Invasive
thymomas with intraluminal
tumor thrombi are rare. Removal of the
thymoma and infiltration of the superior vena cava (SVC) is a curative alternative. We report an autopsy case of invasive
thymoma with intraluminal growth into the intracardiac right atrium extension. Furthermore, the patient died of massive intracardiac
thrombosis 5 days after the start of
chemotherapy. A 66-year-old man with
SVC syndrome was referred to our hospital. He had been aware of swelling of the face for 6 months. The patient was diagnosed with invasive
thymoma by a CT-guided needle biopsy of the anterior mediastinal mass. Contrast-enhanced chest computed tomography showed a mass in the anterior mediastinum extending to the SVC and right atrium. As a result of discussion with surgeons and radiotherapists, we planned a multidisciplinary treatment in which
neoadjuvant chemotherapy would reduce the
tumor size, and surgery and postoperative
radiotherapy were followed by
chemotherapy. He was administered neo-
adjuvant chemotherapy with CBDCA + PTX (
carboplatin, area under the curve = 6, and
paclitaxel, 200 mg/m2). On the 4th day of
chemotherapy, he suddenly developed obstructive
shock due to intracardiac
thrombosis in the right ventricle. We believe that
chemotherapy may trigger rapid
thrombus formation. If an invasive
thymoma spreads into a large vessel or the right atrium, surgical treatment should be considered if possible. However, if surgery is impossible, administration of
anticoagulants should be considered to prevent
thrombus formation before
chemotherapy.