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Onteddu NKR, Mareddy NSR, Vulasala SSR, Onteddu J, Virarkar M. Multilocular thymic cysts- a diagnostic challenge on computed tomography. World J Clin Cases 2025; 13:95167. [PMID: 39866652 PMCID: PMC11577524 DOI: 10.12998/wjcc.v13.i3.95167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 10/09/2024] [Accepted: 10/28/2024] [Indexed: 11/12/2024] Open
Abstract
A recent case report provided a patient scenario, wherein, a 39-year-old male patient presented with occasional palpitations, headache, and fever. Evaluation of tumor markers did not show any abnormal results. Subsequently, a computed tomography (CT) scan was undertaken, and its findings were affirmative of thymic cancer. Finally, the postoperative histopathological assessment of the mass, after its resection, confirmed it as an anterior mediastinal multilocular thymic cyst (MTC), with concurrent acute upper respiratory tract infection and acute myocarditis. Accordingly, this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.
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Affiliation(s)
- Nirmal Kumar Reddy Onteddu
- Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL 32209, United States
| | | | - Sai Swarupa R Vulasala
- Department of Diagnostic Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
| | - Jayabharath Onteddu
- Department of Public Health Sciences, University of Florida, Gainesville, FL 32611, United States
| | - Mayur Virarkar
- Department of Diagnostic Radiology, University of Florida College of Medicine, Jacksonville, FL 32209, United States
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2
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Qin L, Wang F, Chen L, Li T, Wang G, Zhou N. Rare atypical type a thymoma: a case report and literature review. Diagn Pathol 2024; 19:145. [PMID: 39516873 PMCID: PMC11545545 DOI: 10.1186/s13000-024-01565-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 10/17/2024] [Indexed: 11/16/2024] Open
Abstract
BACKGROUND An atypical type A thymoma variant was recently added to the World Health Organization classification of type A thymoma in 2015. This novel form of type A thymoma presents with hypercellularity, increased mitotic activity, and necrosis. In particular, necrosis seems to be related to postoperative recurrence and metastasis, but the clinical significance of these changes still needs to be studied. CASE PRESENTATION A 76-year-old man underwent thoracoscopic surgery for tumour resection due to an anterior mediastinal mass. Pathological examination revealed that the tumour invaded the surrounding thymic tissue. Cells were arranged in nest-like and whirl-like patterns, accompanied by prominent comedo-like necrosis, increased cell density, mild atypia, and a mitotic count of 4-6 per 10 high-power fields. Immunohistochemistry revealed positive expression of cytokeratin 19 and P63 in the tumour cells. Lymphocytes in the background were positive for CD3 and CD5, did not express terminal deoxynucleotide transferase, CD20, or CD117, and had an MIB-1 labelling index(LI) value of 15%. On the basis of these findings, the tumour was finally diagnosed as an atypical type A thymoma variant. CONCLUSIONS We report a case of atypical type A thymoma and review the literature to enhance our understanding of and provide accumulated pathological data on this rare disease.
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Affiliation(s)
- Liling Qin
- Department of Pathology, Mianyang 404 Hospital, Mianyang, Sichuan Province, China
| | - Fanrong Wang
- Department of Pathology, Mianyang 404 Hospital, Mianyang, Sichuan Province, China
| | - Liqiao Chen
- Department of Pathology, Mianyang 404 Hospital, Mianyang, Sichuan Province, China
| | - Tao Li
- Department of Pathology, Mianyang 404 Hospital, Mianyang, Sichuan Province, China
| | - Gang Wang
- Department of Medical Imaging, Mianyang 404 Hospital, Mianyang, Sichuan Province, China
| | - Ning Zhou
- Department of Pathology, Mianyang 404 Hospital, Mianyang, Sichuan Province, China.
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3
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Li Y, Tang M, Wu Q, Yang J, Chen W. First report of a successful surgical management of left atrial myxoma coexisting with pulmonary squamous cell carcinoma and thymic cyst. Eur J Med Res 2024; 29:373. [PMID: 39026357 PMCID: PMC11256657 DOI: 10.1186/s40001-024-01974-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Primary cardiac tumors, while rare, present significant clinical challenges due to their diverse pathology and presentation. Lung cancer frequently metastasizes to the heart; however, cases involving primary cardiac tumors of different origins alongside primary lung cancer are exceedingly rare in the literature. CASE PRESENTATION We report the case of a 53-year-old female who presented with hemoptysis and was subsequently diagnosed with a left atrial myxoma, pulmonary squamous cell carcinoma, and a thymic cyst. This coexistence of multiple non-homologous tumors in a single patient is exceedingly rare. CONCLUSION This case underscores the complexity of diagnosing and managing patients with multiple distinct tumors. The simultaneous occurrence of a primary cardiac myxoma, pulmonary squamous cell carcinoma, and thymic cyst is unprecedented, providing valuable insights for future clinical practice.
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Affiliation(s)
- Yichen Li
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China
| | - Mi Tang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China
| | - Qin Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China
| | - Jinfu Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China
| | - Wangping Chen
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Middle Renmin Road 139, Changsha, 410011, China.
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von der Thüsen J. Thymic epithelial tumours: histopathological classification and differential diagnosis. Histopathology 2024; 84:196-215. [PMID: 37994555 DOI: 10.1111/his.15097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The epithelial and lymphoid compartments of the thymus can give rise to a wide variety of tumours, including thymomas, thymic carcinomas, lymphoreticular proliferations, germ cell tumours, and sarcomas. While some of these have close similarity to their counterparts in other organs, both in terms of histology and immunohistochemistry, as well as molecular features, others are unique to the thymus. The epithelial tumours, which can develop in the thymus, will be discussed in this review, with a particular emphasis on resolving differential diagnosis by means of morphology, immunohistochemical profiles, and molecular diagnostics.
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Affiliation(s)
- Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
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5
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Weissferdt A. Combined Thymic Epithelial Neoplasms - a Review. Int J Surg Pathol 2023; 31:917-926. [PMID: 36036356 DOI: 10.1177/10668969221118324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thymic epithelial neoplasms are the most common tumors of thymic origin but are overall rare in the general population. Their morphologic diversity, ranging from low grade to overtly malignant lesions, along with various histologic growth patterns make them a diagnostically challenging group of tumors. Very occasionally, thymomas and thymic carcinomas may develop in combination with other benign or malignant lesions of thymic origin, further complicating the diagnostic process. The focus of this review lies on the spectrum of thymic epithelial tumors that present with other thymic lesions in the same tumor mass, such as multilocular thymic cysts, neuroendocrine neoplasms, lymphomas, and germ cell tumors among others. Awareness of the existence of such unusual tumors may not only aid in their diagnosis but may also have implications for prognostic and therapeutic purposes.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology and Laboratory Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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6
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Awny S, Alashram M, Eladl A, Awad A, Taysir Y, ElKhasef W, Abdelrahman A, Abdelshaheed M, Fetoh FA, Elshabrawy M, Elshehawi ME, Hamdy O. A Cervical Thymic Cyst in an Adult Female; A Case Report and Comprehensive Literature Review. Indian J Otolaryngol Head Neck Surg 2023; 75:924-933. [PMID: 37275018 PMCID: PMC10234974 DOI: 10.1007/s12070-022-03159-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction: Cervical thymic cyst accounts for (0.3-1) % of cervical cysts in children and are usually present during the first decade of life with few reported cases in adults. Herein, we present a 34-year-old female with a cervical thymic cyst. We conducted a review of all the previously reported cases as well. Case presentation: The patient complained of an anterolateral neck swelling that was noticed one year ago. It was a soft, fluctuant, mobile, non-tender swelling in the midline and the right side of the lower neck. Neck ultrasonography revealed a large thin-walled cyst, with no internal septa, echoes, or solid parts. Post-contrast MRI of the neck showed a well-defined, oblong-shaped, lobulated cystic lesion just beneath the strap muscle. The cyst extended caudally to the superior border of the anterior mediastinum at the level of the upper border of the manubrium sterni. The patient underwent excision of the swelling under general anesthesia via Kocher's collar neck incision. Connection with the thymus gland was detected behind the manubrium sterni which was separated. Pathological examination showed prominent thymic tissue confirming the diagnosis of a cervical thymic cyst. Conclusion: Adult cervical thymic cyst is very rare with a few cases reported in the literature. Surgical excision in symptomatic patients is the treatment of choice. Paper's main novel aspects: • A rare presentation of a cervical thymic cyst in an adult. • A comprehensive literature review including all the previously reported cases in one table.
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Affiliation(s)
- Shadi Awny
- Surgical oncology unit, Mansoura University Oncology centre, Mansoura, Egypt
| | - Marwa Alashram
- Medical intern, Mansoura University Hospitals, Mansoura, Egypt
| | - Aya Eladl
- Medical intern, Mansoura University Hospitals, Mansoura, Egypt
| | - Amira Awad
- Medical intern, Mansoura University Hospitals, Mansoura, Egypt
| | - Yara Taysir
- Radiology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Wagdi ElKhasef
- Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | | | - Fetoh Alaaeldin Fetoh
- Cardiothoracic surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elshabrawy
- Cardiothoracic surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Eslam Elshehawi
- Anasthesia and intensive care Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Omar Hamdy
- Surgical oncology unit, Mansoura University Oncology centre, Mansoura, Egypt
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Han L, Gao B, Wang EH, Wang L. Giant Multilocular-Cystic Metaplastic Thymoma: A Case Report. Pharmgenomics Pers Med 2023; 16:463-466. [PMID: 37229516 PMCID: PMC10204752 DOI: 10.2147/pgpm.s413757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
The metaplastic thymoma with giant multilocular-cyst formation had not been documented. The metaplastic thymoma is an extremely rare primary thymic epithelial tumor with an indolent clinical course. It is characterized by a histologic biphasic appearance, which is consisted of solid epithelial areas and spindle cells as the background. This specific pattern can be easily mistaken as the type A thymoma or the type A components of type AB thymoma. When cystic change occurs in metaplastic thymoma, it will bring more challenges for both imaging and pathological diagnosis. Herein, we reported an extremely rare case of a 14.9-cm giant tumor located in the anterior mediastinum of an elderly female. The tumor is consisted of both multilocular cysts and solid components, with the largest cyst measuring 6 cm in diameter. The multilocular cyst contained hemorrhage, calcification, and cholesterol crystal cracks without cell lining. In the solid area, the epithelial cell nests were surrounded by spindle cells with scattered lymphocytes. With immunostains, neither type of cells was CD20 positive. The epithelial cells were positive for CK and P63, while the spindle cells expressed vimentin and EMA. Fluorescence in situ hybridization analysis revealed that the tumor harbored YAP1-MAML2 gene fusions. Accordingly, although the multilocular cystic pattern set a diagnostic challenge, the diagnosis of metaplastic thymoma was rendered due to the immunohistochemistry staining and YAP1-MAML2 gene rearrangement detection.
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Affiliation(s)
- Lihua Han
- The Central Laboratory of Morphology, Shenyang Medical College, Shenyang, People’s Republic of China
| | - Bo Gao
- Department of Pathology, Cancer Hospital of China Medical University, Shenyang, People’s Republic of China
| | - En-Hua Wang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, People’s Republic of China
| | - Liang Wang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, People’s Republic of China
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8
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Cooley-Rieders K, Van Haren RM. Mediastinal thymic cysts: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:33. [PMID: 36582977 PMCID: PMC9792833 DOI: 10.21037/med-22-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Background and Objective Mediastinal thymic cysts are a relatively rare pathology. With the expansion of eligible individuals screened with cross-sectional imaging for lung cancer, it is likely that there will be an increase in the number of individuals presenting with these cysts. Understanding this rare pathology will become more important when this incidental pathology is encountered. Methods Search of PubMed was undertaken using keywords "mediastinal", "mediastinum", "thymic", "thymus", "cyst". Relevant literature was reviewed and selected for this comprehensive narrative review, including case reports, case series, and retrospective reviews. Key Content and Findings Thymic cysts in the mediastinum can be classified into two broad categories, congenital and inflammatory. Accurate diagnosis by imaging is challenging and the majority of patients are asymptomatic. Literature suggests that the majority of cysts are benign, however an unknown percentage may harbor neoplastic processes and over time can cause significant compressive symptoms. Definitive treatment and diagnosis is surgical, with overall excellent outcomes. The decision to pursue surgical treatment versus surveillance requires a shared decision making approach with patients. Conclusions Given the scarcity of available high quality evidence regarding the management of mediastinal thymic cysts, this review provides practitioners a broad knowledge base to guide patients to make informed decisions.
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Affiliation(s)
- Keaton Cooley-Rieders
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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9
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Histological Classification and Invasion Prediction of Thymoma by Machine Learning-Based Computed Tomography Imaging. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4594757. [PMID: 36051922 PMCID: PMC9410846 DOI: 10.1155/2022/4594757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 12/02/2022]
Abstract
Purpose The values of machine learning-based computed tomography (CT) imaging in histological classification and invasion prediction of thymoma were investigated. Methods 181 patients diagnosed with thymoma by surgery or biopsy in Shantou Central Hospital between February 2017 and March 2022 were selected. According to the concept of simplified histological classification and the latest histological classification by the WHO, thymoma was divided into two groups, including low-risk (types A, AB, B1, and metaplastic type) and high-risk groups (types B2 and B3). CT images were reconstructed by filtering back projection (FBP) algorithm. CT image features were collected for statistical analysis. Results The main symptoms of patients diagnosed with thymoma included respiratory tract infection, chest distress and shortness of breath, and chest pain. 35.91% of them suffered from complicated myasthenia gravis. Tumor size and position in low-risk and high-risk groups showed no statistical significance (P > 0.05). Tumor morphology and boundary between the two groups suggested statistical difference (P < 0.05). Whether tumor invaded adjacent tissues was apparently correlated with simplified histological classification (P < 0.01). The sensitivity and specificity of CT images for the invasion of mediastinal pleura or pericardium were around 90% and negative predictive values both reached above 95%. Those of the CT images for lung invasion were over 80%. The negative and positive predictive values were 93.54% and 63.82%, respectively. Those of the CT images for blood vessel invasion were 67.32% and 97.93%. The negative and positive predictive values were 98.21% and 83%, respectively. Conclusion The machine learning-based CT image had significant values in the prediction of different histological classification and even invasion level.
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10
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Nakagawa T, Masuda R, Shinichiro H, Yamada S, Iwazaki M. Thymic squamous cell carcinoma lurking in a growing large cyst : A case report. PROCEEDINGS OF SINGAPORE HEALTHCARE 2022. [DOI: 10.1177/20101058221117891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
An 81-year-old man was admitted for resection of an asymptomatic left anterior mediastinal tumor. Chest computed tomography showed that a small, homogeneous lesion had grown to a large, cystic lesion (80 mm) over a 5-year period. The cystic tumor was removed with adherent structures such as the left upper pulmonary parenchyma and lower part of the left innominate vein via median sternotomy with assistance from a left thoracoscopic procedure. Macroscopically, a solid tumor was located within the large multilocular cyst. The pathological diagnosis was cystic squamous cell carcinoma (12 mm), which had not infiltrated any surrounding organs. The patient has remained well without recurrence as of 4 years postoperatively.
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Affiliation(s)
- Tomoki Nakagawa
- Department of General Thoracic Surgery, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Ryota Masuda
- Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Hiraiwa Shinichiro
- Department of Diagnostic Pathology, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Shunsuke Yamada
- Department of General Thoracic Surgery, Tokai University Hachioji Hospital, Hachioji, Japan
| | - Masayuki Iwazaki
- Division of General Thoracic Surgery, Department of Surgery, Tokai University School of Medicine, Isehara, Japan
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11
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Czech MM, Ogden W, Batra R, Cooper JD. Multilocular Thymic Cyst in a Patient with Untreated HIV/AIDS: Case Report and Review of the Literature. Curr HIV Res 2022; 20:193-198. [PMID: 34994329 DOI: 10.2174/1570162x20666220106152701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/07/2021] [Accepted: 11/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multilocular thymic cysts (MTCs) in adults with human immunodeficiency virus (HIV) are rarely reported. CASE PRESENTATION We describe a case of symptomatic MTC in a male with untreated HIV. A presumptive diagnosis was established based on radiographic imaging and biopsy. Pathologic diagnosis and exclusion of malignancy were ultimately confirmed the following thymectomy. In conjunction with starting antiretroviral therapy, the patient recovered well post-operatively with a resolution of his presenting symptoms. CONCLUSION Our case report and review of the literature serve to highlight MTCs as an important clinical entity occurring in persons with HIV.
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Affiliation(s)
- Mary M Czech
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - William Ogden
- Department of Cardiothoracic Surgery and Adult Cardiac Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rashmi Batra
- Department of Pathology, Santa Clara Valley Medical Center, San Jose, CA, USA
| | - Joseph D Cooper
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
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12
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Gill S, Dhull P. Association of Multilocular Thymic Cyst with Myasthenia Gravis. Neurol India 2021; 69:1094-1095. [PMID: 34507464 DOI: 10.4103/0028-3886.325305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Shaman Gill
- Department of Neurology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
| | - Pawan Dhull
- Department of Neurology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India
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Yasuda K, Kidokoro Y, Makishima K, Matsui S, Nakanishi A, Nozaka Y, Oshima Y, Kubouchi Y, Takagi Y, Haruki T, Nakamura H. A rare case of combined thymoma and a multilocular thymic cyst discovered due to chest pain. Surg Case Rep 2021; 7:158. [PMID: 34236557 PMCID: PMC8266926 DOI: 10.1186/s40792-021-01243-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/02/2021] [Indexed: 11/14/2022] Open
Abstract
Background A thymoma with chest pain and multilocular thymic cysts (MTCs) is very rare. Case presentation A 49-year-old man presented to another hospital complaining of an anterior chest pain. Chest computed tomography (CT) showed an anterior mediastinal tumor 60 × 30 × 55 mm in size. The boundary with the pericardium or left brachiocephalic vein seemed to be partially unclear while enhanced by the contrast medium, and so the tumor could have invaded them. No definitive diagnosis of myasthenia gravis was made although the serum anti-acetylcholine receptor antibody count was high. We performed an extended thymectomy with combined partial resection of left brachiocephalic vein, left upper lobe, and left phrenic nerve. He was discharged with no chest pain and no complications post-surgery. The tumor was pathologically type B2 thymoma with hemorrhage necrosis and MTCs, and we diagnosed Masaoka stage II because of no histological infiltration to the organs. Conclusions We speculated that hemorrhagic necrosis due to infarction in tumor caused the inflammation to spread to the surrounding organs, which was related to the chest pain and the development of MTCs.
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Affiliation(s)
- Kengo Yasuda
- Center for Clinical Residency Program, Tottori University Hospital, 86, Nishicho, Yonago, Tottori, 683-8503, Japan.,Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Yoshiteru Kidokoro
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan.
| | - Karen Makishima
- Department of Pathology, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Shinji Matsui
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan.,Department of Pathology, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Atsuyuki Nakanishi
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Yuji Nozaka
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Yuki Oshima
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan.,Department of Pathology, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Yasuaki Kubouchi
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Yuzo Takagi
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Tomohiro Haruki
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery and Breast and Endocrine Surgery, Department of Surgery, Faculty of Medicine, Tottori University, 86, Nishicho, Yonago, Tottori, 683-8503, Japan
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14
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Roden AC, Szolkowska M. Common and rare carcinomas of the thymus. Virchows Arch 2021; 478:111-128. [PMID: 33389148 DOI: 10.1007/s00428-020-03000-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022]
Abstract
Thymic carcinoma encompasses a diverse group of rare tumors that occur almost exclusively in the prevascular (anterior) mediastinum. Thymic carcinomas have a worse outcome than thymomas with a median time to death of under 3 years. These tumors lack the typical lobulation of thymomas, exhibit commonly more cytologic atypia, are associated with a desmoplastic stromal reaction, and lack thymocytes, features that distinguish them from thymomas. The most common thymic carcinoma is squamous cell carcinoma; other subtypes include mucoepidermoid carcinoma, NUT carcinoma, and adenocarcinoma, among others. Largely due to multi-institutional and global efforts and meta-analysis of case reports and series, some of the thymic carcinoma subtypes have been studied in more detail and molecular studies have also been performed. Morphology and immunophenotype for the vast majority of thymic carcinoma subtypes are similar to their counterparts in other organs. Therefore, the distinction between thymic carcinoma and metastatic disease, which is relatively common in the prevascular mediastinum, can be challenging and in general requires clinical and radiologic correlation. Although surgical resection is the treatment of choice, only 46 to 68% of patients with thymic carcinoma can undergo resection as many other tumors present at high stage with infiltration into vital neighboring organs. These patients are usually treated with chemotherapy and/or radiation. The search for better biomarkers for prognosis and treatment of thymic carcinomas is important for improved management of these patients and possible targeted therapy.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, Hilton 11, 200 First St SW, Rochester, MN, 55905, USA.
| | - Malgorzata Szolkowska
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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15
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Spontaneous Regression of Type B3 Thymoma With Mesothelial Cyst: A Case Report. J Thorac Imaging 2020; 35:W123-W126. [PMID: 32796252 DOI: 10.1097/rti.0000000000000550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nakazono T, Yamaguchi K, Egashira R, Mizuguchi M, Irie H. Anterior mediastinal lesions: CT and MRI features and differential diagnosis. Jpn J Radiol 2020; 39:101-117. [PMID: 32880074 DOI: 10.1007/s11604-020-01031-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 08/11/2020] [Indexed: 11/24/2022]
Abstract
Anterior mediastinum is the most common location of mediastinal tumors, which include various solid and cystic lesions. The lesion location and CT and MRI features are important in the differential diagnosis. Recently, CT-based mediastinal compartment classification systems were proposed and suggested to be useful for accurate evaluation of mediastinal lesions. CT and MRI reflect the pathological findings of mediastinal lesions, and knowledge of the pathological features is important for the differential diagnosis. In this article, we review the CT and MRI features of anterior mediastinal lesions and describe important points in the differential diagnosis.
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Affiliation(s)
- Takahiko Nakazono
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, 849-8501, Japan.
| | - Ken Yamaguchi
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, 849-8501, Japan
| | - Ryoko Egashira
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, 849-8501, Japan
| | - Masanobu Mizuguchi
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, 849-8501, Japan
| | - Hiroyuki Irie
- Department of Radiology, Faculty of Medicine, Saga University, Nabeshima 5-1-1, Saga City, Saga, 849-8501, Japan
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Abstract
The thymus is a dynamic organ that undergoes changes throughout life and can demonstrate a myriad of pathologic alterations. A number of benign entities of the thymus prove to be diagnostic dilemmas owing to their resemblance and association with true thymic tumors. These are usually discovered incidentally on routine imaging and most patients are either asymptomatic or present with signs and symptoms of compression of adjacent organs. The radiologic appearance of these lesions varies from simple cysts to complex masses that are suspicious for malignancy. The diagnosis is usually made purely on morphologic grounds, however, immunohistochemical stains can help rule out possible differential diagnoses. Surgical removal is usually curative in these lesions and recurrences are rare. The prognosis is excellent, however, some of these lesions may be associated with myasthenia gravis and/or thymomas. In this review, we describe non-neoplastic lesions and benign tumoral lesions of the thymus, with emphasis on the clinical, radiologic, and pathologic features. The differential diagnosis of each entity is also discussed.
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