PMC8155580_01
Diagnostic Evidence of Thymoma with Autoimmune Enteropathy and Myocarditis. An axial, CT contrast-enhanced scan of the chest (A) shows a mediastinal mass (arrows) invading into the left anonymous vein. During surgery, we found that not only the left anonymous vein (white arrow) but also the anterior segment of left-upper lobe (black arrow) were involved by the thymoma (B). The pathological sections of tumor stained with hematoxylin and eosin shows typical B1 thymoma (C). A coronal, CT contrast-enhanced scan of the abdomen and pelvis (D) shows the typical thickening and high-density of the colon wall. The enteroscopy (E) showed the sigmoid colonic mucosa was markedly thinner than normal, and the colon mucosal biopsies (F) detected the colonic mucosa with chronic inflammation, mild lymphocytosis, and extensive loss of goblet cells.
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Four months ago, because of cough and shortness of breath, he underwent a chest computed tomographic (CT) examination, revealing a huge anterior mediastinal mass that measured 7.2 cm craniocaudally, 6.7 cm transversely, and 4 cm anteroposteriorly, as well as invading into the left anonymous vein ( Figure 1A ). 18F-flurodeoxyglucose positron emission tomography/CT showed the mediastinal mass was malignant, and no other malignant lesion was observed. The abdomen and pelvis CT film showed the diffuse wall thickening of the colon ( Figure 1D ). The enteroscopy showed the small intestinal villus atrophy, and the sigmoid colonic mucosa was markedly thinner than normal ( Figure 1E ). The pathological examination confirmed the diagnosis of autoimmune enteropathy ( Figure 1F ). Thymoma, left anonymous vein and involved anterior segment of the left-upper lobe were completely resected via median sternotomy ( Figure 1B ).
The trends of laboratory test results. The levels of TNI, BNP, LDH, and CK-MB were mildly higher than normal before surgery, significantly increased within 10 days after tumor resection, and 3 months later, returned to be normal (A-D). Horizontal dashed black lines in each graph designate the upper and lower limits of the normal range for each variable, as determined by the Beijing Tongren Hospital Clinical Hematology Laboratory.
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On laboratory examination, levels of troponin I (TNI), B-type natriuretic peptide (BNP), creatine kinase-MB (CK-MB), and lactate dehydrogenase (LDH) were mildly higher than normal ( Figures 2A-D ).