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Malignant Thymic Epithelial Tumors

CT-Pathologic Correlation

¹ Department of Radiology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
² Present address: Department of Radiology, Taegu Catholic Medical Center, Catholic University of Taegu-Hyosung School of Medicine, Taegu 705-718, Korea.
³ Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
⁴ Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

View larger version (99K): [in a new window]   Fig. 1A. —Atypical thymoma in 35-year-old woman with myasthenia gravis. CT scan using mediastinal window of unenhanced thin-section (1-mm) collimation obtained at level of azygos arch shows 18-mm left anterior mediastinal mass (arrows) with smooth margin. Mediastinal fat plane is well preserved.

View larger version (88K): [in a new window]   Fig. 1B. —Atypical thymoma in 35-year-old woman with myasthenia gravis. Photomicrograph of histologic specimen shows organotypical features of thymic differentiation in low magnification. Note lobular pattern with intervening septa (solid arrows) and perivascular cystic spaces (open arrows). (H and E, x40)

View larger version (125K): [in a new window]   Fig. 1C. —Atypical thymoma in 35-year-old woman with myasthenia gravis. Photomicrograph of histologic specimen shows epithelial cells with atypical polygonal features (distinct epidermoid differentiation) (arrows). Cells are admixed with small lymphocytes (arrowheads). (H and E, x200)

View larger version (111K): [in a new window]   Fig. 2A. —Thymic large cell neuroendocrine carcinoma in 22-year-old man with Cushing's syndrome. Enhanced CT scan (7-mm collimation) obtained at subcarinal level shows 27-mm mass in right anterior mediastinum. Mass contains nodular calcification (arrow) and shows enhancement, with slightly higher attenuation than chest wall muscles. Fat plane between mass and adjacent mediastinal structure is not obliterated.

View larger version (99K): [in a new window]   Fig. 2B. —Thymic large cell neuroendocrine carcinoma in 22-year-old man with Cushing's syndrome. Photomicrograph of histologic specimen shows organoid growth pattern in low magnification. Note absence of organotypical features (interlobular septa and perivascular cystic spaces) of thymic differentiation. (H and E, x40)

View larger version (128K): [in a new window]   Fig. 3A. —Thymic small cell and neuroendocrine carcinoma in 43-year-old man with dyspnea. Enhanced CT scans (7-mm collimation) obtained at levels of aortic (A) and azygos (B) arches, respectively, show 120-mm slightly heterogeneous anterior mediastinal mass with lobulated margin. Left innominate vein was obliterated by tumor invasion. Superior vena cava is seen to contain tumor thrombus (arrow, A) in A and is markedly narrowed and compressed in B. Also note stippled calcification (arrows, B) in tumor on B.

View larger version (116K): [in a new window]   Fig. 3B. —Thymic small cell and neuroendocrine carcinoma in 43-year-old man with dyspnea. Enhanced CT scans (7-mm collimation) obtained at levels of aortic (A) and azygos (B) arches, respectively, show 120-mm slightly heterogeneous anterior mediastinal mass with lobulated margin. Left innominate vein was obliterated by tumor invasion. Superior vena cava is seen to contain tumor thrombus (arrow, A) in A and is markedly narrowed and compressed in B. Also note stippled calcification (arrows, B) in tumor on B.

View larger version (129K): [in a new window]   Fig. 3C. —Thymic small cell and neuroendocrine carcinoma in 43-year-old man with dyspnea. CT scan obtained at level of intrahepatic inferior vena cava shows pleural effusion and nodular lesions (arrows), suggesting pleural tumor implantation.

View larger version (97K): [in a new window]   Fig. 4A. —Thymic small cell carcinoma in 70-year-old woman with chest discomfort. Enhanced CT scan (7-mm collimation) obtained at subcarinal level shows 53-mm left anterior mediastinal mass with inhomogeneous attenuation. Adjacent mediastinal fat plane is partially obliterated.

View larger version (109K): [in a new window]   Fig. 4B. —Thymic small cell carcinoma in 70-year-old woman with chest discomfort. Enhanced CT scan obtained at level of lower lobar bronchi shows enlarged lymph nodes in right hilum (arrowhead) and subcarinal area (arrow).

View larger version (145K): [in a new window]   Fig. 4C. —Thymic small cell carcinoma in 70-year-old woman with chest discomfort. Enhanced CT scan obtained at level of liver dome shows nodular and bandlike thickening of pleura (arrows).

View larger version (191K): [in a new window]   Fig. 4D. —Thymic small cell carcinoma in 70-year-old woman with chest discomfort. Enhanced CT scan obtained at level of mid pole of kidney shows two round areas of poorly defined low attenuation (arrows) in liver, suggesting hepatic metastases.

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