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Presented by Dr. Pedram Argani and prepared by Dr. Monica Butcher
This case talks about a 60 year old male with a pleural mass
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1. Question
This is a 60 year old male with a pleural mass
Diagnosis:
Correct
Answer: B
Histologic Description: In the pleural adipose tissue adjacent to skeletal muscle, there are nodules of neoplastic epithelial cells associated with cyst formation. These cells have a squamoid appearance, and there are perivascular spaces adjacent to small capillaries, some of which are hyalinized. On high power examination, the neoplastic cells have vesicular chromatin and fairly prominent nucleoli, and show mitotic activity, but do not demonstrate pleomorphism. There are admixed lymphocytes throughout the lesion. The lesion has a multinodular pattern of infiltration. The lesional cells are positive for p40, but are negative for CD5. The lymphocytes within the lesion label for T-cell markers like CD5 and CD3, and also label for TDT and CD99, indicating immature T-lymphocytes. These features are diagnostic of metastatic thymoma.
Differential Diagnosis: Metastatic squamous cell carcinoma would typically demonstrate greater cytologic atypia, and would not be associated with admixed immature T-cells. Thymic carcinoma typically labels with CD5, and demonstrates overt cytologic atypia not seen in the current case. Malignant mesothelioma typically would have a greater surface component, and would not label for p40 or have immature lymphocytes within.
Incorrect
Answer: B
Histologic Description: In the pleural adipose tissue adjacent to skeletal muscle, there are nodules of neoplastic epithelial cells associated with cyst formation. These cells have a squamoid appearance, and there are perivascular spaces adjacent to small capillaries, some of which are hyalinized. On high power examination, the neoplastic cells have vesicular chromatin and fairly prominent nucleoli, and show mitotic activity, but do not demonstrate pleomorphism. There are admixed lymphocytes throughout the lesion. The lesion has a multinodular pattern of infiltration. The lesional cells are positive for p40, but are negative for CD5. The lymphocytes within the lesion label for T-cell markers like CD5 and CD3, and also label for TDT and CD99, indicating immature T-lymphocytes. These features are diagnostic of metastatic thymoma.
Differential Diagnosis: Metastatic squamous cell carcinoma would typically demonstrate greater cytologic atypia, and would not be associated with admixed immature T-cells. Thymic carcinoma typically labels with CD5, and demonstrates overt cytologic atypia not seen in the current case. Malignant mesothelioma typically would have a greater surface component, and would not label for p40 or have immature lymphocytes within.
