Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2021; 9(7): 1676-1681
Published online Mar 6, 2021. doi: 10.12998/wjcc.v9.i7.1676
Metastatic thymic-enteric adenocarcinoma responding to chemoradiation plus anti-angiogenic therapy: A case report
Man Li, Xiao-Yu Pu, Li-Hua Dong, Peng-Yu Chang
Man Li, Xiao-Yu Pu, Li-Hua Dong, Peng-Yu Chang, Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
Author contributions: Dong LH, Chang PY, Li M, and Pu XY were involved in case diagnosis, case report conception and design, and drafting and revising the manuscript; Dong LH and Chang PY reviewed the case, confirmed the diagnosis, and revised the paper in detail; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publishing this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this manuscript.
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Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Li-Hua Dong, PhD, Chief Physician, Department of Radiation Oncology, The First Hospital of Jilin University, No. 71 Xinmin Street, Changchun 130021, Jilin Province, China.
Received: September 23, 2020
Peer-review started: September 23, 2020
First decision: December 14, 2020
Revised: December 26, 2020
Accepted: January 6, 2021
Article in press: January 6, 2021
Published online: March 6, 2021

Thymic-enteric adenocarcinoma with positive expression of CDX2 and CK20 is rare in adults, with only 16 reported cases. However, standard treatment options for this type of thymic adenocarcinoma has not yet been established. Therefore, we report a case of stage IV thymic-enteric adenocarcinoma treated with radiotherapy, chemotherapy, and anti-angiogenesis therapy.


We report a case of thymic-enteric adenocarcinoma occurring in a 44-year-old woman. The tumor was considered unresectable owing to its invasiveness. The patient was treated with six cycles of oxaliplatin (130 mg/m2, day 1) and capecitabine (1000 mg/m2 BID, days 1-14). During the first three cycles of chemotherapy, concurrent radiotherapy (60 Gy/30 fractions) and anti-angiogenic therapy using apatinib were recommended. The primary tumor achieved partial remission based on the Response Evaluation Criteria in Solid Tumors. During follow-up, there was no evidence of disease relapse, except a high serum CA19-9 level. The patient is alive and regularly followed. Based on the previous literature and the present case, we believe that early diagnosis of thymic-enteric adenocarcinoma is important.


XELOX (capecitabine plus oxaliplatin) combined with radiotherapy is an optional therapy for inoperable thymic-enteric adenocarcinoma.

Keywords: Radiotherapy, Chemotherapy, Case report, Thymic adenocarcinoma, Anti-angiogenic therapy, Thymic-enteric adenocarcinoma

Core Tip: This report introduces the diagnosis and treatment of a metastatic thymic-enteric adenocarcinoma with positive expression of CDX2 and CK20. For the first time, radiotherapy and chemotherapy combined with anti-angiogenesis therapy were used. The tumor was partially remitted, and there was no sign of recurrence. XELOX (capecitabine plus oxaliplatin) combined with radiotherapy is an alternative treatment for inoperable metastatic thymic-enteric adenocarcinoma.