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Presented by Ashley Cimino-Mathews, M.D. and prepared by Sarah Karram, M.D.
50 year-old male with a lung mass.
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Question 1 of 1
1. Question
Week (613): Case 3
50 year-old male with a lung mass.
Correct
Answer: Metastatic thymoma
Histology: The lung wedge resection shows benign alveolated lung parenchyma with a discrete, well circumscribed nodule consisting of lymphoid tissue. Careful examination reveals that this nodule lacks germinal centers, a distinct capsule and a subcapsular sinus, thus does not show definite features of lymph node architecture. Close examination reveals sheets of epithelioid cells dispersed throughout the lymphocytes in the nodule. There is minimal mitotic activity, no atypia, and no necrosis.
Discussion: This patient has a history of locally invasive thymoma (type B2) in the lateral neck, and this current lesion represents a metastatic thymoma. Thymomas may be seen in patients with myasthenia gravis, or sporadically as in this patient. The WHO classification of thymic epithelial neoplasms separates thymomas into various types depending upon the degree of the epithelial component (spindled versus epithelioid/cortical) and the degree of the admixed lymphocytes. In general type A contained spindled cells; type AB is mixed; type B1 is lymphocyte-rich; type B2 has admixed lymphocytes and epithelioid epithleial cells; and type B2 has a predominance of epithelial cells. “Type C” thymoma is actually thymic carcinoma and contains an overtly malignant epithelial component and are typically immunoreactive for CD5 and CKIT. Even though type B thymomas are not “carcinomas,” they still have the capacity to locally invade and even metastasize as seen in this case.
References:
1. Moran CA, Weissferdt A, Kalhor N, Solis LM, Behrens C, Wistuba II, Suster S. Thymomas I: a clinicopathologic correlation of 250 cases with emphasis on the World Health Organization schema. Am J Clin Pathol. 2012 Mar;137(3):444-50.
2. Moran CA, Walsh G, Suster S, Kaiser L. Thymomas II: a clinicopathologic correlation of 250 cases with a proposed staging system with emphasis on pathologic assessment. Am J Clin Pathol. 2012 Mar;137(3):451-61.Incorrect
Answer: Metastatic thymoma
Histology: The lung wedge resection shows benign alveolated lung parenchyma with a discrete, well circumscribed nodule consisting of lymphoid tissue. Careful examination reveals that this nodule lacks germinal centers, a distinct capsule and a subcapsular sinus, thus does not show definite features of lymph node architecture. Close examination reveals sheets of epithelioid cells dispersed throughout the lymphocytes in the nodule. There is minimal mitotic activity, no atypia, and no necrosis.
Discussion: This patient has a history of locally invasive thymoma (type B2) in the lateral neck, and this current lesion represents a metastatic thymoma. Thymomas may be seen in patients with myasthenia gravis, or sporadically as in this patient. The WHO classification of thymic epithelial neoplasms separates thymomas into various types depending upon the degree of the epithelial component (spindled versus epithelioid/cortical) and the degree of the admixed lymphocytes. In general type A contained spindled cells; type AB is mixed; type B1 is lymphocyte-rich; type B2 has admixed lymphocytes and epithelioid epithleial cells; and type B2 has a predominance of epithelial cells. “Type C” thymoma is actually thymic carcinoma and contains an overtly malignant epithelial component and are typically immunoreactive for CD5 and CKIT. Even though type B thymomas are not “carcinomas,” they still have the capacity to locally invade and even metastasize as seen in this case.
References:
1. Moran CA, Weissferdt A, Kalhor N, Solis LM, Behrens C, Wistuba II, Suster S. Thymomas I: a clinicopathologic correlation of 250 cases with emphasis on the World Health Organization schema. Am J Clin Pathol. 2012 Mar;137(3):444-50.
2. Moran CA, Walsh G, Suster S, Kaiser L. Thymomas II: a clinicopathologic correlation of 250 cases with a proposed staging system with emphasis on pathologic assessment. Am J Clin Pathol. 2012 Mar;137(3):451-61.
