A case of thymoma

Merina^1*, Subathra Devi. M², Maha Lakshmi³

¹Senior Safety Nurse, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

²Nurse Educator, Kauvery Hospital. Cantonment, Trichy, Tamil Nadu

³Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

Thymoma is a rare neoplasm arising from the epithelial cells of the thymus, commonly located in the anterior mediastinum. It is often associated with paraneoplastic syndromes, especially Myasthenia Gravis. Clinical presentation may vary from asymptomatic cases to symptoms related to mass effect or associated autoimmune conditions

Key words: Thymoma; Paraneoplastic syndromes; Myasthenia Gravis

Introduction

Thymic epithelial lesions are mostly thymomas. They are a common cause of anterior mediastinal mass in adults however, thymoma is the most common. They are extremely uncommon in young people and are more prevalent among individuals in their fifth and sixth decades of life. It affects females slightly more commonly than males. My patient is a 23-year-old male and despite that young age, they have been diagnosed with a thymoma.

Case presentation

We report on the case of a 23-year-old patient who presented a history of significant unintentional weight loss of approximately 17kg over one year. The patient was apparently asymptomatic during this period and had received symptomatic treatment. Recently, the patient developed acute onset respiratory distress and chest discomfort, prompting hospital admission. Imaging studies, including computed tomography (CT) scan, revealed mass in the mediastinum. Further evaluation suggested the diagnosis of thymoma.

Relevant Clinical Findings

Social History: He has a Tobacco chewing for the past 1 year

Allergies: No known medicine or environmental allergies

Past medical history: Childhood history seizure disorder at present not on any medications.

Past Surgical history: Chest wall cyst removal 6 month

Physical examination

Vitals signs

Temp: 100F
HR: 133/min
BP: 140/80 mmHg
SPO2: 98% on 2L O₂
RR: 20/min
Patient conscious, oriented, afebrile
Dyspneic
Tachypneic
Tachycardia
RS : NVBS (+), Bilateral rhonchi (+)
Circulation – all peripheral pulse +
Random blood sugar (GRBS) – 130mg/dl

Relevant Investigation

Hemoglobin	13.1g/dl
PCV	39.8%
MCH	25.4 pg/cell
Creatinine	0.7 mg/dL
Glucose	114 mg/dL
HBsAg	Negative
Anti HCV	Non-Reactive
Potassium	4.0 mmol/L
Sodium	135 mmol/L
Urea Serum	19.26 mg/dL
Platelet Count	468000 cells/µl
Test (APTT)	11.7Seconds
Test (PT)	13.0 Seconds
INR	1.11
Total RBC Count	5.16 mL/10^g
Total WBC Count	9420 Cells/Cumm
Absolute Basophil Count (ABC)	6210 cells/µl
Eosinophil	0.3%
Basophil	0.5%
ESR	84 mm/1hr

Echocardiogram

Normal chambers
No RWMA
Good LV systolic function LV EF-60%
Severe TR/PAH
Trivial MR
Septae intact
No respiratory variation
(2X1.5CM) pericardial effusion left side of heart.

Non calcified non-fatty partly necrotic anterior mediastinal mass infiltrating the main pulmonary artery and causing severe narrowing of the pulmonary artery bifurcation on the right pulmonary artery with moderate pericardial effusion.

Diagnosis

Mediastinal mass with vascular compression
Moderate pericardial effusion
Severe PAH
Respiratory failure
Seizure disorder

Management

The patient was admitted with the complaints Cough with cold on & off for one year and increased more since 20 days, breathlessness x 3 weeks. He was treated with antibiotics, PPI, bronchodilators and other supportive medications. His respiratory failure was managed with oxygen. He underwent a USG guided biopsy. He improved with treatment.

Nursing Management.

Assessed respiratory status (RR, SpO₂, breath sounds) regularly
Monitored for signs of respiratory distress (dyspnoea, use of accessory muscles)
Position patient in semi-Fowler’s or high-Fowler’s to improve lung expansion
Administered oxygen therapy as prescribed
Monitored vital signs (BP, HR, RR,) and Neck vein distension
Watch for superior vena cava (SVC) obstruction signs:
Maintained IV access for emergency management
Monitored for myasthenia crisis (respiratory muscle weakness)
Assessed pain using pain scale
Early ambulation and leg exercises to prevent DVT
Provided soft or small frequent meals
Assisted feeding if muscle weakness present
Monitored swallowing ability
Provided emotional support
Educating patients about disease and treatment.

Discharge Advice Medication

S.No	Drug Name	Strength	Frequency	Relationship with meal	Days
1	Tab. Medrol	4 mg	BD	After food	10 days
2	Cap. Esofag d	40/30 mg	OD	Before food	10 days
3	Tab. Allegra	120 mg	BD	After food	10 days
4	Tab. Ventidox m	400/10 mg	OD	After food	10 days
5	Tab. Hifenac p	100/325 mg	BD	After food	10 days
6	Tab. Dytor plus	5 mg	OD	After food	10 days
7	Tab. Ivabrad	5 mg	BD (1/2)	After food	10 days
8	Syp. Dicodyl t	10 mg	TDS	After food	10 days
9	Tab. Xyzal	5 mg	OD	After food	10 days
10	Tab. Zyrtec	10 mg	OD	After food	10 days

He was advised to review the Biopsy report in OPD.

Discussion

The 23-year male admitted c/o breathlessness and cough and fever and 17kg weight loss initially went to an outside hospital. Diagnosed with pulmonary tuberculosis, and AKT was started. Initially the patient was stable but later his vitals became abnormal, with saturation dropping to 88%. CT chest was performed subsequently the patient was referred to another hospital (Kauvery) for further care. He was admitted under a pulmonologist at that hospital and an x- ray was done which as well showed a pleural effusion and a mediastinal mass. The patient’s condition was explained to the attendants, and he was placed under critical care observation. A biopsy was taken and the report confirmed thymoma. Based on the consultant’s advice he was transferred to the oncologist care where medical treatment was started, and chemotherapy was initiated the patient is now in stable recovery

Conclusion

Thymoma is a rare mediastinal tumour that requires a multidisciplinary approach involving surgery, chemotherapy, and radiation therapy. Early diagnosis and appropriate treatment significantly improve patient outcomes. Nursing management plays a vital role in ensuring patient safety by maintaining airway and breathing, managing pain, preventing complications and closely monitoring for associated conditions like Myasthenia Gravis. Effective patient education, psychological support and continuous monitoring help in faster recovery, reduce complications and improved quality of life. Thus, coordinated medical and nursing care is essential for optimal management of thymoma.

A case of thymoma

A case of thymoma

Merina1*, Subathra Devi. M2, Maha Lakshmi3

Nightingale Journals

Merina^1*, Subathra Devi. M², Maha Lakshmi³