: A 79-year-old female with a history of hypertension and thymoma treated with radiation therapy in 2017 presented with acute respiratory distress, requiring initial BiPAP support. She reported a week of cough, wheezing, and worsening shortness of breath. Examination revealed an emaciated state with diffuse wheezing and elevated blood pressure, tachypnea, and tachycardia. Laboratory findings included unremarkable CBC and CMP, troponin of 20, and D-dimer of 435. Chest CT ruled out pulmonary embolism but identified a 2.4 x 3.2 x 3.4 cm mass in the right hilum with invasion of the bronchial structures, causing air trapping, alongside additional masses in the lingula and left lower lobe. Abdominal CT showed an enhancing mass in the left mid-abdomen and right hemipelvis, suggestive of additional metastatic disease. Bronchoscopy revealed a large fungating lesion in the right main bronchus, and biopsy indicated lymphocytic predominance, with samples sent for cytology and pathology. Pathology confirmed squamous cell carcinoma in the bronchus and metastatic thymoma in the abdominal mass. Discussion: Recurrent thymoma, occurring in 10-30% of cases, may metastasize to distant sites, although this is rare. This case is further complicated by synchronous squamous cell carcinoma in the bronchus, a finding that raises questions about secondary malignancy or transformation due to prior radiation exposure. This case underscores the need for a multidisciplinary approach and highlights the importance of bronchoscopy and imaging in managing complex malignancies. Conclusion: This case demonstrates the aggressive nature of recurrent thymoma with dual malignancies, emphasizing the need for vigilant surveillance in thymoma patients. The rarity of concurrent squamous cell carcinoma calls for further research to better understand and manage such cases. Multidisciplinary care is essential to optimize outcomes in these challenging scenarios.
Volume
211
