Diseases List » Blog Archive » CASE REPORTS (CASE 2)

A 54-year-old white man without any significant past medical history presented to our institution in June 1989 with a 4-year his­tory of vague anterior neck swelling and discomfort. A neck MRI at this time demonstrated a large solid soft-tissue mass in the lower area of the left side of the neck with mediastinal extension, tracheal deviation, and left innominate vein occlusion. A chest radiograph suggested a right pleural effusion. He was subsequently admitted to the hospital, and a needle biopsy of the neck mass demonstrated malignant thymoma. He received 3 courses (every 21 days) of cy­clophosphamide (500 mg/m ), doxorubicin (50 mg/m2), and cis- platin (50 mg/m2) from July 28 to September 20, 1989, resulting in a 50% reduction in the tumor size and resolution of the pleural ef­fusion. A thymectomy was performed in October of 1989 with re­section of all visible tumor. He had mediastinal radiotherapy (60 Gy) thereafter, completing treatment in December 1989. He did well for 5 years until February 1995 when he presented with cough and hoarseness. An ear, nose, and throat evaluation revealed left vocal cord paralysis, tracheal deviation to the right, and a palpable mass in the suprasternal notch adjacent to the left sternoclavicular joint. A CT scan of the neck and chest demonstrated an ill-defined 3.0×2.5-cm mass to the left of the trachea at the thoracic inlet and a 1.5×2.0-cm anterior mediastinal lymph node. Recurrent thymoma was confirmed by ultrasoundguided biopsy of the tumor. He began 4 courses (every 28 days) of carboplatin (300 mg/m2), doxorubicin (40 mg/m2), and cyclophosphamide (400 mg/m2) from Feb­ruary to June 1995. A postchemotherapy chest CT scan showed that the tumor and anterior mediastinal lymph node were no longer detectable. A positron emission tomography scan done 2 months later revealed no evidence of malignancy. He continues to do well and remains in remission as of February 1996, 8 months after his remission was noted.