SHM Converge Scientific Abstract ePoster Gallery-A Yellow Flag: Unique Presentation of Thymoma

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This case report describes a rare presentation of thymoma-associated paraneoplastic disease in a 77-year-old woman who presented with 3 weeks of pruritus and 1 week of jaundice and fatigue. She had no significant liver history, alcohol use, or new medications other than recently started ACE inhibitors. Exam showed jaundice without other classic signs of chronic liver disease.<br /><br />Initial labs revealed severe liver injury and cholestasis: AST 750, ALT 960, total bilirubin 15, alkaline phosphatase 459, and INR 1.0. Extensive autoimmune and infectious workup was unrevealing. Imaging showed diffuse fatty liver and a 7.6 × 4.5 cm anterior mediastinal mass with invasion of the left brachiocephalic vein near the aortic arch, making the tumor unresectable. MRI and mammogram also noted a right breast mass, which was biopsied and found to be a cyst.<br /><br />Liver biopsy showed lymphocyte aggregates suggestive of paraneoplastic cholestatic hepatitis, without classic histologic features of autoimmune hepatitis. Biopsy of the mediastinal mass confirmed thymoma, WHO type B1, with immunostaining showing predominant CD3-positive T cells and fewer CD68-positive macrophages and rare B cells.<br /><br />The patient did not improve with pulse steroids. Because of severe liver dysfunction, chemotherapy options were initially limited. She was ultimately treated with carboplatin and dose-reduced etoposide, which led to decreased thymoma size and improvement in liver function tests, supporting a paraneoplastic autoimmune process.<br /><br />The report emphasizes that acute liver dysfunction can rarely be the initial manifestation of thymoma-related paraneoplastic syndrome. It also highlights that autoimmune hepatitis may lack classic biopsy findings, and diagnosis may depend on clinical response to treatment.

Asset Subtitle

Courtney Amegashie

Meta Tag

Author List Courtney Amegashie, Gilmer J. Rodriguez

Category Clinical Vignettes

Concept Thymoma

Concept Paraneoplastic Syndrome

Concept Acute Liver Dysfunction

Concept Cholestatic Hepatitis

Concept Anterior Mediastinal Mass

Distinguished Non-Finalist

Presenter Organization University of Chicago Medicine

Presenting Author Courtney Amegashie

Track Adult

Keywords

thymoma

paraneoplastic syndrome

cholestatic hepatitis

acute liver dysfunction

jaundice

autoimmune hepatitis

mediastinal mass

carboplatin

etoposide

liver biopsy

Thymoma

Paraneoplastic Syndrome

Acute Liver Dysfunction

Cholestatic Hepatitis

Anterior Mediastinal Mass