PMC9207123_01
Skin manifestation in form of multiple tumors at right chest (A and B), neck and shoulder (C).
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Dermatological status revealed multiple tumors on the chest, right shoulder and neck with well-defined border and serous crust found on several tumor surfaces (Figure 1).
Enhanced chest CT-scan in mediastinal window showed: (A) solid mass in the anterior mediastinum (red arrow) that infiltrate the superior vena cava (blue arrow); (B) right pleural effusion (white arrow); (C) left pleural effusion (yellow arrow).
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In the internal medicine department, the patient had undergone several examinations; chest radiography showed right pleural effusion with lymphocytic effusion on cytologic examination, while enhanced chest CT-scan showed a solid mass in the anterior mediastinum, superior vena cava syndrome, and pleural effusion (Figure 2).
Histopathological result: (A) atrophic stratified squamous cell epithelium (black arrow) in the epidermis; (B) round, hyperplastic and hyperchromatic cells in the dermis; (C) subcutaneous tissue consisting of fibrodysplastic connective tissue (black arrow).
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The histopathological result from affected skin revealed round, hyperplastic, and hyperchromatic cells in the dermis consistent with metastases to the skin (Figure 3).
Immunohistochemistry staining result: positive for CK7 (A); negative for CD5 (B), CD117 (C), p63 (D), CK20 (E), P40 (F), and TTF-1 (G).
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IHC results for CD5, CD117, p63, CK20, P40, and TTF-1 were negative (Figure 4). It was determined that the primary tumor originated from thymic carcinoma because CK7 was positive on IHC examination of the skin tissue and lymph nodes, and enhanced chest CT-scan revealed a mass in the mediastinum that favors thymic carcinoma.