Case presentations and recommendations from the 2018 ITMIG Annual Meeting

Abstract

The 9th International Thymic Malignancy Interest Group's (ITMIG) Annual Meeting was held in Seoul, South Korea in October 2018, and in this article, we discuss three of the cases presented and review the radiology imaging and pathology slides. The first two cases involve thymic carcinoma: the first reviews systemic therapy recommendations for non-resectable recurrence and the second case the optimal treatment recommendations after incomplete resection. The third case discusses treatment recommendations for recurrent thymoma after complete resection.

Keywords: Thymoma; case presentation; thymic carcinoma; tumor board.

Figure 1

Forty-six-year-old man with chest pain. (A) Unenhanced chest CT (soft tissue windows) at the level of the transverse aorta demonstrates a prevascular mass (M) with some punctate calcifications within it abutting and inseparable from the transverse aorta; (B) sagittal reconstruction of the chest CT (bone windows) show a poorly defined mottled sternal lesion (arrows) with cortical destruction consistent with a bone metastasis and the primary mass (M); (C) FDG PET-CT sagittal image similar in orientation to image B shows the marked FDG avidity in the primary mediastinal mass (M) and sternal metastasis (arrow).

Figure 2

Following neoadjuvant therapy the mass decreased in diameter from 9.3 to 6.1 cm. The sclerotic sternal metastasis also demonstrated a partial response (not shown).

Figure 3

Non keratinizing squamous cell carcinoma. (A) An infiltration of lung parenchyma (Ca, carcinoma; L, lung); (B) medium and (C) high power magnification of the neoplastic tissue. The neoplasm is composed of spindle and epithelioid cells with multiple mitotic figures (circles) and clear cellular atypia [Hematoxylin and eosin staining; magnification ×100 (A), ×200 (B) and ×400 (C)].

Figure 4

Three months after completion of radiation therapy FDG PET-CT shows (A) FDG avid recurrence in the visceral mediastinum, within the pericardial recess (V), and in the subcutaneous tissue, anterior to the reconstructed chest wall (arrowhead); (B) FDG avid metastases are also seen along the pleura (arrows) and an intra-parenchymal liver metastasis (arrowhead).

Figure 5

Eighty-year-old healthy woman followed for a slowly growing pulmonary nodule. (A) Unenhanced chest CT at the level of the left pulmonary artery (LP) shows an 8 mm in short-axis diameter mediastinal lymph node (arrow) which was not present on prior (not shown) chest CT scans; (B) lung windows of the same unenhanced chest CT as in A demonstrate a 1 cm solid pulmonary nodule (black arrow); (C) FDG PET-CT at the same level of A demonstrates some FDG uptake in this new small lymph node; (D) FDG PET-CT (same as in C) demonstrates minimal FDG uptake in the left lower lobe pulmonary nodule.

Figure 6

Thirty-three-year-old man who presented with symptoms compatible with myasthenia gravis. Contrast enhanced chest CT at presentation at the level of the left pulmonary artery (LP) demonstrates a lobular prevascular homogenous mass (arrow). Due to the relatively long length of the mass’ abutment to and indistinct margin with the pericardium, the question of pericardial involvement was raised.

Figure 7

Microscopic images of tumor submitted for review by ITMIG (×100). (A) Hematoxylin and eosin staining; (B) AE1AE3; (C) CD5; (D) CD117.

Figure 8

Follow up imaging of the 33-year-old man who initially presented with symptoms compatible with myasthenia gravis and a mediastinal mass. (A) Contrast enhanced chest CT 18 months after resection of the mediastinal mass, shows interval development of two large, up to 3 cm in diameter pleural metastases (arrows). Minute nodularity to the remaining pleura (arrowhead) may represent additional minute metastatic pleural foci. (B) Contrast enhanced chest CT at the level of the spleen (S), 18 months following resection of the pleural metastases seen in A, shows a new 5 cm × 3 cm pleural mass at the insertion of the diaphragm to the chest wall (arrows). The mass bulges through the intercostal space, suggestive of chest wall involvement. (C) FDG PET-CT at the same level as image B shows FDG uptake at the periphery of the chest wall mass.