PMC5961320_01
(a) Initial chest X-ray revealed large mediastinal mass of 7 cm indicating a thymic carcinoma; (b) initial chest computed tomography scan demonstrates large mediastinal mass protruding into trachea; (c) direct microscopic examination revealed irregular nuclei consistent with thymic papillary adenocarcinoma confirmed by positive immunostaining for cytokeratin-19, (1) H and E, x 20, (2) cytokeratin-19, x 40 and (d) subsequent chest computed tomography following palliative placement of endotracheal stent
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F1
Incidental 6.5 cm mediastinal mass was revealed [Figure 1a]. Computed tomography (CT) revealed enlarged subcarinal lymph nodes and necrotic mass (6.5 cm) protrudes into distal trachea and compression of vena cava inferior (VCI) [Figure 1b]. Immunohistochemistry of necrotic tissue showed positivity for EA, CK-5/6/7/19, CD-5/117, CD-5, galectin-3, and carcinoembryonic antigen, what confirmed the diagnosis of thymic papillary adenocarcinoma [Figure 1c]. Recanalization with plasma coagulation, debridement of necrotic masses, and the placement of Polyflex endotracheal stent (Boston Scientific Co, Boston, Massachusetts, USA) [Figure 1d] was performed, followed by radiotherapy and chemotherapy (carboplatin 5 mg/ml and paclitaxel 225 mg/m2).
Visualization of the double stent of the trachea and esophagus with thorax computed tomography scan
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F2
Therefore, 12 cm tracheoesophageal stent was placed to cover fistula [Figure 2].