2013, Number 2
Rev Hematol Mex 2013; 14 (2)
Case report: Thymoma associated with pure red cell aplasia in a 78 years old female patient
Cruz-Contreras LH, Chávez-Martínez S, Arias-González ML
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Thymoma is the epithelial thymic neoplasm, they are rare, with a prevalence ranging from 0.2% to 1.5% of all neoplasm. Anterior mediastinum is the most frequent localization. Ectopic localizations can occur. Over half of the cases present as asymptomatic chest mass the rest in association with paraneoplastic syndromes. The most frequent of all is myasthenia gravis.
We present the case of a 78 year old female patient who presented with clinical signs and symptoms of anemia. The blood count showed normal mean corpuscular volume and normal mean corpuscular hemoglobin. Bone marrow aspiration revealed pure red cell aplasia. Chest X-ray and CT showed the presence of a tumor located in right hemithorax, with well-defined borders, attached to the mediastinum. The patient then was submitted for surgery for tumor resection. The surgical specimen had smooth, lobulated surface. Microscopic examination revealed that the tumor had two types of cells, non-neoplastic small lymphocytes and epithelial cells. Immunohistochemistry stains were performed. CD3 and CD99 antigen was expressed in the non-neoplastic lymphocytes confirming the immature T lymphocyte origin. Epithelial cell expressed cytokeratin. Mixed type thymoma with tumor free margin was diagnosed. Ectopic localizations can make diagnosis difficult. Pure red cell aplasia is present in 5-10% of cases. Surgery is the treatment of choice in most cases, the utility of chemotherapy and radiotherapy is not well established.
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