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Su C, Zhu X, Wang Q, Zhang J. A basaloid carcinoma with multilocular thymic cyst mimicking a mediastinal teratoma. J Cardiothorac Surg 2024; 19:198. [PMID: 38600577 PMCID: PMC11007915 DOI: 10.1186/s13019-024-02712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/29/2024] [Indexed: 04/12/2024] Open
Abstract
This case report details a rare thymic basaloid carcinoma initially misinterpreted as a mediastinal teratoma, underscoring the diagnostic challenges posed by such tumors. A 71-year-old female presented with an asymptomatic anterior mediastinal tumor discovered incidentally during a routine health examination. Surgical intervention, followed by pathological and immunohistochemical analysis including CK-pan, p63, p40, and CD117 molecules, led to a definitive diagnosis of basaloid carcinoma of the thymus. This case highlights the critical importance of differential diagnosis in mediastinal lesions, especially those presenting with multilocular thymic cysts on chest CT. The subxiphoid video-assisted thoracoscopic surgery enabled complete tumor resection with minimal trauma and favorable postoperative outcomes. The patient opted against further radiotherapy or chemotherapy and she has survived for over eight months without recurrence. This case report contributes to the growing understanding of thymic basaloid carcinoma, a rare and potentially aggressive thymic carcinoma subtype. It emphasizes the necessity for precise surgical techniques and enhanced diagnostic acumen among cardiothoracic surgeons and oncologists.
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Affiliation(s)
- Chen Su
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Xiaobo Zhu
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Qiang Wang
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China
| | - Junjie Zhang
- Department of Cardiothoracic Surgery, Wujin Hospital Affiliated with Jiangsu University, No.2 North Yongning Road, Changzhou, 213000, China.
- Department of Cardiothoracic Surgery, Wujin Clinical college of Xuzhou Medical University, No.2 North Yongning Road, Changzhou, Jiangsu Province, China.
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Oramas DM, Moran CA. Multilocular thymic cyst (MTC) and other tumors with MTC features: Pitfalls in diagnosis. Semin Diagn Pathol 2021; 39:105-112. [PMID: 34147305 DOI: 10.1053/j.semdp.2021.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/11/2022]
Abstract
Cystic lesions of the anterior mediastinum represent a well-known group of benign lesions that are relatively common in the general practice, namely in the pediatric age group. In the adult population, multilocular thymic cyst (MTC) plays an important role in occurrence as it presents as a cystic anterior mediastinal mass that clinically may mimic another anterior mediastinal tumor. In general, MTC is of rather unusual occurrence and its histopathological features have been well described in the literature. However, similar histopathological features may also be associated with a gamut of other tumoral conditions that although unrelated may be encountered growing along the walls of these cystic structures. Herein a presentation of the classical MTC and the classical histopathological features of such entity in association with other tumoral conditions will be discussed. It is highly important to underscore that the final interpretation of some of these tumors is based on a thorough evaluation of the cystic lesion and a reasonable sampling for histological evaluation so that the proper interpretation can be reached. Needless to say, the radiological and clinical information of the patients with cystic anterior mediastinal lesions is very important in the final analysis of these cases.
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Affiliation(s)
- Diana M Oramas
- From the Department of Pathology at the University of Texas, M D Anderson Cancer Center, Houston, TX, USA.
| | - Cesar A Moran
- From the Department of Pathology at the University of Texas, M D Anderson Cancer Center, Houston, TX, USA
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Illei PB, Shyu S. Fine needle aspiration of thymic epithelial neoplasms and non-neoplastic lesions. Semin Diagn Pathol 2020; 37:166-173. [PMID: 32444245 DOI: 10.1053/j.semdp.2020.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
Thymic epithelial neoplasms are rare as these tumors represent less than 1% of all human tumors. In addition, thymic hyperplasia and thymic cysts can also present as anterior or less often superior mediastinal masses. Fine needle aspirates and core biopsies of thymic epithelial neoplasms are rarely encountered in routine pathology practices. Histologic classification of these lesions requires microscopic examination of the entire lesion as a significant number of tumors can have more than one histologic type and the status of invasion into adjacent soft tissues or organs is needed for accurate staging. Therefore, it is important to understand the limitations of the information these biopsy methods can provide. The accuracy of the diagnosis can be improved by using ancillary techniques like immunohistochemistry and flow cytometry. In this review, we are summarizing the clinical, histologic and cytologic characteristics of thymic cysts, thymic hyperplasia and thymic epithelial neoplasms including different types of thymoma and thymic carcinoma.
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Affiliation(s)
- Peter B Illei
- Johns Hopkins University School of Medicine, Baltimore, MD United States
| | - Susan Shyu
- Johns Hopkins University School of Medicine, Baltimore, MD United States
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Chen WL, Shen CL, Chang YM, Hsieh CM, Chang CK, Hsian-He-Hsu, Tzao C. Pulmonary Metastatic Gastric Cancer Mimicking A Giant Mediastinal Cyst. Ann Thorac Surg 2014; 98:329-31. [DOI: 10.1016/j.athoracsur.2013.09.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/02/2013] [Accepted: 09/10/2013] [Indexed: 11/16/2022]
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Nwankwo N, Gilman AD, Mirrakhimov AE, Iroegbu NA. Mediastinal involvement in ovarian cancer. BMJ Case Rep 2013; 2013:bcr-2013-009795. [PMID: 23645704 DOI: 10.1136/bcr-2013-009795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Nwabundo Nwankwo
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, Illinois, USA
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Weissferdt A, Moran CA. Primary MALT-type lymphoma of the thymus: a clinicopathological and immunohistochemical study of six cases. Lung 2011; 189:461-6. [PMID: 21989494 DOI: 10.1007/s00408-011-9335-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 09/27/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Six cases of primary extranodal marginal zone B-cell lymphoma of the thymus (MALT [mucosa-associated lymphoid tissue]) are described. METHODS The patients were all women between 48 and 59 years. Clinically, all patients, except for one, were Caucasians. Two patients had a history of autoimmune disease, while one was being investigated for such a possibility. The remaining three patients did not have a history of autoimmune disorders. RESULTS In those patients who had symptoms related to their anterior mediastinal masses, nonspecific symptoms, including shortness of breath and chest pain, predominated. Histologically, the tumors had the classical morphologic features of cystic and solid areas with an atypical monocytoid cellular proliferation. Immunohistochemical stains performed in all cases showed kappa monotypic expression and B-cell phenotype. CONCLUSIONS The current cases highlight that MALT lymphomas of the thymus can occur in a setting not related to autoimmune disease or in those not of Oriental ethnic background and that mediastinal cystic lesions require proper sampling in order to adequately evaluate the possibility of MALT lymphoma.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Ortega PF, Sosa LA, Patel M, Zambrano E. Cystic paraganglioma of the anterior mediastinum. Ann Diagn Pathol 2010; 14:341-6. [DOI: 10.1016/j.anndiagpath.2010.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 04/30/2010] [Indexed: 10/19/2022]
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Zannoni GF, Vellone VG, Distefano MG, Fadda G, Scambia G. Ovarian serous carcinoma presenting with mediastinal lymphadenopathy 20 months before the intraabdominal mass: Role of immunohistochemistry. Gynecol Oncol 2007; 104:497-500. [PMID: 17126890 DOI: 10.1016/j.ygyno.2006.09.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 09/15/2006] [Accepted: 09/23/2006] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Metastatic involvement of the mediastinal lymph nodes is an extremely uncommon finding in epithelial ovarian cancers. CASE REPORT A 63-year-old woman was admitted to hospital for dyspnoea due to an anterior mediastinal mass. The surgical biopsy showed a 6-cm metastatic lymph node with a papillary pattern, scattered psammomas and immunoreactivity for WT1, Cytokeratin 7, EMA and negative for E-cadherin, GCFDP-15, Thyroglobulin, Cytokeratin 20, Cytokeratin 5/6, CEA, Vimentin, Calretinin, TTF1. After 20 months a follow-up CT identified an ovarian mass with the same histological pattern and immunoreactivity of the mediastinal nodule. RESULTS Immunohistochemistry, especially WT1, is useful in assessing the ovarian origin of an unusual metastasis particularly if it is the first presentation of the disease.
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Affiliation(s)
- Gian Franco Zannoni
- Department of Pathology, Faculty of Medicine Agostino Gemelli, Catholic University, 00168 Rome, Italy.
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Abstract
Cysts of the mediastinum comprise a relatively diverse group of lesions that include neoplastic and nonneoplastic constituents, the latter of which are largely congenital in nature. Therefore, a grasp of their clinicopathologic characteristics is bolstered by knowledge of which tumors in the chest may undergo cystic change, as well as the embryologic development of the thoracic organs. That information, as well as radiological and pathologic features of these lesions, is discussed in this review.
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Affiliation(s)
- Mark R Wick
- Division of Surgical Pathology and Cytopathology, University of Virginia Health System, Charlottesville, Virginia 22908-0214, USA.
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Moran CA, Suster S. Cystic well-differentiated neuroendocrine carcinoma (carcinoid tumor): a clinicopathologic and immunohistochemical study of two cases. Am J Clin Pathol 2006; 126:377-80. [PMID: 16880146 DOI: 10.1309/6l9p8w46jjda3n78] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Two cases of primary neuroendocrine carcinoma (carcinoid tumor) arising in the walls of a multilocular thymic cyst (MTC) are described. The patients were 2 men, ages 36 and 44 years. Clinically, the patients had chest pain, cough, and dyspnea. Radiographic evaluation demonstrated the presence of anterior mediastinal tumor in both patients, and complete surgical resection of the tumor mass was performed. The tumors measured approximately 6 and 8 cm in greatest dimension and were cystic with solid areas but did not show areas of necrosis or hemorrhage. Histologic examination revealed a cystic tumor with features similar to those previously described for MTCs. In addition, in the walls of the cystic structures, there was cellular proliferation arranged in a nesting growth pattern, similar to the more solid areas of the tumor. The tumor was characterized by a homogenous cellular proliferation with mild cellular atypia and no more than 2 mitotic figures per 10 high-power fields. Immunohistochemically, the tumor cells showed strong positive reactions for keratin and neuroendocrine markers, ie, chromogranin and synaptophysin. Both patients were alive after periods of 12 and 18 months.
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Affiliation(s)
- Cesar A Moran
- Department of Pathology, M.D. Anderson Cancer, Center, Houston, TX 77030, USA
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Verbruggen MB, Verheijen RHM, van de Goot FRW, van Beurden M, Dorsman JC, van Diest PJ. Serous Borderline Tumor of the Ovary Presenting With Cervical Lymph Node Involvement. Am J Surg Pathol 2006; 30:739-43. [PMID: 16723852 DOI: 10.1097/00000478-200606000-00010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supradiaphragmatic lymhadenopathy is extremely rare in patients with a serous borderline ovarian tumor (BOT), and clinically difficult to recognize. We describe 3 cases of serous BOT that primarily presented with arm thrombosis due to supradiaphragmatic lymphadenopathy. In all the 3 cases, fine needle aspiration cytology initially indicated metastatic adenocarcinoma. The primary tumor was not immediately apparent, and multiple diagnostic examinations had to be done before the definitive diagnosis of serous BOT, International Federation of Gynecology and Obstetrics stage IV could be made. In the meanwhile, erroneous therapies had been given in 1 case. After surgical removal of the adnexal masses and full surgical staging, all the 3 patients remained free of disease after a follow-up period of 48 to 84 months. In conclusion, supradiaphragmatic lymph node involvement can be present in patients with serous BOTs, and can even be the presenting symptom. When fine needle aspiration cytology of such a lymph node is compatible with adenocarcinoma of unknown primary, serous BOT should be included in the differential diagnosis and pelvic examination should be performed.
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Affiliation(s)
- Marjolijn B Verbruggen
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, VU University Medical Center, and Department of Gynecology, Dutch Cancer Institute, Amsterdam, The Netherlands
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