Pleural thymoma: Radiological and histological findings

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Presentation transcript:

Pleural thymoma: Radiological and histological findings Eliseo Picchi, Francesca Di Giuliano, Donatella Ferrari, Chiara Adriana Pistolese, Francesco Garaci, Roberto Floris European Journal of Radiology Open Volume 5, Pages 147-152 (January 2018) DOI: 10.1016/j.ejro.2018.08.003 Copyright © 2018 The Authors Terms and Conditions

Fig. 1 Chest X-ray, on posterior-anterior (A) and lateral (B) views, demonstrates hilar-mediastinal enlargement with multiple nodular radiopacities in right hemithorax and pleural effusion on the same side. European Journal of Radiology Open 2018 5, 147-152DOI: (10.1016/j.ejro.2018.08.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 2 Abdomen Ultrasound (A and B) showed lobular and inhomogeneous masses in the right hemithorax with pleural effusion. European Journal of Radiology Open 2018 5, 147-152DOI: (10.1016/j.ejro.2018.08.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 3 Chest Computed Tomography (CT) axial plane, on mediastinal windows, showing multiple masses in mediastinum and right pleura, with pleural free fluid, without displacement of mediastinal structures (A–B). No bronchial compression or atelectasis of lung is noted on lung window (C). After injection of iodinated contrast, the lesion appears hypo-vascular, with enhancing margins, internal lobulation and septation, and few calcific spots (D). European Journal of Radiology Open 2018 5, 147-152DOI: (10.1016/j.ejro.2018.08.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 4 Positron Emission Tomography (PET) images show increased uptake of 18[F]-fluorodeoxyglucose in the parietal and mediastinal pleura of right lung (A–B). Chest and abdomen coronal section demonstrates no further uptakes suspicious for recurrences (C). European Journal of Radiology Open 2018 5, 147-152DOI: (10.1016/j.ejro.2018.08.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 5 The first Region of Interest (ROI) positioned on anterior chest wall shows SUV 3,6 (A), the second one near the posterior cost-vertebral arch shows SUV 4,4 (B). European Journal of Radiology Open 2018 5, 147-152DOI: (10.1016/j.ejro.2018.08.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 6 Histopathological examination shows findings consistent with type B2 (cortical) thymoma. The hematoxylin and eosin stain with original magnification 2X (A), 10X (B) and 40X (C) show that the tumor is made up of epithelial cells and a high population of lymphocytic cells with bands of sclerosis. Note the neoplastic cells which are large and polygonal with high ratio nucleus/cytoplasm. The immunohistochemical with CD3 at magnification 20X (D) shows the presence of CD3, a co-receptor of T-cells that is first expressed in the cytoplasm of pro-thymocyte stem cells to whom raise thymus T-cells. It is also high specific marker of T-cells because it is expressed at each stage of development of T-cells. Note the high-density of the T-cells in the specimen. The immunohistochemical with Calretinin 20X (E), shows the presence of a monolayer of cells of pleural origin in close proximity with the population of lymphocytes of thymic origin. The immunostaining for pan-CK (AE1/AE3) at magnification 20X (F) is useful in demonstrating the epithelial origin or not of tumors, because these monoclonal antibodies bind with high affinity the human cytokeratin. Here CKAE1-AE3 shows the epithelial cells that made up mucoepidermoid carcinoma component. European Journal of Radiology Open 2018 5, 147-152DOI: (10.1016/j.ejro.2018.08.003) Copyright © 2018 The Authors Terms and Conditions

Fig. 7 According to International Thymic Malignancy Interest Group (ITMIG) modified RECIST measurement criteria, this thymoma get a score of 16.6 cm, consisting of the sum of the mediastinal primary tumor long axis diameter (A) and the six pleural diameters attributed to two pleural implants, measured at three different level (ABC): 6.6 cm + (1.0 cm + 1.3 cm + 1.9 cm) + (2.0 cm + 1.7 cm + 2.1 cm). The mediastinal lymph node (D) has not been indicated as a target lesion due to its size less than 15 mm. European Journal of Radiology Open 2018 5, 147-152DOI: (10.1016/j.ejro.2018.08.003) Copyright © 2018 The Authors Terms and Conditions