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This case report describes a very late extra-thoracic recurrence linked to preoperative biopsy seeding, emphasizing how distant recurrence can occur despite more common local and regional patterns. Case description: A 75-year-old woman developed painful extra-thoracic nodules 8 years after type A thymoma excision, with imaging and clinical review supporting recurrence from biopsy seeding. Conclusions: The report discusses diagnostic, treatment, and follow-up changes, considering risks of biopsy tract management and the need for longer surveillance.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/distant-recurrence-from-thymoma-biopsy-seeding-a-case-report/441755/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/distant-recurrence-from-thymoma-biopsy-seeding-a-case-report/441755.png","ImageObject",300,407,{"name":92,"@type":93},"นรินทร์","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the main clinical issue described in this case report?","Question",{"text":113,"@type":114},"The report focuses on distant extra-thoracic recurrence associated with seeding from a preoperative thymoma biopsy, presenting as thoracic wall metastases years after surgery.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did the patient present and when did recurrence occur?",{"text":118,"@type":114},"A 75-year-old woman developed painful palpable extra-thoracic nodules 8 years after excision of a type A thymoma, after years of regular computed thoracic tomography with no signs of recurrence.",{"name":120,"@type":111,"acceptedAnswer":121},"Why do the authors caution against preoperative percutaneous biopsy in some cases?",{"text":122,"@type":114},"They highlight the potential risk of tumor seeding in the needle tract if the tumor capsule is violated, which can lead to thoracic wall and pleural metastases even years later.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},441755,1790988564,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":34,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},2336475104957,"https://ap-avatar.wpscdn.com/avatar/22000c4c6bd8a5076e1?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787554080175789136","Case Report: iMDT Corner  \nDistant recurrence from thymoma biopsy seeding: a case report  \nAnita Paiva1, Carlos S. Pinto1, Susana Guimarães2, Andrea V. Arrossi3, Ritsuko Komaki4, Paolo Mendogni5, Pedro Fernandes1  \n1Thoracic Surgery Functional Unit, Cardiothoracic Department, ULS-São João, Porto, Portugal; 2Department of Pathology, ULS-São João, Porto, Portugal; 3Department of Pathology, Cleveland Clinic, Cleveland, OH, USA; 4Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; 5Department of Thoracic Surgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy  \nContributions: (I) Conception and design: A Paiva, CS Pinto; (II) Administrative support: P Fernandes; (III) Provision of study materials or patients: S Guimarães; (IV) Collection and assembly of data: A Paiva, CS Pinto; (V) Data analysis and interpretation: CS Pinto, AV Arrossi, R Komaki, PMendogni; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.  \nCorrespondence to: Carlos S. Pinto, MD. Thoracic Surgery Functional Unit, Cardiothoracic Department, ULS-São João, Alameda Prof. Hernâni  \nMonteiro, 4200-319 Porto, Portugal. Email: [carlos.pinto@chsj.min-saude.pt](carlos.pinto@chsj.min-saude.pt).  \nBackground: Although some evidence shows an increase in its incidence, epithelial thymic tumors that comprise thymomas, thymic neuroendocrine tumors and thymic carcinomas, are rare (ranging from 2.5–2.8 per million) . Thymomas, as presented in this paper, although slow growing lesions are malignant tumors, as the potential to invade surrounding structures and metastasize has been proven. In this case report, we present another feature of these neoplasms, recurrence. Although local and regional are far more frequent, distant can also occur. We present a case of late extra-thoracic recurrence associated with seeding from a preoperative biopsy, a very rare, but real scenario, that needs to be taken into account when deciding  \nthe need for invasive staging.  \nCase Description: We present a case of a 75-year-old woman who was sent for evaluation of painful palpable extra-thoracic nodules, 8 years after a type A thymoma excision. After image reconstruction, surgical exploration and detailed clinical history and record examination, it was considered as recurrence associated with seeding from preoperative biopsy. She had been followed with regular computed thoracic tomography imaging, with no signs of recurrence during the 5-year period, at the moment of oncological follow-up  \ndischarge.  \nConclusions: This case is a statement for the changes that have been made in diagnosis, treatment and follow-up of epithelial thymic tumors in the last years. Nowadays, the biopsy is not proposed when aresectable epithelial tumor of the mediastinum is the probable diagnosis, as the case presented. We believe that a longer follow-up for these patients is needed as they can recur later than the initially considered 5-year period, and the absence of surgical excision of the biopsy tract or in the presence of a complex biopsy  \n(involving, for example, pleural puncture), should possibly be considered a pseudo-R0 .  \nKeywords: Thymoma; recurrence; seeding; biopsy; case report  \nReceived: 23 April 2025; Accepted: 25 November 2025; Published online: 26 December 2025.  \ndoi: 10.21037/med-25-27  \nView this article at: [https://dx.doi.org/10.21037/med-25-27](https://dx.doi.org/10.21037/med-25-27)  \nIntroduction  \nThymomas are primary tumors of thymic epithelial cells that are classified according to the cell morphology and degree of accompanying thymic lymphocytes in five main  \ntypes: A, AB, B1, B2 and B3 . Metastases are uncommon and most frequently involve intrathoracic organs (local or regional) such as diaphragm, pleura or pericardium (1) . Biopsy seeding is possible, and it usually happens in the first years of follow-up, but rare cases are found in the literature.  \n© AME Publishing Company. Medi","cbCaid37bvFKbkJY","https://ap.wps.com/l/cbCaid37bvFKbkJY","pdf",3277478,"English","# Introduction\n# Case Description\n# Rationale\n# Knowledge gap\n# Objective\n# Conclusions","[{\"question\":\"What is the main clinical issue described in this case report?\",\"answer\":\"The report focuses on distant extra-thoracic recurrence associated with seeding from a preoperative thymoma biopsy, presenting as thoracic wall metastases years after surgery.\"},{\"question\":\"How did the patient present and when did recurrence occur?\",\"answer\":\"A 75-year-old woman developed painful palpable extra-thoracic nodules 8 years after excision of a type A thymoma, after years of regular computed thoracic tomography with no signs of recurrence.\"},{\"question\":\"Why do the authors caution against preoperative percutaneous biopsy in some cases?\",\"answer\":\"They highlight the potential risk of tumor seeding in the needle tract if the tumor capsule is violated, which can lead to thoracic wall and pleural metastases even years later.\"}]","Distant recurrence from thymoma biopsy seeding: a case report | PDF",1790697340,18]