PMC6801126_01
(
A
) Computed tomography (CT) angiography shows the tumor mass in an anatomical relationship with the right heart. Here, a tumor vascularization from the right coronary artery was presumed (red arrow). (
B
/
C
) Triple-rule-out-computed tomography (TRO-CT) three-dimensional reconstruction showing a big tributary branch of left internal thoracic artery, displaced in the right parts of the anterior mediastinum, directly penetrating and vascularizing the tumor mass, and how the tumor vein opens into the brachiocephalic vein. (
D
) TRO-CT scan excluding any infiltration of the heart and great blood vessels and vascularization of the tumor from coronary artery.
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Fig. 1A ) and as a surgical resection was indicated, we needed to distinguish the arterial blood supply of the tumor. For further investigation, We saw how a single big artery branching from the left internal thoracic artery (LITA) was removed through the right parts of the anterior mediastinum, vascularizing the tumor directly ( Fig. 1B/C ). As we excluded a coronary vascularization of the tumor and infiltration of the tumor to the heart and great blood vessels ( Fig. 1D ), the surgical access to the tumor was accomplished through the upper partial J-sternotomy.
(
A
) Hematoxylin and eosin stain of type AB thymoma with areas consists of whorls of spindle thymic epithelial cells surrounded by areas of lymphoid stroma; magnification x 50/x 200. (
B
) Extirpated tumor, measuring 11 x 9.5 x 6.5 cm.
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The histopathological analysis of the extirpated mass, measuring 11 x 9.5 x 6.5 cm ( Fig. 2B ), revealed AB thymoma according to the World Health Organization classification and Masaoka-Koga stage I ( Fig. 2A ).