PULMONARY PUZZLE
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Transthoracic needle aspiration of the mass showed abundant small mature lymphocytes and some atypical cells with cytological abnormalities. An immunoperoxidase panel revealed a positive reaction with pankeratin, vimentin and LCA stains. Stains for MOC-31, Ber-EP4, TTF-1 and calretinin were negative. The pathologist at the local hospital suggested a possible large cell carcinoma of a lymphoepithelioma type but requested further investigation.
A CT-guided core biopsy stained for cytokeratin 5/6 and p63, supporting the diagnosis of a pleural-based thymoma. There was a separate infiltrate consistent with lymphocytic interstitial pneumonitis (LIP). This was confirmed by a video-assisted thoracoscopic surgical lung biopsy (fig 1
). The diagnosis of a pleural-based thymoma was made in the absence of a mediastinal mass on initial imaging.
Figure 1 (A) Photomicrograph of thymoma demonstrating the typical features of a lymphoid and epithelial proliferation (*) traversed by hyalinised fibrous septae (arrow). H&E; 40x original magnification. (B) Medium power photomicrograph of | |||||||||
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Thorax 2007 62: 666.[Extract] [Full Text] [PDF]
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