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A complete surgical resection is the cornerstone in the therapy of thymic tumors. Unfortunately, the recurrence of invasive thymoma is a frequent event and, to date, no standard therapeutic strategy has been validated. We report a case of a 48-year-old patient with an initial diagnosis of myasthenia gravis who underwent radical thymectomy and adjuvant radiotherapy in 1988 for an invasive thymoma. Six years after the first operation the patient was submitted to re-iterative surgery (pleural recurrence) and, as of the period from 1994 until today, the patient has been re-operated an additional five times. The last of these episodes, which we describe in this report, concerned a recurrence at the level of the sternum and the liver. To date the patient is alive and well, with no evidence of further relapse. We take the opportunity of this report to briefly discuss the re-iterative surgical strategy in repetitive recurrent invasive thymoma that we advocate as feasible and beneficial if survival is benchmarked, according to the experiences reported so far.

Twenty-one-year survival in an invasive thymoma successfully treated with seven-fold iterative surgery☆