Lawek Berzenji, BM, Paul E

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Mesothelioma With a Large Prevascular Lymph Node: N1 Involvement or Something Different? Lawek Berzenji, BM, Paul E. Van Schil, MD, PhD, Annemie Snoeckx, MD, Marjan Hertoghs, MD, Laurens Carp, MD The Annals of Thoracic Surgery Volume 105, Issue 5, Pages e189-e191 (May 2018) DOI: 10.1016/j.athoracsur.2017.12.016 Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Axial nonenhanced computed tomographic imaging (mediastinal window setting) at the lung base shows a large pleural effusion on the right side (asterisk). Also note the focal calcified pleural plaque, indicating asbestos exposure (white arrow). (B) Axial contrast-enhanced chest computed tomographic image (mediastinal window) shows a 15 mm well-defined nodule (white arrowhead) in the anterior mediastinal fat (prevascular compartment). The nodule has an oval morphology with some lobulation and relative homogeneous density. Also note the pleural fluid on the right side (white arrow). The Annals of Thoracic Surgery 2018 105, e189-e191DOI: (10.1016/j.athoracsur.2017.12.016) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Fluorodeoxyglucose positron emission tomography–computed tomography of the thorax. (A, B) Diffuse increased uptake of fluorodeoxyglucose of the pleura in the right lung with a hypermetabolic margin (arrows). (C) Increased metabolic activity of a nodular structure in the anterior mediastinum (arrow). (D) Increased uptake of fluorodeoxyglucose of a paratracheal lymph node (arrow). The Annals of Thoracic Surgery 2018 105, e189-e191DOI: (10.1016/j.athoracsur.2017.12.016) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Photomicrograph of pleural biopsy shows an epithelioid malignant mesothelioma with a tubular growth pattern and invasion into adipose tissue (hematoxylin and eosin; original magnification ×40). (B) Photomicrograph of the prevascular nodule shows a type B2 thymoma characterized by lobular architecture, fibrous tumor capsule, and clusters of neoplastic epithelial cells admixed with immature T cells (hematoxylin and eosin; original magnification ×40). The Annals of Thoracic Surgery 2018 105, e189-e191DOI: (10.1016/j.athoracsur.2017.12.016) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions