PMC7227442_01
Pleural biopsy histological images showing (A) H&E stain, (B) 20xP63 stain (highlighting epithelial cell nuclei), (C) 20xAE1/AE3 stain (highlighting epithelial cell cytoplasm), and (D) 20xCD45 stain (highlighting lymphoid cells).
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F1
She underwent a left pleural percutaneous needle biopsy the day after delivery and was diagnosed with a WHO type AB (indicating oval/spindle cells admixed with abundant small lymphocytes), Masaoka stage IVA (indicating pleural or pericardial dissemination) thymoma [Figure 1; ].
Patient timeline.
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F2
Our patient's health and myasthenia gravis were regularly monitored by a neurologist during the metabolic intervention, which consisted of a periodic fasting regimen (starting with a 12-day, water-only fast followed by a series of 7-day, fluid-only fasts every 1-2 months) combined with a modified ketogenic diet (60% fat, 30% protein, 5% fiber, and 5% net carbohydrate by weight, consisting largely of green vegetables, meats, eggs, nuts, seeds, creams, and natural oils) on feeding days (Figure 2).
CT chest (coronal and axial views, bulk of tumor circled in red) showing total tumor volumes at diagnosis, 8, 12, 25, and 29 months post-diagnosis.
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F3
All adverse effects were documented. An oncologist monitored the thymoma with a CT scan every 4-5 months, and a radiologist blinded to treatment simultaneously assessed all CT scans with volumetric analysis at the end of the intervention (Figure 3).