Synchronous tumors (breast cancer and thymoma)

Case contributed by Margory Madrid
Diagnosis almost certain


Upper left limb edema and ecchymosis for three days

Patient Data

Age: 60 years
Gender: Female

Ultrasound of left arm showing absence of compressibility in the proximal third of the left brachiocephalic and subclavian veins, suspicious for venous thrombosis

CT with contrast of the chest shows a solid soft tissue density (20 - 41 HU) lesion with irregular mildly enhancing margins. This measures 6.25 x 5.15 cm in maximal diameter. Multiple perilesional lymph nodes were seen. The mass moves the major aortic branches posteriorly without invading them.

Infiltration of sternocostal junction is shown on the left, extending into the pectoralis major muscle. Tomographic findings suggest an invasive thymoma or thymic lymphoma.

Inflammatory changes are seen in the left breast.

Left breast CC and MLO projections show a spiculated nodule at the outer superior quadrant, with internal tiny grouped calcifications.

Case Discussion

This case demonstrates synchronous tumors which are defined as those that occur in the same subject simultaneously.

A biopsy was taken directly from the mediastinal tumor and histopathology reported type B1 thymoma. At the same time a biopsy was performed at left breast, reporting a different primary tumor; carcinoma of the breast lobular subtype.

Different criteria to be considered as synchronous tumors:

  • Each tumor must have a defined pattern of malignancy.
  • It should be excluded that one constitutes metastasis of another.
  • Each tumor must have a different histopathology.
  • Each tumor can present with different symptoms or be an incidental finding during the study of the first.

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