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Presented by Peter Illei, M.D. and prepared by Andrea Subhawong, M.D.
Case 3: 54 year old male with a history of “malignant thymoma” and a new 7.5 cm anterior mediastinal mass.
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1. Question
Week 395: Case 3
54 year old male with a history of “malignant thymoma” and a new 7.5 cm anterior mediastinal mass that is adherent to the pleura and pericardium. A CD5 immunostain is shown below. CD117 was also positive.images/6.1.09.03a.jpg
images/6.1.09.03b.jpg
images/6.1.09.03c.jpg
images/6.1.09.03d.jpgCorrect
Answer: Thymic carcinoma with treatment effect
Histology: none provided
Discussion: The tumor exhibits extensive dense fibrosis and sparse lymphoid tissue. The tumor cells are predominantly spindled and are arranged in small arborizing sheets and complex microcystic structures. Cytologically, the tumor cells are relatively large and uniform.
The patient’s clinical history is notable for a malignant thymoma treated with chemotherapy. Immunohistochemistry demonstrates that the tumor cells are cytokeratin (AE1/AE3), CD5 and c-kit (CD117) positive, and CK7, CK20 and TTF-1 negative. This phenotype is most commonly seen in thymic carcinomas. The tumor is difficult to classify according to the WHO classification since it exhibits a predominatly spindle cell morphology (WHO type A pattern) but is associated with extensive dense fibrosis and an immunophenotype most often seen in thymic carcinomas. The dense fibrosis and the lack of lymphoid cells are attributed to therapy effect.
Incorrect
Answer: Thymic carcinoma with treatment effect
Histology: none provided
Discussion: The tumor exhibits extensive dense fibrosis and sparse lymphoid tissue. The tumor cells are predominantly spindled and are arranged in small arborizing sheets and complex microcystic structures. Cytologically, the tumor cells are relatively large and uniform.
The patient’s clinical history is notable for a malignant thymoma treated with chemotherapy. Immunohistochemistry demonstrates that the tumor cells are cytokeratin (AE1/AE3), CD5 and c-kit (CD117) positive, and CK7, CK20 and TTF-1 negative. This phenotype is most commonly seen in thymic carcinomas. The tumor is difficult to classify according to the WHO classification since it exhibits a predominatly spindle cell morphology (WHO type A pattern) but is associated with extensive dense fibrosis and an immunophenotype most often seen in thymic carcinomas. The dense fibrosis and the lack of lymphoid cells are attributed to therapy effect.
