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Dyspnea and chest discomfort.
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There is a 105*108*112 mm large lobulated solid enhancing mass located at the thoracic inlet, anterior and middle mediastinum with encasement of the aortic arch and its great arteries including brachiocephalic, left CCA and subclavian arteries.
Displacement of the trachea to the right and posterior side as well as SVC to the right side also is noted.
The mass also shows close contact with the inner surface of the manubrium and body of the sternum causing bone abnormal signal and enhancement, which could be due to bony infiltration.
Pathologic proved the case of thymic carcinoma.
Microscopic description: Sections show fibroconnective tissue infiltrated by nests and sheets of round to ovaloid small tumor cells with hyperchromatic nuclei, indistinct nucleoli, and scant eosinophilic cytoplasm. some mitotic figures are noted. No necrosis is identified. foci of squamous differentiation are also noted.
IHC staining is positive for cytokeratin, EMA, P63, CK7, CK 20, C-kit, CD5 and CK 5/6.
Morphologic study and IHC staining are in favor of thymic carcinoma.