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Presented by Peter Illei, M.D. and prepared by Wang (Steve) Cheung, M.D., Ph.D.
Case 6: 50 y.o. African American male patient whose chest x-ray performed to confirm placement of a PICC line for intravenous antibiotics.
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1. Question
Week 339: Case 6
50 y.o. African American male patient whose chest x- ray performed to confirm placement of a PICC line for intravenous antibiotics showed a large anterior mediastinal mass. Further tests documented a 4 x 7 x 4.5 cm mediastinal mass causing a 90% occlusion of the superior vena cava, as well as associated mediastinal lymphadenopathy, bilateral lung infiltrates and a right lower lobe nodule. Biopsy documented a “malignant thymoma”. It was considered to be unresectable so chemotherapy with cisplatin, adriamycin and cytoxan was started in 07/2007. His response to chemotherapy permitted a surgical resection 4 month later./images/205086a.jpg
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Answer: Invasive thymoma, WHO type B3
Histology: Sections of this mediastinal mass show islands of large atypical epithelial cells in dense fibrotic stroma. Scattered small lymphocytes are noted within the epithelial islands, which are composed of large polygonal epithelial cells that have large oval nuclei with small nucleoli and open chromatin that lack frankly malignant cytologic features. The mitotic rate is low. The tumor infiltrates into surrounding stroma and is adherent to the lung (not shown).
Discussion: In the current WHO classification of thymic neoplasm this tumor is best characterized as B3 thymoma (also referred to as well differentiated thymic carcinoma; epithelial, atypical or squamoid thymoma in previous classifications). Immunohistochemistry demonstrates that the atypical epithelial cells are c-kit (CD117) and CD5 negative. This staining pattern supports the diagnosis. The majority of thymic carcinomas are CD5 positive (70-75%) and C-kit positive (80-85%), whereas most thymomas (including WHO type B3 thymomas) are negative for both markers.
Incorrect
Answer: Invasive thymoma, WHO type B3
Histology: Sections of this mediastinal mass show islands of large atypical epithelial cells in dense fibrotic stroma. Scattered small lymphocytes are noted within the epithelial islands, which are composed of large polygonal epithelial cells that have large oval nuclei with small nucleoli and open chromatin that lack frankly malignant cytologic features. The mitotic rate is low. The tumor infiltrates into surrounding stroma and is adherent to the lung (not shown).
Discussion: In the current WHO classification of thymic neoplasm this tumor is best characterized as B3 thymoma (also referred to as well differentiated thymic carcinoma; epithelial, atypical or squamoid thymoma in previous classifications). Immunohistochemistry demonstrates that the atypical epithelial cells are c-kit (CD117) and CD5 negative. This staining pattern supports the diagnosis. The majority of thymic carcinomas are CD5 positive (70-75%) and C-kit positive (80-85%), whereas most thymomas (including WHO type B3 thymomas) are negative for both markers.
