PMC8794430_01
Radiological images of type A thymoma. (A) CT scan performed in 2011 demonstrated a well encapsulated round mass measuring 55x58x44 mm with a calcification in the anterior-superior mediastinum; (B) CT scan performed in 2019 showed the thymic tumor invading the tracheal wall and growing inside the tracheal lumen. CT, computed tomography.
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At the time of diagnosis, the computed tomography (CT) scan revealed a well encapsulated round mass of the anterior mediastinum, measuring 55x58x44 mm with focal calcifications (Figure 1A). As the patient refused surgery and radiation therapy, a follow-up with a yearly CT scan was scheduled, showing slow-growing disease until the last exam of February 2018, which revealed tracheal compression without any sign of invasion. The CT scan of the thorax revealed a bulky anterior mediastinal tumor with an endotracheal polypoid growth, almost obstructing the airway (Figure 1B).
Bronchoscopic examination revealing a pink polypoid tumor in the mid-trachea causing a severe tracheal stenosis with 20% residual lumen.
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At the fiberoptic bronchoscopy we observed a severe tracheal stenosis caused by a vegetating endoluminal tumor with a mild extrinsic compression (Figure 2).
Pathological images of type A thymoma. (A) Tissue fragments were composed by spindle and oval neoplastic cells with bland nuclei and no mitotic activity (hematoxylin-eosin, 400x). Immunohistochemical analysis showed (B) strong expression for pankeratin (400x) and (C) PAX8 (400x). (D) Few immature lymphocytes resulted positive for TdT (400x). PAX8, paired-box gene 8; TdT, terminal deoxynucleotidyl transferase.
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Immature lymphocytes resulted positive for terminal deoxynucleotidyl transferase (TdT) (Figure 3).
Timeline for clinical presentation, diagnosis of thymoma invading the trachea, surgery and follow-up.
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Figure 4 displays the timeline for clinical presentation, diagnosis of thymoma invading the trachea, surgery and follow-up.