Intrapericardial thymoma: report of two incidental autopsy cases and review of the literature.

OBJECTIVES

To report the pathologic features of intrapericardial thymoma and discuss their possible clinical relevance.

DESIGN

Retrospective evaluation of autopsy cases and the available clinical records.

SETTING

A large autopsy population (>31,000 postmortem examinations between 1980 and 1995) in an Italian general hospital.

RESULTS

Two cases of thymoma showing an exclusive intrapericardial growth were retrieved from autopsy files. The patients were 61 and 82 years of age, both were women, and both were referred to the hospital with terminal conditions due to either neoplastic or chronic diseases. Myasthenia gravis and/or immunologic dysfunctions were not noted, although one of the patients had serum hypogammaglobulinemia. Roentgenography showed enlargement of mediastinal profiles and suggested cardiomegaly. At autopsy, tumors were bulky, noninvasive, and from 6 to 10 cm in largest dimension. Histologically, they were spindle cell "medullary" thymomas, frequently showing cell arrangement around microcystic spaces. They were strongly immunoreactive for epithelial markers.

CONCLUSIONS

This study confirms that thymomas may occur in the pericardium. Tumor-related symptoms may be overlooked owing to concomitant heart disease or equivocal instrumental features, especially in the absence of immune system disturbances. Based on these premises, they may deserve a specific distinction in the expanding chapter of ectopic thymomas.