Ectopic pleural thymoma with T-cell lymphocytosis and bone metastasis: a case report

Our plain-English summary of Ectopic pleural thymoma with T-cell lymphocytosis and bone metastasis: a case report, by J. Li, L. Liu, J. Li, et al (BMC Pulmonary Medicine, 2024).

The study

• Authors: J. Li, L. Liu, J. Li, Z. Yang, Y. Liu
• Journal: BMC Pulmonary Medicine
• Published: 2024;24(1):280
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: The diagnostic complexities that arise in radiographic distinction between ectopic pleural thymoma and other thoracic neoplasms are substantial, with instances of co-occurring T-cell lymphocytosis and osseous metastasis being exceedingly rare.

Case Presentation: A 51-year-old woman was admitted to our hospital with dyspnea and chest pain. Upon imaging examination, she was found to have diffuse and nodular pleural thickening on the left side, collapse of the left lung and a compression in the second thoracic vertebrae. All lesions showed significant 18F-FDG uptake on 18F-FDG PET/CT examination. Furthermore, she exhibited T-cell lymphocytosis in her peripheral blood, lymph nodes, and bone marrow. After ruling out malignant pleural mesothelioma (MPM), lung cancer with pleural metastasis, and T-cell lymphoma, the definitive diagnosis asserted was ectopic pleural thymoma with T-cell lymphocytosis and bone metastasis.

Conclusion: Physicians need to expand their knowledge of the imaging features of ectopic pleural thymoma. Cases with T-cell lymphocytosis may exhibit increased aggressiveness and prone to bone metastasis.

© 2024. The Author(s).

In plain English

This case report described one patient, a 51-year-old woman admitted to the authors' hospital in Chongqing, China, with two months of dry cough, breathlessness and left-sided chest pain. CT scanning showed diffuse, nodular thickening of the left pleura (the lining around the lung) that had collapsed the left lung and was infiltrating the mediastinum and pericardium. PET/CT showed increased tracer uptake in the left pleura and in a compressed second thoracic vertebra. Her blood, lymph nodes and bone marrow contained raised numbers of T-cells. Tests found these were polyclonal, with no clonal T-cell receptor rearrangement. The doctors considered malignant pleural mesothelioma, lung cancer spread to the pleura, and T-cell lymphoma. A pleural biopsy found cells positive for epithelial markers and negative for a mesothelial marker and a lung-origin marker. The final diagnosis was ectopic pleural thymoma (WHO type B1) with T-cell lymphocytosis and bone metastasis. The patient declined further chemotherapy or radiotherapy. The authors concluded that this tumor is difficult to diagnose from imaging alone and that pleural biopsy is necessary. They suggested that cases with T-cell lymphocytosis may be more aggressive and prone to bone metastasis. The article does not mention asbestos.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: One 51-year-old woman, a lifelong non-smoker, admitted to Chongqing University Cancer Hospital, China; dates of care not given
• Main results:
  • In the patient's peripheral blood, CD4-positive T-cell count was 4,180 cells per microlitre and CD8-positive count 1,679 cells per microlitre; the lymphocytes were polyclonal T-cells
  • Lymph node and bone marrow biopsies showed small T-cell lymphocytosis, and gene rearrangement analysis found no clonal T-cell receptor rearrangement
  • Contrast-enhanced CT showed diffuse nodular thickening of the left pleura with mild enhancement, collapse of the left lung, and infiltration of the mediastinum and pericardium
  • PET/CT showed increased FDG uptake in the left pleura (SUVmax 8.3) and a compressed second thoracic vertebra with increased uptake (SUVmax 8.2)
  • Bronchoscopy found narrowing of the left lower lobe bronchus, but no malignant cells in the bronchial biopsy
  • On pleural biopsy, medium-sized cells were positive for epithelial markers (PCK, CK19, P63) and negative for the mesothelial marker CR and the lung-origin marker TTF-1
  • Final diagnosis: ectopic pleural thymoma, WHO type B1, with T-cell lymphocytosis and bone metastasis
  • The patient declined further chemotherapy or radiotherapy
• The authors' conclusion: The authors concluded that ectopic pleural thymoma is difficult to diagnose from imaging features and that pleural biopsy is necessary. They suggested that cases with T-cell lymphocytosis may be more aggressive and prone to bone metastasis.

Topics

Medical terms in this study, explained in our Lexicon: Metastasis, Neoplasm, Dyspnea, Pleural Thickening, Pleural Mesothelioma, Lung Cancer.

Related studies

• Pleural metastasis of malignant thymoma. A pitfall in the CT-diagnosis of pleural mesothelioma — J. Görich, S.A. Beyer-Enke, et al. (1989)
• Pulmonary and pleural thymoma. Diagnostic application of lymphocyte markers to the thymoma of unusual site — M. Fukayama, Y. Maeda, et al. (1988)
• A case of cardiac herniation after extrapleural pneumonectomy for malignant thymoma — S. Sonoda, Y. Kumagawa, et al. (2010)
• Extended pleurectomy decortication for thymoma with pleural dissemination — N. Imanishi, Y. Nabe, et al. (2019)
• Identification of prognostic and bone metastasis​-related alternative splicing signatures in mesothelioma — R. Huang, Z. Zheng, et al. (2021)
• Prognostic Bone Metastasis-Associated Immune-Related Genes Regulated by Transcription Factors in Mesothelioma — Z. Hao, S. Wang, et al. (2022)

Browse more research in BMC Pulmonary Medicine, or return to medical research.