PMC9975811_01
Imaging series of thymic carcinoma, pericardial effusion, and pleural effusions. a Axial PET CT showing anterior mediastinal mass and right pleural disease. b Axial CT upper abdomen showing 15.4 mm pericardial effusion. c Axial CT upper abdomen showing bilateral pleural effusions.
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F1
He subsequently underwent a fluorodeoxyglucose (FDG)-positron emission tomography scan which showed this mass was FDG-avid (Fig. 1a). Approximately 1 week later, there was an incidental finding of a new pericardial effusion (Fig. 1b). CT showed a new left-sided pleural effusion which was drained under ultrasound guidance (Fig. 1c). Cytology of the pericardial and pleural fluid showed inflammatory cells only.
Morphological and immunohistochemical features of thymic carcinoma and pericarditis. a Haematoxylin and eosin stain - high-grade carcinoma with solid sheets. b Immunohistochemical staining for PAX8. c Immunohistochemical staining for CD5. d Immunohistochemical staining for CD117. e Dual immunohistochemical staining for p40 (brown chromogen) and CK5/6 (red chromogen). f Haematoxylin and eosin stain of the pericardial biopsy - acute inflammation with fibrinoid material and granulation tissue. Figure panels a-e magnification, x20, panel f magnification, x10.
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F2
A biopsy of a paravertebral soft tissue mass confirmed metastatic thymic cancer with squamous differentiation (Fig. 2). Histology of the pericardial biopsy showed fibrin, granulation tissue, neutrophils, histocytes, and occasional multinucleated giant cells with no evidence of malignancy, consistent with acute pericarditis (Fig. 2d).
PMC9975811_02
Image series of metastatic thymic carcinoma. a Coronal PET CT showing thymic carcinoma with liver lesions. b Chest X-ray showing thymic mass. c Axial CT upper abdomen showing liver metastases.
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F3
FDG-positron emission tomography scan confirmed metastatic malignancy involving the liver, lungs, bones, lymph nodes, and anterior mediastinum (Fig. 3a).
Morphological and immunohistochemical features of thymic carcinoma. a Tumour nests with abundant necrosis, with similar morphology to the tumour in case 1 (Fig. 2). b Immunohistochemical staining for PAX8. c Immunohistochemical staining for CD5. d Immunohistochemical staining for CD117. e Immunohistochemistry for cytokeratin. f Dual immunohistochemical staining for p40 (brown chromogen) and CK5/6 (red chromogen). a-f magnification, x20.
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F4
A biopsy of the supraclavicular mass showed a metastatic high-grade carcinoma positive for CD5 and CKIT, in keeping with thymic carcinoma (Fig. 4).