One Lesion at a Thyme: Oligometastatic Thymoma to the Liver
Recommended Citation
Abusuliman M, Jamali T, Abusuliman A, Nimri FM, Rehman S, Hammad T, Pompa R. One Lesion at a Thyme: Oligometastatic Thymoma to the Liver. Am J Gastroenterol 2024; 119(10):S2812-S2813.
Document Type
Conference Proceeding
Publication Date
10-1-2024
Publication Title
Am J Gastroenterol
Abstract
Introduction: Thymomas are rare slowly growing tumors that can infiltrate directly through contiguity. They account for 40% of all mediastinal masses, resulting from neoplastic transformation of thymus epithelial cells. They mostly affect the surrounding structures via direct invasion. Extra-thoracic metastasis of thymomas is exceedingly rare, and the exact incidence is not known. Available literature revealed a total of 50 cases of extra-thoracic metastasis of thymoma. Of these have been 18 cases with liver metastasis,10 with simultaneous liver and other organs metastasis, and only 8 with solely liver metastasis. We herein report the first endoscopic ultrasound (EUS)-guided biopsy of metastatic thymoma solely to the liver Case Description/Methods: An 89-year-old man presented to his primary physician with urinary retention. Computed tomography (CT) scan incidentally noted a 6.8 x 5.2 cm heterogeneous mass in the aortopulmonary window suspicious for primary mediastinal malignancy or metastatic disease and an indeterminate 1.9 cm lesion in the left hepatic lobe. Abdominal Magnetic resonance imaging confirmed a 1.9 cm lesion in the left hepatic lobe concerning malignancy (Figure 1B). The mediastinal mass was biopsied, and pathology showed features consistent with Thymoma type B2. Gastroenterology team were consulted for an endoscopic ultrasound-guided biopsy of the liver lesion. The lesion appeared hypoechoic, heterogenous, and solid with well-defined borders, 16 mm 320 mm in diameter (Figure 1A). Pathology findings were consistent with metastatic thymoma. PET-CT confirmed a hypermetabolic anterior mediastinal mass and segment III liver mass consistent with metastatic thymoma. Radiation therapy was recommended as the patient was a poor candidate for surgery or chemotherapy given his advanced age and comorbidities Discussion: Extra-thoracic dissemination of thymomas is an extremely rare occurrence of these already rare tumors (Table 1). EUS-guided liver biopsy is a useful tool for diagnosis and easy access to metastatic lesions in the liver, and also morphologically characterize the lesion, avoiding more invasive diagnostic methods.
Volume
119
Issue
10
First Page
S2812
Last Page
S2813
