(Disclaimer: This article is for scientific use only, and relevant information in the following content has been processed to protect patient privacy)
Abstract: Recurrent pain in the anterior chest region requires vigilance for malignant thymoma in addition to the exclusion of cardiovascular disease. Malignant thymoma develops rapidly and can be treated surgically if diagnosed early, or only with chemotherapy or radiation therapy if surgery is missed. In this case, a male patient was admitted to the hospital with recurrent anterior chest pain for 3 months with chest tightness, and the examination was diagnosed as malignant thymoma. After standardized chemotherapy and radiotherapy, the chest pain symptoms were improved and the condition was temporarily controlled and stabilized.
Basic information】Male, 77 years old
Disease Type】Malignant thymoma
Hospital】The Second Affiliated Hospital of Anhui Medical University
Date of Consultation】May 2022
Treatment plan】Inserted puncture tube drainage + chemotherapy (compound cyclophosphamide tablets, etoposide capsules) + radiation therapy
Treatment period】Inpatient treatment for 1 week, re-admission 2-3 weeks later
Treatment effect】Pleural effusion was effectively controlled, chest pain was relieved, and the disease was temporarily controlled and stabilized.
I. Initial consultation
A 77-year-old male patient with recurrent anterior chest pain for 3 months with chest tightness came to the clinic. He reported that he had no fever, no cough and sputum, and the pain was persistent and gradually worsened. Surgery was recommended, but I and my family were reluctant to operate because they had concerns about surgery, and then the chest pain continued to develop, and I was admitted to our hospital as an emergency. After the outpatient chest CT examination, it was suggested that there was a huge occupancy in the anterior mediastinum and malignant thymoma was suspected, accompanied by a large amount of right pleural effusion.
II. Treatment process
After admission, the patient’s heart rate was 80 beats/min and the blood tumor index (CEA, CA19-9, etc.) was significantly elevated. The patient was given chemotherapy with compound cyclophosphamide tablets and etoposide capsules, and local radiotherapy of the anterior mediastinum, because the tumor stage was late and the opportunity of surgery was lost.
III. Treatment effect
After continuous drainage of the thoracic cavity by indwelling puncture tube, the patient’s pleural effusion gradually disappeared, and under the combined treatment of chemotherapy and radiotherapy, the general condition improved significantly and the chest pain was relieved, and the chest drain was successfully removed. The patient was discharged after 1 week of hospitalization. The patient was instructed to be re-admitted for chemotherapy and radiotherapy in 2-3 weeks to control the development of mediastinal tumor, effectively relieve the symptoms and prolong the survival time of the patient.
IV. Precautions
Although the patient cannot undergo radical surgery, it is gratifying to see that the condition is temporarily controlled and stabilized after chemotherapy and radiotherapy. Patients are still advised to pay attention to the following matters after discharge from the hospital.
1, malignant thymoma is highly malignant and physically exhausting, so it is necessary to strengthen nutritional support treatment, increase nutrition in daily diet, and keep a light diet, avoid spicy and stimulating food, and avoid drinking and smoking.
2, during the chemotherapy process, we should pay attention to check the blood routine, timely detection of bone marrow suppression and other conditions, if there is anemia or leukopenia, to correct and treat in a timely manner.
3.If coughing or even fever occurs during radiation therapy, you should be alert to radiation pneumonia, seek medical attention, stop or delay radiation therapy, and actively manage pneumonia to reduce the occurrence of pulmonary complications.
V. Personal insight
It is easy to consider cardiovascular disease for recurrent anterior chest pain. After performing routine electrocardiogram and cardiac enzyme examination, it is usually necessary to perform chest CT examination to diagnose or exclude mediastinal occupying diseases, mainly thymoma in the anterior mediastinum, especially malignant thymoma, which can cause obvious anterior chest pain. If surgery is not possible, chemotherapy and radiation therapy can be administered to control the development of the tumor after puncture for pathology. Malignant thymoma is more sensitive to chemotherapy and radiation therapy, and the treatment effect is better, which can improve patients’ quality of life and prolong their survival time.