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Presented by Jonathan Epstein, M.D. and prepared by Orin Buetens, M.D.
Case 2: 60 year-old male with a mediastinal mass.
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Question 1 of 1
1. Question
Week 7: Case 2
60 year-old male with a mediastinal mass.
Correct
Answer: Thymoma
Histology: At low magnification, the lesion consists of basaloid nests of cells separated by fibrous trabeculae. At higher magnification, the nests are composed of short spindle cells admixed with a prominent benign lymphocytic infiltrate. The nuclei appear uniform without pleomorphism and mitotic figures.
Discussion: Paragangliomas lack the low magnification appearance of larger lobules of cells dissected by broad fibrous septae. Rather, paragangliomas consist of small nests of tumor cells with a prominent intervening vascular pattern. Hemangiopericytomas, similar to thymomas, have short spindle cells. However, in hemangiopericytomas, the short spindle cells are arranged around a prominent vascular network with many of the vessels revealing a staghorn appearance. Synovial sarcomas may have a spindle cell morphology. However, the spindle cells in synovial sarcomas are arranged in medium sized fascicles that are cut in different planes of section rather than the haphazard growth pattern seen in a thymoma. The presence of lymphocytes sprinkled throughout the lesion is typical of thymoma and not seen within any of the other lesions.
Incorrect
Answer: Thymoma
Histology: At low magnification, the lesion consists of basaloid nests of cells separated by fibrous trabeculae. At higher magnification, the nests are composed of short spindle cells admixed with a prominent benign lymphocytic infiltrate. The nuclei appear uniform without pleomorphism and mitotic figures.
Discussion: Paragangliomas lack the low magnification appearance of larger lobules of cells dissected by broad fibrous septae. Rather, paragangliomas consist of small nests of tumor cells with a prominent intervening vascular pattern. Hemangiopericytomas, similar to thymomas, have short spindle cells. However, in hemangiopericytomas, the short spindle cells are arranged around a prominent vascular network with many of the vessels revealing a staghorn appearance. Synovial sarcomas may have a spindle cell morphology. However, the spindle cells in synovial sarcomas are arranged in medium sized fascicles that are cut in different planes of section rather than the haphazard growth pattern seen in a thymoma. The presence of lymphocytes sprinkled throughout the lesion is typical of thymoma and not seen within any of the other lesions.
