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Saturday 18 May 2013

CASE 188: MEDIC RADIOLOGY CASE 5: THYMOMA and THYMOCARCINOMA, Dr Nguyễn văn Công-Dr Hồ Chí Trung, Medic Medical Center, HCMC, Vietnam.

Mr A. and Mr B. are two 64 yo male patients, have a heath check at Medic Center some days apart.



On the PA and lateral CXR a round shadow about 3-6 cm of diameter seen on anterior mediastinum R side.

On thoracic US examination, 2 encapsulated, with septations mixed structrure of solid and liquid contents on R lower anterior mediastinum of 3-5 cm diameter look alike on both patients.

CT scan of both chests show almost the same findings as a mixed components with solid and fluid, septated, encapsulated, contrast enhanced on R lower anterior mediastinum.

Imaging diagnosis: Right Anteroinferior Mediastinal Tumor can be thymic origin.
Both men go for surgery to remove the anterior mediastinum tumor.

 But the resullts from pathology are different:

The pathology report of Mr A.: THYMOMA TYPE A  WITH CYSTIC CHANGE. 
The pathology report of Mr B.:Undifferentiated Adenocarcinoma, invading lung tissue, EGFR (+)

Outcome of the patients:

Mr A. after the surgery is still living and working till now.
Mr B. still alive some months after radiation and chemotherapy.

A coincidence : 2 cases of incidentaloma with different outcomes. From this lesson we can learn that:

1/ Imaging diagnosis is only the shadow of the truth.
2/ Pathology give us one part of the truth.
3/ Clinical findings, imaging and pathology can give us almost the truth.
4/ But the truth itself  is the outcomes of the patients .


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