What happened, in summary

A 41-year-old woman receiving regular hemodialysis for severe chronic kidney disease had been followed for an anterior mediastinal mass and a small right upper-lung nodule. She initially declined surgery because of concerns about her health. Over the next 1 year and 9 months, the lung nodule increased from about 9 mm to 11 mm.

Because both lesions could be removed surgically, the team planned one minimally invasive operation to reduce the burden of multiple procedures. The mediastinal mass was removed, and a wedge resection of the right upper lobe was performed through the same operative approach.

Pathology showed that the mediastinal tumor was a separate B1 thymoma, while the lung nodule was invasive acinar-type lung adenocarcinoma. The two cancers were therefore kept as separate disease processes. She did not receive postoperative anticancer treatment for the lung cancer because it had been surgically removed and was considered at low risk of recurrence.

She continued regular dialysis and recovered without major perioperative complications. During nearly 2 years of follow-up, there were no signs of lung-cancer recurrence.