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Synchronous triple thymoma and true thymic hyperplasia simultaneously detected by 18F FDG PET-CT
Timoma triple sincrónico e hiperplasia tímica verdadera detectada mediante PET/TAC con 18F-FDG
G. Leuzzia,
Corresponding author
gio.leuzzi@yahoo.it

Corresponding author.
, M. Marinob, G. Alessandrinia, R. Sciutoc, E. Pescarmonab, F. Faccioloa
a Department of Surgical Oncology, Thoracic Surgery Unit, Regina Elena National Cancer Institute – IFO, Rome, Italy
b Division of Pathology, Regina Elena National Cancer Institute – IFO, Rome, Italy
c Division of Nuclear Medicine, Regina Elena National Cancer Institute – IFO, Rome, Italy
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 56-years-old Caucasian woman was admitted to our Department for evaluation of mediastinal enlargement detected during investigations for angor and long-lasting dyspnoea&#46; A non-contrast enhanced chest CT scan evidenced multiple swellings in the anterior mediastinum making a proper radiological evaluation of the mediastinum unfeasible&#46; Thus&#44; a <span class="elsevierStyleSup">18</span>F-FDG PET-CT-scan was performed and revealed a round-shaped lesion in the upper mediastinum &#40;1&#46;8<span class="elsevierStyleHsp" style=""></span>cm&#44; SUV 4&#46;0&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#8211;D&#41;&#44; a lower lesion &#40;3&#46;0<span class="elsevierStyleHsp" style=""></span>cm&#44; SUV 4&#46;8&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#8211;E&#41; and a round irregularly-shaped nodule &#40;1&#46;4<span class="elsevierStyleHsp" style=""></span>cm&#41; between the two ones &#40;SUV 3&#46;0&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#8211;E&#41;&#46; In addition&#44; the thymus gland uptake was increased &#40;SUV of 2&#46;8&#44; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; while the <span class="elsevierStyleSup">18</span>F-FDG distribution was slightly decreased in the cardiac muscle &#40;due to a Tako Tsubo syndrome subsequently confirmed by cardiac examination&#41;&#46; Considering the different mediastinal uptakes&#44; cytology was obtained by fine-needle aspiration biopsy &#40;FNAB&#41; of the upper lesion and was suggestive for thymoma&#46; Thus&#44; the patient underwent a trans-sternal radical thymectomy plus wedge resection of the left upper lobe&#46; Final pathology characterized the three lesions as different nodules of type AB thymoma&#58; in particular&#44; the lower &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A&#41; and medium nodule &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>C&#41; were encapsulated &#40;Masaoka-stage I&#41;&#44; while the upper one &#40;Masaoka-stage III&#41; invaded the visceral pleura &#40;star&#44; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>B&#41;&#46; Moreover&#44; the thymic parenchyma was consistent with true thymic hyperplasia &#40;TTH&#44; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>D&#41;&#46; Based on the histo-pathological findings&#44; a diagnosis of synchronous triple AB thymoma &#40;with different Masaoka staging&#41; associated to TTH was achieved&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Multiple thymoma has been rarely reported and its incidence in large series ranges from 0 to 3&#46;1&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a> In the English literature&#44; most cases have involved double lesions&#44; while diagnosis of triple lesions is anecdotic&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Actually&#44; it is controversial whether cases of multiple thymoma represent multi-centric origin or intra-thymic metastases&#46; Some authors<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a> reported histologically similar subtype of tumours and suggested that such lesions were synchronous with a multi-centric origin &#40;due to non-invasiveness and other histological features&#41; even if the possibility of intra-thymic metastasis could not be completely ruled out&#46; In our case&#44; the lesions were detached and totally &#40;medium and lower lesion&#41; or partially encapsulated &#40;upper one&#41;&#59; in addition&#44; the TTH<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> could have set a suitable environment for the growth of cancer cells&#46; According to these evidences&#44; we postulated the multi-centric origin of the three lesions&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In conclusion&#44; in those cases with multiple mediastinal lesions&#44; <span class="elsevierStyleSup">18</span>F-FDG PET-CT may be useful to characterize metabolically the nodules in order to plan the optimal preoperative assessments &#40;FNAB&#44; surgical biopsy or primary surgery&#41;&#46; In addition&#44; <span class="elsevierStyleSup">18</span>F-FDG PET-CT is effective for the preoperative diagnosis of synchronous thymic lesions and for identifying underlying thymic disease &#40;TTH e&#46;g&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a>&#41; as possible cause of thymoma&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Macroscopic findings&#58; thymus gland measuring 9<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm&#46; The larger lesions &#40;upper and lower ones&#41; are visible in the picture&#46; The white arrow indicates the pulmonary resection due to lung invasion by the upper nodule&#46; Morphological features of the triple thymoma and peri-tumoral thymus&#46; &#40;A&#8211;C&#41; three distinct thymoma nodules with AB thymoma features&#44; according to WHO classification&#46; &#40;A&#41; Lower nodule &#40;Haematoxylin and eosin&#44; original magnification &#215;100&#41;&#59; &#40;B&#41; upper nodule &#40;Haematoxylin and eosin&#44; original magnification &#215;200&#41;&#59; &#40;C&#41; intermediate smaller nodule &#40;Haematoxylin and Eosin&#44; original magnification &#215;200&#41;&#46; The star indicates the visceral pleura invasion by the upper lesion&#46; Despite of zonal variation in lymphocytic content&#44; the tumours showed the same histologic subtype&#46; &#40;D&#41; Peri-tumoral thymus appeared well represented and hyperplastic in the adipose tissue of the remnant thymus&#44; confirming diagnosis of true thymic hyperplasia &#40;Haematoxylin and eosin&#44; original magnification &#215;100&#41;&#46;</p>"
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Article information
ISSN: 22538089
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos