PEDIATRIC THYMOMA (TYPE B1, STAGE IIIA) PRESENTING AS RIGHT LUNG INFILTRATION: A CASE REPORT
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We present a rare case of a 1-year and 7-month-old female diagnosed with Thymoma Type B1 Stage IIIA, initially presenting with symptoms suggestive of an atypical chest infection and extensive right lung opacification. This case is notable given the extreme rarity of thymomas in the pediatric population, particularly in infancy, with fewer than 50 cases reported in children and none in newborns prior to some recent observations (Chand et al., 2021). The initial clinical presentation, characterized by a large thoracic mass effect and midline shift, further underscores the diagnostic complexities associated with these infrequent pediatric malignancies (Chand et al., 2021). The successful management of this case involved a multidisciplinary approach, including surgical intervention and subsequent chemotherapy, highlighting the critical need for prompt and accurate diagnosis in such cases (Brillantino et al., 2021). This report details the diagnostic journey and therapeutic response, contributing to the limited literature on pediatric thymomas and informing future clinical approaches. This detailed account aims to provide insights into the clinical presentation, diagnostic challenges, and management strategies for pediatric thymoma, which often mimics more common pediatric respiratory illnesses, thereby posing a significant diagnostic dilemma for clinicians (Rivera et al., 2024). This case emphasizes the importance of considering rare oncological etiologies, such as thymoma, even in very young patients presenting with atypical pulmonary infiltrates that do not respond to conventional treatments (Chand et al., 2021). The presentation of mediastinal masses in children can manifest with life-threatening symptoms, including airway compression, necessitating a thorough differential diagnosis that considers various etiologies beyond common infections, such as thymic hyperplasia or neoplastic processes (Tejza & Grześk, 2023). This case underscores the challenges in differentiating rare tumors from more common pediatric respiratory conditions, particularly when the initial presentation mimics an infection (Rivera et al., 2024). The unique presentation in this infant, coupled with the pathological confirmation of Thymoma Type B1 Stage IIIA, provides valuable data for the understanding of these rare tumors in extreme pediatric age groups. This report aims to expand the knowledge base on pediatric thymoma, a condition seldom encountered in this age group, by detailing its atypical presentation and the diagnostic and therapeutic strategies employed (Chand et al., 2021) (Jiao et al., 2023).
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Bilotta, C., Perrone, G., Maresi, E., Lisi, G. D., Pasquale, P. D., Piro, E., Argo, A., & Zerbo, S. (2021). Case Report: Unusual Clinical Presentation of a Rare Cardiac Inflammatory Myofibroblastic Tumor in Children: The Differential Diagnosis With Pediatric Emergencies. Frontiers in Pediatrics, 9. https://doi.org/10.3389/fped.2021.718157 Brillantino, C., Rossi, E., Minelli, R., Bifano, D., Baldari, D., Pizzicato, P., Zeccolini, R., & Zeccolini, M. (2021). Mediastinal thymoma: A difficult diagnosis in the pediatric age. Radiology Case Reports, 16(9), 2579. https://doi.org/10.1016/j.radcr.2021.06.035 Camela, F., Gallucci, M., Palmo, E. di, Cazzato, S., Lima, M., Ricci, G., & Pession, A. (2018). Pulmonary Inflammatory Myofibroblastic Tumor in Children: A Case Report and Brief Review of Literature. Frontiers in Pediatrics, 6. https://doi.org/10.3389/fped.2018.00035 Chan, Y. C., Kan, A., Yuen, L. Y. P., Wan, I. Y. P., Fung, K. F. K., Cheung, Y., Leung, K. K. Y., Ku, D. T. L., & Liu, A. P. Y. (2022). Case Report: Primary Thoracic Low-Grade Fibromyxoid Sarcoma in a Young Girl Presenting With Mediastinal Mass Syndrome. Frontiers in Pediatrics, 10. https://doi.org/10.3389/fped.2022.885068 Chand, M., Edens, J., Lin, T., Goshorn, D. P., & Pham, T. L.-B. (2021). Congenital thymoma [Review of Congenital thymoma]. Autopsy and Case Reports, 11. University of São Paulo. https://doi.org/10.4322/acr.2021.327 Çmega, V. G., Jakupi, A., & Agaj, A. (2023). A Rare Case Resistant Chemotherapy Thymoma B2 Type, New Approach. International Journal of Biomedicine, 13(4). https://doi.org/10.21103/article13(4)_cr5 Ferrari, A., Schneider, D. T., Bisogno, G., Réguerre, Y., Godziński, J., Bień, E., Stachowicz‐Stencel, T., Cecchetto, G., Brennan, B., Roganović, J., Ami, T. B., Virgone, C., Farinha, N. R., Mancini, S., Orbach, D., & Brecht, I. B. (2021). Facing the challenges of very rare tumors of pediatric age: The European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT) background, goals, and achievements. Pediatric Blood & Cancer, 68. https://doi.org/10.1002/pbc.28993 García, I. V., Gutierrez, A. S., Guzmán, S. B., & Viveros, B. A. (2024). Inflammatory myofibroblastic tumor in pediatric patients: challenges in diagnosis, multidisciplinary management, and surgical strategies. Egyptian Pediatric Association Gazette, 72(1). https://doi.org/10.1186/s43054-024-00269-z Geng, Z.-Y., Li, Z.-H., Li, S., Wu, B., Sheng, Y., Yuan, P., Li, F., & Qi, Y. (2023). Case report: Uniportal video-assisted thoracoscopic sleeve lobectomy in a 6-year-old patient with inflammatory myofibroblastic tumor (IMT). Frontiers in Pediatrics, 11. https://doi.org/10.3389/fped.2023.1285181 Hemmati, H., & Memarian, M. (2023). Thymoma; clinical presentations, pathology, and prognostic factors – a surgery point of view. Immunopathologia Persa, 10(2). https://doi.org/10.34172/ipp.2023.40581 Hoogstra, D. J., Chu, R., Bhambhani, K., Yankelevich, M., Taub, J. W., Hochberg, J., Oesterheld, J., Militano, O., Klejmont, L., Harrison, L., Nickerson, B., Cairo, M. S., Sholler, G. L. S., Ferguson, W., Bergendahl, G., Bond, J. P., Roberts, W. L., Bredlau, A., Mitchell, D., … Graham, R. (2016). 2016 ASPHO ABSTRACTS. Pediatric Blood & Cancer, 63. https://doi.org/10.1002/pbc.25998 Irodi, A., Chacko, B. R., Prajapati, A., Prabhu, A. J., Vimala, L. R., Christopher, D. J., & Gnanamuthu, B. R. (2020). Inflammatory myofibroblastic tumours of the thorax: Radiologic and clinicopathological correlation. Indian Journal of Radiology and Imaging - New Series/Indian Journal of Radiology and Imaging/Indian Journal of Radiology & Imaging, 30(3), 266. https://doi.org/10.4103/ijri.ijri_93_20 Jiao, J., Yu, J., Chen, C., Chen, T., Zheng, T., Le-jian, H., & Zeng, Q. (2023). Thoracoscopic approach for massive thymic hyperplasia in an infant: Case report and literature review. Frontiers in Pediatrics, 11. https://doi.org/10.3389/fped.2023.1144384 Karagüzel, G., & Bahadır, K. (2024). Thymectomy in Children. In IntechOpen eBooks. IntechOpen. https://doi.org/10.5772/intechopen.114888 Khadim, B., & F, H. T. (2018). Thymoma B3 & Myasthenia Gravis in Adolescent: Case Report. Journal of Oncology Medicine & Practice, 3(2). https://doi.org/10.4172/2576-3857.1000122 Khalilian, M. R., Shamsian, B. S., Tehrani, R. B., Kharaz, L., & Talebian, N. (2023). Inflammatory myofibroblastic tumor of the pericardium in an 11‐month‐old infant: A case report. Clinical Case Reports, 11(2). https://doi.org/10.1002/ccr3.6949 Kumar, N., Saravanamuthu, T., Srinivasan, A., Ramalingam, T. R., & Scott, J.-X. (2018). Pediatric Inflammatory Myofibroblastic Tumors of the Airway: Two Case Reports with Varying Clinical Presentation. DOAJ (DOAJ: Directory of Open Access Journals), 30(98), 171. https://doaj.org/article/068d695a61584e56a25f0aea1f6d5c71 Li, Y., & Wen, Y. (2023a). A pediatric tuberculosis with recurrent fever confirmed to be inflammatory myofibroblastic tumor. Research Square (Research Square). https://doi.org/10.21203/rs.3.rs 2512238/v1 Li, Y., & Wen, Y. (2023b). Diagnosis of inflammatory myofibroblastic tumor in a pediatric patient initially suspected of tuberculosis. BMC Pediatrics, 23(1). https://doi.org/10.1186/s12887-023-04431-1 Lowe, E., & Mossé, Y. P. (2024). Podcast on Emerging Treatment Options for Pediatric Patients with ALK Positive Anaplastic Large Cell Lymphoma and Inflammatory Myofibroblastic Tumors. Oncology and Therapy, 12(2), 247. https://doi.org/10.1007/s40487-024-00275-6 Maruyama, Y., Fukushima, T., Gomi, D., Kobayashi, T., Sekiguchi, N., Sakamoto, A., Sasaki, S., Mamiya, K., & Koizumi, T. (2017). Relapsed and unresectable inflammatory myofibroblastic tumor responded to chemotherapy: A case report and review of the literature. Molecular and Clinical Oncology, 7(4), 521. https://doi.org/10.3892/mco.2017.1383 Mittal, A., Gupta, A., Rastogi, S., Barwad, A., & Sharma, S. (2021). Near-complete response to low-dose ceritinib in recurrent infantile inflammatory myofibroblastic tumour. Ecancermedicalscience, 15. https://doi.org/10.3332/ecancer.2021.1215 Okamoto, M., Kimura, S., Hotta, M., Tsuruno, Y., & Fukuzawa, H. (2023). Infantile type I pleuropulmonary blastoma presenting with dyspnea due to compression by pneumothorax and an occupying tumor: a case report. Surgical Case Reports, 9(1). https://doi.org/10.1186/s40792-023-01777-7 Patelli, G., Bencardino, K., Tosi, F., Pugliano, M., Lanzani, F., Innocenti, A., Rinaldo, A., Mauri, G., Cerea, G., Sartore‐Bianchi, A., Torre, M., Agostoni, E. C., & Siena, S. (2021). Chemotherapy-induced myasthenic crisis in thymoma treated with primary chemotherapy with curative intent on mechanical ventilation: a case report and review of the literature [Review of Chemotherapy-induced myasthenic crisis in thymoma treated with primary chemotherapy with curative intent on mechanical ventilation: a case report and review of the literature]. Journal of Medical Case Reports, 15(1). BioMed Central. https://doi.org/10.1186/s13256-020-02601-8 Rivera, S. M., Lozano-Samaniego, A. S., Lozano, R. M. A., Campoverde, J. L., & Mascote, R. C. (2024). Decoding complex mediastinal masses in children: insights from a clinical case. MOJ Surgery, 12(1), 1. https://doi.org/10.15406/mojs.2024.12.00248 Rodrigues, H. C., Videira, W., Rodrigues, L., Pinheiro, R., & Ferro, F. (2022, September 23). Inflammatory myofibroblastic tumor of the lung - an explosive metastatic case. In Jornal Brasileiro de Pneumologia. Sociedade Brasileira de Pneumologia e Tisiologia. https://doi.org/10.36416/1806-3756/e20220127 Rodrigues, L., Domingues, R., Amaral, D., & Cavaco, J. E. (2020). Lesão Tumoral Primária do Pulmão em Adolescente. Acta Médica Portuguesa, 33, 512. https://doi.org/10.20344/amp.12690 Sun, Y., Zhou, J., Zhu, J., Li, M., Yang, S., Bin, S., & Tan, L. F. (2025). Case Report: Rare primary bronchogenic acinic cell carcinoma in a pediatric patient. Frontiers in Oncology, 15. https://doi.org/10.3389/fonc.2025.1640216 Szpytma, M., Yang, Y., & Crouch, G. (2023). The Immunological considerations in patients with Thymoma : A case report with lessons beyond resection. Research Square (Research Square). https://doi.org/10.21203/rs.3.rs-3497280/v1 Takashima, M., Kagawa, K., Sawada, T., Hino, H., Naruse, K., Takeuchi, E., Sakiyama, S., & Shinohara, T. (2022). Type A thymoma: a rare cause of neoplastic cardiac tamponade with long-term survival. BMC Pulmonary Medicine, 22(1). https://doi.org/10.1186/s12890-022-02034-7 Tanaka, T., Amano, H., Tanaka, Y., Takahashi, Y., Tajiri, T., Tainaka, T., Shirota, C., Sumida, W., Yokota, K., Makita, S., Tani, Y., Hinoki, A., & Uchida, H. (2020). Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience. BMC Pediatrics, 20(1). https://doi.org/10.1186/s12887-020-02183-w Tejza, B., & Grześk, E. (2023). Mediastinal tumor: thymoma or lymphoma? Acta Haematologica Polonica. https://doi.org/10.5603/ahp.95457 Wawszczak, M., Kraj, G., Lange, J., & Langfort, R. (2023). Pulmonary inflammatory myofibroblastic tumor in children. Pediatria Polska, 98(4), 320. https://doi.org/10.5114/polp.2023.133535
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