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Presented by Peter Illei, M.D. and prepared by Joseph J. Maleszewski, M.D.
Case 1: 72-year-old female with a history of invasive thymoma now presents with an endobronchial mass.
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Question 1 of 1
1. Question
Week 384: Case 1
72-year-old female with a history of invasive thymoma now presents with an endobronchial mass.images/jjm030209/case1a.jpg
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images/jjm030209/case1e.jpgCorrect
Answer: Metastatic thymoma
Histology: none provided
Discussion:
Sections show a predominantly spindled epithelial neoplasm with intermixed small lymphocytes. The tumor cells have finely granular chromatin and no or small inconspicuous nucleoli. Mitotic figures are not readily identified and no necrosis is present. Immunostains demonstrate that the tumor cells are keratin (AE1/AE3) positive, and synaptophysin and chromogranin negative. Morphologically, the main differential diagnosis of this endobronchial mass is between metastatic thymoma and carcinoid tumor. The tumor is primarily composed of spindle shaped epithelial cells with scattered areas of more rounded epithelial cells that are separated by mature small lymphocytes. This pattern is consistent with a WHO type AB thymoma, a finding that is further supported by the lack of staining for neuroendocrine markers.
The endobronchial localization suggests that the tumor represents an embolic metastasis rather than direct extension.
Incorrect
Answer: Metastatic thymoma
Histology: none provided
Discussion:
Sections show a predominantly spindled epithelial neoplasm with intermixed small lymphocytes. The tumor cells have finely granular chromatin and no or small inconspicuous nucleoli. Mitotic figures are not readily identified and no necrosis is present. Immunostains demonstrate that the tumor cells are keratin (AE1/AE3) positive, and synaptophysin and chromogranin negative. Morphologically, the main differential diagnosis of this endobronchial mass is between metastatic thymoma and carcinoid tumor. The tumor is primarily composed of spindle shaped epithelial cells with scattered areas of more rounded epithelial cells that are separated by mature small lymphocytes. This pattern is consistent with a WHO type AB thymoma, a finding that is further supported by the lack of staining for neuroendocrine markers.
The endobronchial localization suggests that the tumor represents an embolic metastasis rather than direct extension.