PMC3161649_01
Chest X-ray showing superior mediastinal mass.
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African American man with a 75 pack-year tobacco history presented with intermittent nocturnal anterior chest and non-productive cough. A chest x-ray showed a density adjacent to the aortic arch (Fig. 1).
Chest CT demonstrating mass with involvement of aortic arch.
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Chest CT revealed an 8 x 2.3 cm anterior mediastinal mass located superiorly which extended from the inner margin of the sternum along the aortic arch and encased the left subclavian and left common carotid arteries (Fig. 2).
Hematoxylin-Eosin stain of primary tumor (40x).
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He underwent mediastinoscopy with partial thoracotomy (Chamberlain procedure) and biopsy which showed poorly differentiated thymic carcinoma (Fig. 3) with immunohistochemistry positive for AE1/AE3, CD5, and vimentin (Fig. 4).
PET-CT demonstrates uptake in mediastinal mass, and two foci close to proximal small intestine.
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There was also uptake with SUV of 8.5 in a region close to the proximal intestine (Fig. 5).
Endoscopic photograph of ulcerated mass in distal duodenum.
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This revealed a large fungating and ulcerated mass in the 4th (horizontal) part of the duodenum, about 3 cm in diameter (Fig. 6).
Endoscopic ultrasound of duodenal mass.
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EUS showed an ulcerated intramural lesion, involving deep mucosal layer, submucosa, muscularis propria and serosal (Fig. 7).
Biopsy of duodenal mass; immunohistochemistry positive for AE1/3 (epithelial marker).
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The duodenal biopsy showed an ulcerated duodenal mucosa with an infiltrating epithelial neoplasm, composed of large polygonal cells, with abundant cytoplasm (Fig. 8).