|Year : 2009 | Volume
| Issue : 1 | Page : 41-42
Invasive thymoma with intraorbital metastases
S Nirmala1, MG Janaki1, K Malavika2, Karthik S Rishi1
1 Department of Radiotherapy, MS Ramaiah Medical College, Bangalore - 560 054, India
2 Department of Ophthalmology, MS Ramaiah Medical College, Bangalore - 560 054, India
|Date of Web Publication||17-Mar-2009|
Department of Radiotherapy, MS Ramaiah Medical College, Bangalore - 560 054
Source of Support: None, Conflict of Interest: None
Thymomas are epithelial neoplasm of thymus and most common primary neoplasm of anterior and superior mediastinum affecting males and females equally. It occurs usually in the fifth to seventh decade. Approximately one-third of thymomas are invasive. Metastases to distant extrathoracic sites such as the liver, lung, lymph node, kidneys, ovary and brain occur infrequently. This is more common with invasive thymomas. Although brain has been shown to be a site of infrequent metastases, intraorbital metastases has not yet been reported. Here we report one such case of invasive thymoma of anterior superior mediastinum, which later metastasized to orbit as well as the brain.
Keywords: Intraorbital metastases, invasive thymoma, brain metastases
|How to cite this article:|
Nirmala S, Janaki M G, Malavika K, Rishi KS. Invasive thymoma with intraorbital metastases. J Can Res Ther 2009;5:41-2
| > Case Report|| |
A 62-year-old male patient presented to the department of thoracic surgery with complaints of extreme weakness that lasted for three days. A chest X-ray [Figure 1] done showed an anterior mediastinal mass.
CT scan of the thorax showed heterogeneously enhancing mass in the anterior mediastinum displacing the SVC and ascending aorta measuring 9.7 × 8.4 cms. A median sternotomy and tumour excision with partial pericardial excision was done for this patient.
Histopathology of the mass was reported as anterior mediastinum - mixed thymoma minimally invasive Stage T2 [Figure 2]. Sections show encapsulated tumor made of admixture of epithelial cells and nonepithelial lymphocytes. Epithelial cells are plump to round with vesicular nuclei and abundant eosinophillic cytoplasm, some of the cells arranged around blood vessels. Tumor cells show invasion into surrounding fat.
Patient received postoperative radiotherapy to the anterior superior mediastinum to a dose of 50Gy/25Fr/5Fr/week on Co-60. He was on regular follow-up and was doing well.
One year and seven months later he came with H/O proptosis in Lt Eye with diminished vision.
CT scan of the brain revealed a retro orbital mass lesion in both the eyes with intracranial extensions [Figure 3].
Fine needle aspiration cytology (FNAC) from the right orbital mass through the medial canthus of right eye was reported as epithelial type of malignant thymoma.
He was given palliative RT of 40 Gy/20Fr to the orbital metastases and brain. His vision improved from Perception of light to Counting fingers at 1 meter. He was lost for follow-up after completion of treatment.
| > Discussion|| |
Thymoma is an epithelial neoplasm of the thymus and represents the most common primary neoplasm of the anterior superior mediastinum. The majority of thymomas are completely encapsulated lesions, but in a minority of the cases there may be invasion of the tumour capsule and / or surrounding structures.  The most common sites of metastases are liver, lung, lymph nodes including pelvic group, ovary,  kidney,  bone,  intestines,  spine,  retro vesicle soft tissue  and Brain, ,, and pelvis.  Until now about 17 cases of brain metastasis have been reported and as per our knowledge this is the first case of orbital metastases with intracranial extension. Radiotherapy has a role in the management of metastasis. Extrathoracic disease is associated with poor prognosis and the average time of survival after the diagnosis of metastases is 1.5 years. 
| > Acknowledgement|| |
We acknowledge Late. Dr. Nithyananda Shetty, Professor and Head of department Cardiothoracic Surgery at our Hospital who was the treating Surgeon and also Dr. Manjunath. Pathologist of Metropolis, M.S. Ramaiah Memorial Hospital, who helped us in getting the microphotographs of the histopathology.
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[Figure 1], [Figure 2], [Figure 3]