PMC3420573_01
Clinical photograph of patient showing axillary lump.
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fig1
Local examination of left axilla showed a lump of 8 x 8 cm., firm in consistency, fixed to underlying structures, and overlying skin was normal (Figure 1).
X-ray chest (PA view) showing a mediastinal mass.
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fig2
X-ray chest posteroanterior view revealed a mediastinal mass (Figure 2).
CECT at the level of arch of aorta showing thymic mass.
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fig3
CECT obtained at the level of arch of aorta and main pulmonary artery showed a well-defined enhancing mass of soft tissue attenuation in the left anterior mediastinum abutting arch of aorta, main and left pulmonary artery with maintained fat planes (Figure 3).
(a) Smears showing dual population of epithelial cells and lymphocytes (H & E x500). (b) Section showing mature lymphocytes admixed with neoplastic epithelial cells (H & E x125).
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fig4
The epithelial cells comprised of oval to elongated nuclei with dispersed chromatin and inconspicuous nucleoli (Figure 4(a)). Histopathology of mass revealed loose aggregates of lymphocytes admixed with neoplastic epithelial cells (Figure 4(b)).
Section showing cells having spindle-shaped pleomorphic and hyperchromatic nuclei (H & E x50).
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fig5
Excisional biopsy of axillary mass was done which was composed of cells having pleomorphic, hyperchromatic spindle-shaped nuclei with clumped chromatin (Figure 5).
(a) Section showing vimentin positivity x50. (b) Section showing focal CD 68 positivity x50. (c) and (d) Sections showing SMA and desmin negativity x50.
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fig6
Immunohistochemical analysis showed positivity for vimentin (Figure 6(a)) and focal positivity for CD 68 (Figure 6(b)) along with negative smooth muscle actin (Figure 6(c)), desmin (Figure 6(d)), epithelial membrane antigen (Figure 7(a)), CD 45 (Figure 7(b)), CD 3 (Figure 7(c)), and CD 30 (Figure 7(d)).
Section showing EMA, CD 45, CD 3, and CD 30 negativity x50.
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fig7
Immunohistochemical analysis showed positivity for vimentin (Figure 6(a)) and focal positivity for CD 68 (Figure 6(b)) along with negative smooth muscle actin (Figure 6(c)), desmin (Figure 6(d)), epithelial membrane antigen (Figure 7(a)), CD 45 (Figure 7(b)), CD 3 (Figure 7(c)), and CD 30 (Figure 7(d)).