Data for: Thymoma Causing Bilateral Upper Extremity Deep Vein Thrombosis

A 38-year-old African American male presented with progressive pain, swelling, numbness, and warmth of the left upper extremity ten days before admission. A chest computerized tomography scan showed a large 8.3 cm x 6.1 cm x 9.9 cm anterior mediastinal mass with compression of the left brachiocephalic vein and superior vena cava. A venous doppler showed multiple occlusive venous thrombi in bilateral upper extremities, including the bilateral internal jugular and subclavian veins, as well as the left subclavian, axillary, cephalic, brachial and median cubital veins. Further laboratory workup came positive for acetylcholine receptor binding antibody suggesting myasthenia gravis, but the patient was asymptomatic for myasthenia gravis. A percutaneous core CT guided biopsy pathology resulted in a predominant T-cell population CD5 positive with few B cells; the immunophenotypic features suggested Type B2 thymoma. To the best of our knowledge, this case is the only reported thymoma presenting with bilateral deep vein thrombosis of the upper extremities. The deep vein thrombosis therapy was enoxaparin 1mg/kg subcutaneously every 12 hours and dexamethasone 4mg intravenously every 4 hours as an anti-inflammatory drug for thymoma related compression of the mediastinum. The patient was referred to a tertiary oncological medical center for a total thymectomy, chemotherapy, and adjuvant radiotherapy.一名38岁非裔美国男性，于入院前10天出现左上肢进行性疼痛、肿胀、麻木及皮温升高。胸部计算机断层扫描（computed tomography, CT）显示前纵隔存在一大小为8.3 cm×6.1 cm×9.9 cm的巨大肿块，压迫左侧头臂静脉（left brachiocephalic vein）与上腔静脉（superior vena cava）。静脉多普勒超声（venous doppler）检查显示双侧上肢存在多处闭塞性静脉血栓，累及双侧颈内静脉、锁骨下静脉，以及左侧锁骨下静脉、腋静脉、头静脉、肱静脉与肘正中静脉。 进一步实验室检查结果显示，乙酰胆碱受体结合抗体（acetylcholine receptor binding antibody）呈阳性，提示重症肌无力（myasthenia gravis），但该患者无重症肌无力相关临床症状。CT引导下经皮穿刺芯针活检（percutaneous core CT guided biopsy）的病理结果提示以CD5阳性（CD5 positive）T细胞群为主，仅见少量B细胞（B cells）；免疫表型特征符合B2型胸腺瘤（Type B2 thymoma）。据我们所知，本病例为目前仅报道的以双侧上肢深静脉血栓形成为首发表现的胸腺瘤病例。深静脉血栓的治疗方案为依诺肝素（enoxaparin）1mg/kg皮下注射，每12小时一次，同时予地塞米松（dexamethasone）4mg静脉注射，每4小时一次，以作为抗炎药物缓解胸腺瘤所致纵隔压迫症状。患者被转诊至三级肿瘤医学中心，拟行全胸腺切除术（total thymectomy）、化疗（chemotherapy）及辅助放疗（adjuvant radiotherapy）。