Successful treatment of pure red cell aplasia with thymoma by only extended thymothymectomy

Abstract

This case involved a 74-year-old female. A year ago, an anterior mediastinal tumor, suspected of being a thymoma, had been noted on computed tomography (CT). Eight months ago, the patient developed hepatitis B. While under hepatitis B treatment, anemia was also diagnosed. After further examination, the patient was diagnosed with pure red cell aplasia (PRCA). Four months ago, the anemia progressed to the point that the patient needed a weekly 2-unit red blood cell transfusion. Although the anterior mediastinal tumor had not grown on CT re-examination, the patient was admitted for surgical resection of the tumor in order to improve the anemia. The patient underwent extended thymothymectomy via a median sternotomy. Upon histological examination, the resected tumor was diagnosed as type AB thymoma (WHO classification) and Masaoka stage II. The postoperative course was uneventful. Two months after surgery, the anemia went into remission, negating the need for blood transfusion and immunosuppressive therapy. No recurrence of symptoms has been noted in the 18 months since surgery. The optimal management of thymoma-associated PRCA remains unclear. We report a patient with pure red cell aplasia with thymoma who was successfully treated by extended thymothymectomy alone.