36 yo male with Concurent Chondrosarcoma and Thymoma

I’m a 36 yo male, active duty in US military, w/ hx of Ollier’s Diesease and low-grade chondrocoma (excised 6 yr ago).  Recently another suspected low-grade chondrocoma was identified in my scapula for which they planed a partial resection.  

On studying the scapula, they found pulmonary nodules and a 2.5 x 4.5cm enhancing mediastinal mass, which demonstrated hypermetobolic activity on PEC/CT scan.  

Based on normal blood work (chem./CBC, and negative tumor markers) the fact that I’m not sick or have any suspicious signs or symptoms they are calling this is a stage 1 thymoma which they plan to excise.  This surgery usurps the partial scapula resection.  

Interventional radiologist have declined the opportunity for percutanious biopsy and thus I’m scheduled for en bloc radical thymectomy via medium sternotomy w/o prior bx.

At this point, since I feel fine, the idea of all this surgery is like knowing stepping in front of a bus.  I’m going to go through with it but would feel better if I could find anything that would lead me to a less painful recovery.

Questions.

Chondrocoma and thymoma are rare – anyone ever heard of an association?  I’m unable to find anything in the medical literature.  Given my hx, are there other more likely enhancing mediastinal masses that should be considered?

The bulk of the literature seems to support medium sternotomy for radical en bloc thymectomy .  In my search I find the literature demonstrates that VATS or RATS is technically achievable, however there does not seem to be enough evidence to establish superiority over the more invasive approach.  As long as I’m going through this I want to go with the best evidence.  Anyone know of a RCT or other long term data that supports the minimally invasive approaches?  I’m going to feel foolish if I go through all this pain only to find that my procedure is out dated.

The sternal wires are concerning to me.  Not only will I be frequently followed with MRI for the various tumors related to my Ollier’s disease but I imagine someone will be interested in following my pulmonary tumors too.  Are there concerns with artifacts from the sternal wires?  Do they make a nonferromagnetic sternal closure devise that might be better in my case.  As the magnets in the MRI’s get bigger, will I experience pain or discomfort from these wires in the MRI?

Thanks.

[Tamihart]

My dad had a sternotomy 4 years ago for a thymoma and said it was not too bad.  He was 70 when he had the surgery.  The minimally invasive approach does not allow the Dr. to see well enough incase their is more tumor than they thought.  The sternal wires have not bothered him at  all.  You really should have a biopsy so they know for sure what they are dealing with.  The results will make a tremendous difference in the treatment.  Lymphoma is one thing they consider when they think it is a thymoma and a biopsy will rule that out. If it was lymphoma no surgery is needed.

[Fernando Roque, MD]

Hi.  Assuming that your previous diagnosis of Ollier's disease is correct, I think your doctors should also have considered the possibility that the benign lesions (enchondromas) seen in Ollier's disease could have undergone malignant transformation into osteosarcoma or chondrosarcoma (there's a 5-50% chance of transformation).  Those pulmonary nodules and mediastinal mass  could actually be metastatic lesions from a sarcoma instead of a thymoma (which could not explain the presence of the  pulmonary nodules).  In my opinion, your doctors could have first proceeded with a percutaneous biopsy of the mediastinal mass.  If the biopsy yields sarcoma, resection of the pulmonary nodules (called metastasectomy) should be done in addition to the thymectomy.  Removal of pulmonary metastases can be a potentially curative procedure for sarcomas and should be done whenever possible.