Presentation
Two-month history of dry cough, recently complicated by left-sided chest pain (with deep breathing and coughing), shortness of breath on exertion, and difficulty maintaining left lateral position.
Patient Data
Anterior mediastinal heterogeneously enhanced large soft tissue mass with necrotic areas, measures about 108 x 94 x 92 mm, associated with left side malignant pleural nodular thickening nearly encasing the left hemithorax and involving the pericardium inseparable from it, accompanied by left side moderate pleural effusion with collapsed left lower lung lobe and minimal pericardial effusion. The mass is compressing the aortic arch, pulmonary trunk, and its main left branch as well as the left brachiocephalic vein, while the latter two are markedly affected with reduced attenuated calibers but no definite thrombosis or invasion. Multiple bilateral upper and lower lung lobe nodules ranging from 5 to 12 mm; the largest is at the right lower lobe, which measures about 12 x 10 mm.
Scanned cuts through the upper abdomen reveal a hypodense exophytic soft tissue lesion noted at segment II of the left liver lobe, which measures about 35 x 31 x 30 mm.
No right pleural effusion. No osteolytic or osteosclerotic bony lesions.
Opinion was:
Invasive mediastinal mass with direct involvement of left pleura, pericardium, multiple pulmonary deposits, and hepatic deposits.
DD: invasive thymoma and thymic carcinoma, for biopsy and histopathology correlation.
A CT-guided core biopsy was taken, and the case was pathologically proven as thymic carcinoma.
Case Discussion
Numerous histologic classification systems for thymic epithelial neoplasms have been proposed over the years. A widely used and simple division is into:
non-invasive thymoma
-
invasive
invasive thymoma
Useful features for thymic carcinoma include:
larger and highly aggressive anterior mediastinal mass
areas of necrosis, hemorrhage, calcification, or cyst formation
gross invasion of contiguous mediastinal structures and widespread to involve distant intrathoracic sites
high incidence of extrathoracic metastases
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