Tumor-to-tumor metastasis: lung cancer within a thymoma
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CASE REPORT
Tumor‑to‑tumor metastasis: lung cancer within a thymoma H. Takahashi1 · Y. Asato1 · Y. Ikeda2 · S. Kijima2 · Y. Tamura2 · T. Hiraki3 · K. Hatanaka4 Received: 8 January 2020 / Accepted: 3 July 2020 © The Japanese Association for Thoracic Surgery 2020
Abstract Tumor-to-tumor metastasis is a rare phenomenon. We present a rare case of an 83-year-old man with pulmonary squamous cell carcinoma and thymoma. Thymectomy and superior segmentectomy of the left lower lobe were successfully performed on the patient. This thymoma had a region of lung cancer. Metastasis from other tumors to thymoma is rare, and we found a report that described a pancreatic carcinoma metastasizing to thymoma. We report an extremely rare case of metastasis from lung cancer to a thymoma. Keywords Tumor-to-tumor metastasis · Thymoma · Lung cancer · Pulmonary squamous cell carcinoma
Introduction Tumor-to-tumor metastasis is a rare phenomenon. In a previous investigation, it was found that renal cell carcinoma and meningioma were common recipients, whereas lung and breast cancers were common donors [1]. Here, we present a case of pulmonary squamous cell carcinoma that metastasized to a thymoma. To our knowledge, such a case has not been reported previously.
Case report An 83-year-old man was hospitalized owing to pneumonia and chronic obstructive pulmonary disease. He underwent computed tomography (CT), and a mass shadow in the left lower lobe of the lung and a mediastinal mass were found.
* H. Takahashi soumuka@kanoya‑aishinkai.com 1
Department of Surgery, Oosumi Kanoya Hospital, 6081‑1, Shinkawa‑cho, Kanoya‑shi, Kagosima 893‑0015, Japan
2
Department of Internal Medicine, Oosumi Kanoya Hospital, Kagoshima, Japan
3
Department of Pathology, Graduate School of Medicine and Dental Sciences, Kagoshima University, 8‑35‑1, Sakuragaoka, Kagoshima‑shi, Kagoshima, Japan
4
Department of Pathology, Tokai University School of Medicine, 143, Shimokasuya, Isehara‑shi, Kanagawa‑ken, Japan
According to the results of CT-guided lung biopsies, squamous cell carcinoma and thymoma were diagnosed. On performing positron emission tomography (PET), F-18 fluorodeoxyglucose uptake was detected in the lung tumor and thymoma. Thus, we made our final diagnoses of lung cancer (T1N0M0) and thymoma [clinical stage I (Masaoka classification)]. The patient underwent thymectomy and superior segmentectomy of the left lower lobe. The excised lung tumor measured 35 × 25 × 18 mm and showed notching. The thymoma measured 70 × 45 × 40 mm and appeared as a solid tumor covered with a capsule (Fig. 1a, b). In microscopic examination, the lung tumor consisted of tumor cells forming solid nests with keratinization and coagulative necrosis. Vascular invasion was seen, but pleural invasion was not observed. In immunohistochemical examination, the tumor cells showed diffuse positivity for p40, but negativity for CD5 and c-kit. The findings supported the diagnosis of primary lung squamous cell carcinoma, and the margin was negative. Meanwhile, the thymic tumor
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