even more infrequent.* Surgical resection is the treat- ment of choice for this tumor. Treatment of recurrent invasive thymoma, however, is difficult. There are few.
T-cell Chronic Lymphocytic Leukemia in a Patient with lnvasive Thymoma in Remission with Chemotherapy J. THOMAS, MD,'
C. DE WOLF-PEETERS, MD,t G. TRICOT, MD,* J. BEKAERT, MD,t AND A. BROECKAERT-VAN ORSHOVEN, MD*
This is a case report of a patient with invasive thymoma. Subsequently to radiotherapy and steroids, a combination chemotherapy of cis-platinum (CDDP) and doxorubicin was tested with good results. The patient later developed a chronic lymphocytic leukemia (CLL); morphologically and cytochemically a T-CLL with skin localizations, hepatomegaly, and a high leukocyte count. Cancer 52:313-317, 1983.
T
are rare, representing 10%of all primary mediastinal neoplasias.' Invasive thymomas are even more infrequent.* Surgical resection is the treatment of choice for this tumor. Treatment of recurrent invasive thymoma, however, is difficult. There are few reports on ~hemotherapy,~-~ but recently reviews have been published on monochemotherapy ' and combination chemotherapy.' ' - I 2 HYMOMAS
Case Report A 40-year-old man, a steel plate worker, developed dyspnea in January 1974, resulting in orthopnea in February 1974. At that time a pencardial effusion was found and an evacuating puncture performed. Eight weeks later the effusion relapsed. The patient was referred to our hospital. At that time no clinical, biochemical, or radiologic abnormalities were found except for a massive pericarditis: 1.5 liter hemorrhagic fluid was evacuated. Cytologic and bacteriological examination did not reveal any etiology. Therefore, a thoracotomy was performed in June 1974. A large infiltrating tumor mass, mainly located in the anterior mediastinum was found. This mass invaded the arteria pulmonalis, the right heart, and the aorta. Surgical removal was impossible. A biopsy specimen was taken and the pericard left open. The intervention was followed by an irradiation with telecobalt over the mediastinum and the heart up to a 40 Gray (Gy) tumor dose (2 Gy per day, 5 fractions a week). After therapy the mediastinum was normal. The patient remained well until September 1979 when a left supraclavicular mass appeared. A new biopsy specimen was taken. Clinical, hematologic, and biochemical investigations revealed n o other abnormalities. A Gallium total body scintigraphy failed to detect the tumor. The immunoelectroforesis was normal. The local recurrence was irradiated again (tele-
* Department of Oncology (Head, A. Drochmans), University Hospital, Leuven, Belgium. t Department of Pathology, University Hospital, Leuven. Department of Hematology, University Hospital, Leuven. Address for reprints: J. Thomas, Department of Oncology, University Hospital St. Rafael, Capucijnenvoer 33,3000 Leuven, Belgium. Accepted for publication April 12, 1982.
cobalt) to a tumordose of 50 Gy in the cervical area. The mass disappeared clinically. In July 1980, the patient noticed a swelling in the neck (VCS). On clinical examination he presented with a vena cava superior syndrome. No adenopathies were palpable. He had severe dyspnea. Hematologic investigation showed a high leukocyte count (20 X 109/1)with a normal differentiation. On radiography of the thorax there was a bilateral pleural effusion and a mass in the left hilus visible. The CAT scan of the thorax (Fig. IA) revealed a mediastinal mass. Cytologic findings of the pleural fluid revealed no malignant cells. The patient was treated by repeated pleural evacuations (over 5 liters in two weeks). On August 7, 1980 40 mg of prednisone daily was started. This resulted in a slight improvement of the VCS syndrome, but the dyspnea worsened. On August 19, I980 and August 29, I980 10 mg of nitrogen mustard was injected intrapleurally without any effect on the effusion. Meanwhile the mass in the left hilus increased in size, infiltrating the left lung. On September 12, 1980 a treatment ofAdriamycin (doxorubicin) 25 mg/m2day I and cis-platinum (CDDP) 20 mg/m2 daily for five days was started. At the end ofthe first cycle the patient improved dramatically. The pleural effusion disappeared and the mediastinal-hilar mass decreased i n size. The patient was free of symptoms seven days after the start of the chemotherapy and the clinical examination returned to normal. The CAT scan of the thorax confirmed the shrinkage of the mediastinal mass but a small, less opaque mass remained in the retrosternal area (Fig. IB). The therapy was repeated every four weeks. In December 1980 during the fourth cycle, cutaneous nodules were noted over the entire body. The nodules were dark-red, 0.5 to 2 cm in diameter, slightly indurated and ill defined. A skin biopsy was performed. The radiogram of the thorax was normal. The hematologic examination was normal on the December 4, 1980. On January 1, 1981 the general condition of the patient deteriorated: he developed fever, diffuse pains, night sweats, and polydipsia. Five days later the nodules had increased. On clinical examination a small adenopathy in the left axilla was found. An hematologic examination revealed a leukemia ( I I3 X 102/1). The hematologic and immunologic data are discussed. The patient died January 8, 198 1. An autopsy was performed.
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