Occurrence of Hematological Malignancy in Long-term Survivors With Advanced Thymic Cancer

Case Reports

Ethical approval was obtained and informed consent was given by the patients.

Case 1. A 56-year-old man underwent surgical resection following the diagnosis of TC with a histological indication of squamous cell carcinoma (stage III), which was followed by radiotherapy (60 Gy) in March 2013. Subsequently, the patient was treated with surgical resection for three pulmonary metastases in July 2015. However, there was obvious evidence of recurrence by multiple pulmonary metastases that were inoperable. Thus, systemic chemotherapy with carboplatin and paclitaxel was initiated from May 2016. Although his recurrent tumor yielded a partial remission after first-line chemotherapy, he experienced relapse and developed regrowth of pulmonary metastases in December 2016. As second-line chemotherapy, amrubicin monotherapy was initiated, following which marked shrinkage was noted at the sites of recurrence. He continued to receive 21 cycles of amrubicin without any recurrence until June 2018. Although chest computed tomography (CT) showed an obvious progression of pulmonary metastases, S-1 monotherapy as third-line chemotherapy was subsequentially administered in December 2018. He experienced a partial response after oral intake of S-1, and S-1 treatment was continued until August 2019. However, the regrowth of some pulmonary metastases was observed and carboplatin with nab-paclitaxel was administered in September 2019. The patient had consistent severe myelosuppression from October 2019 to December 2019 despite cessation of chemotherapy, indicating grade 4 neutropenia and grade 3 thrombocytopenia. Therefore, the patient was referred to a hematological physician and a definite diagnosis of acute promyelocytic leukemia was made using bone marrow analysis. All-trans retinoic acid was initially administered to the patient. His condition improved and he continues to receive chemotherapy.

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Figure 1.

A: Chest computed tomography showing nodules in contact with the left pleura (arrows), indicating disseminated lesions due to thymic cancer. B: Chest computed tomography revealing nodules arising from thymic cancer (black arrows) and marked mediastinal lymphadenopathy (white arrows). C: 2’-Deoxy-2’-[¹⁸F] fluoro-D-glucose positron-emission tomography revealing increased accumulation in the cervical, axillary, mediastinal and inguinal regions (white arrows) and nodules secondary to thymic cancer (black arrow).

Case 2. A 49-year-old man was referred to our Institution because of dyspnea. Pleural biopsy revealed the definite diagnosis of advanced TC with pleural effusion in December 2015. As first-line chemotherapy, carboplatin with paclitaxel was initiated for 6 cycles. As there was confirmed evidence of pleural dissemination, he was treated with amrubicin monotherapy as second-line chemotherapy in August 2016. The amrubicin treatment was effective in reducing tumor progression, and he received 54 cycles of amrubicin until November 2019 (Figure 1A). However, chest CT for response evaluation revealed marked lymphadenopathy in the mediastinum (Figure 1B). Positron-emission tomography revealed increased uptake of 2’-deoxy-2’-[¹⁸F] fluoro-D-glucose, indicating new lesions on CT (Figure 1C). Transbronchial nodal biopsy confirmed T-cell lymphoblastic lymphoma without recurrence of TC. Steroid therapy was initiated, and his condition was improved.