Tumor Board Conference Thymic Carcinoma

1
Tumor Board ConferenceThymic Carcinoma

• Sinai Hospital of Baltimore
• Sanjay Munireddy
• Feb 27, 2007

2
HPI

• Mr. HH is a 78 yo AA male who presented to Sinai
  ER in May 2006 with c/o rt. arm and rt. leg
  weakness lasting for few hours
• Had around 10 episodes each of which lasted for
  few hours and resolved
• Admitted for TIA workup

3
HPI

• PMH TIAs, CVA Lt. thalamus, GSW to rt. shoulder
  in the past, cardiac murmur, HTN and
  hyperlipidemia
• ROS negative for myasthenia gravis symptoms,
  asbestos exposure, wt. loss, dysphagia, SOB,
  tobacco
• PE non-significant findings
• Labs WBC 14.5
• Diagnostics Head, Chest CT
• Chest CT soft tissue mass in the ant.
  mediastinum 4.7 x 2.5 cm

4
Operative Course

• Went to OR on 5/19/2006
• Underwent Chamberlain procedure (anterior
  mediastinotomy) on the rt. side and biopsy of the
  mass
• Mass was unresectable due to the fact that it was
  abutting the ascending aorta

5
Pathology

• Frozen section while in the OR showed tissue with
  a question of carcinoma
• Final path report showed features of poorly
  differentiated non-small cell carcinoma vs.
  thymic carcinoma

6
Post-Op Course

• Pt. was discharged 4 days later
• Pt had an appointment with thoracic surgery,
  radiation oncology and medical oncology teams.
• Pt. was started on systemic chemotherapy with
  Taxotere, Erbitux and Carboplatin and also
  received concomitant radiotherapy (total
  cumulative dose of 6120 cGy)

7
Chemotherapy

• Pt did very well and was in complete remission
  with combined therapy
• After the conclusion of combined therapy, pt was
  started on Gleevec and then later Tarceva both
  which he did not tolerate well
• Plan to start single therapy with Erbitux

8
Thymic Carcinoma

• Relatively rare malignant epithelial tumor of
  thymus represents about 0.2 to 1.5 of all
  malignancies
• Accounts for only 0.06 of all thymic neoplasms
• Most patients are aged 40 through 60 years.
• Etiology is not known.
• Are detected by chance with plain-film chest
  radiography in 50 of pts
• 90 occur in the anterior mediastinum.

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Thymic Carcinoma

• Approximately 30 of the patients are
  asymptomatic at the time of diagnosis.
• Presenting signs/symptoms include cough, chest
  pain and signs of upper airway congestion
• Most patients present with advanced disease
  (stage III or IV) that manifests as mediastinal
  masses

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Work-Up

• Chest radiograph is indicated.
• CT scan or MRI in addition to PET scan is
  indicated in all patients with a suspected mass.
• FNA and core needle biopsy are indicated.
• Mediastinoscopy provides large tissue sample.
• Immunohistochemistry provides the most useful
  method to differentiate thymic carcinoma from
  other similar neoplasms

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Thymic Carcinoma

• Standard primary treatment is surgical with en
  bloc resection which has the best long-term
  result.
• The mortality rate is more than 85 in reported
  cases
• Median survival among patients with incompletely
  resected tumors is 12-36 months

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Thymic Carcinoma

• Multimodal treatment, especially complete
  resection and postoperative radiotherapy with or
  without chemotherapy, is a curative therapy for
  thymic carcinomas1
• Radiotherapy plays an important role in treating
  thymic carcinoma in terms of reducing local
  recurrence and prolonging survival time2
• 1 Ogawa K et. al Cancer 2002 Jun 1594(12)3115-9
• 2 Nonaka T et. Al Japan J Clinical Onc 2004
  Dec34(12)722-6.