PMC8520479_01
Fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography images of the patient at the time of diagnosis. Note bilateral uptake of fluorine-18 fluorodeoxyglucose in cervical (A), axillary (B), hilar (C), and abdominal para-aortic lymph nodes (D), in addition to a mass anterior mediastinum (B).
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Positron emission tomography combined with computed tomography (CT) revealed fluorine-18 fluorodeoxyglucose uptake within a mass in anterior mediastinum and lymph nodes throughout the body (Figure 1).
Histopathological examination of the anterior mediastinal tumor. Hematoxylin/eosin staining (A) shows a fascicular pattern composed primarily of spindle-shaped or oval epithelial cells. Cytokeratin AE1/AE3 (B) and p40 (C) immunostaining of the tumor specimen demonstrates a thymic epithelial tumor (magnification, x400).
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Immunohistochemical examination demonstrated that the sample was positive for cytokeratin AE1/AE3 and p40 (Figure 2), consistent with thymic epithelial tumor.
Clinical course. Top left, chest radiograph of the patient before chemotherapy. Top center, chest radiograph after chemotherapy, showing marked regression of both the tumors and the pleural effusion. Top right, last chest radiograph. Bottom, Line chart shows a reduction in the levels of soluble interleukin-2 receptor (sIL-2R) and a plateau in IgG levels following treatment with the ADOC combination chemotherapy regimen, comprising doxorubicin, cisplatin, vincristine, and cyclophosphamide, in combination with intravenous immunoglobulin.
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The size of the primary thymoma, systemic lymph node metastases, parenchymal lung metastases, and bilateral pleural effusion diminished in parallel to a decline in sIL-2R levels to the normal range (Figures 3 and 4). Of note, the sIL-2R level was elevated in parallel to the clinical exacerbation (Figure 3).
Computed tomography images and immunoglobulin levels of the patient during the clinical course. Computed tomography image of the patient before chemotherapy (A), after chemotherapy showing the best response (B), just prior to death (C).
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The size of the primary thymoma, systemic lymph node metastases, parenchymal lung metastases, and bilateral pleural effusion diminished in parallel to a decline in sIL-2R levels to the normal range (Figures 3 and 4).