Pleural thymoma: Radiological and histological findings
A 49-years old woman was admitted to the Emergency Department with shortness of breath and mild respiratory discomfort. Cardiovascular examination was normal. There was no significant lymphadenopathy or thyromegaly. Respiratory sounds were impaired on the right lung. No abnormalities were detected in blood chemistry.

A first chest X-Ray executed in posterior-anterior (PA) and lateral projection, showed multiple nodules, hilar-mediastinal enlargement and nodular radiopacity at right hilum; also, pleural effusion on the right lung and obliteration of ipsilateral costophrenic angle was detected.

As collateral findings, US confirmed the pleural effusion with multiple solid rounded masses at pulmonary bases. The CT revealed a large mediastinal mass overrunning the right hemithorax, with pleural free fluid and multiple solid pleural masses on the right. No displacement of mediastinal structures has been noted. After injection of iodinated contrast, the lesions appeared hypo-vascular, with enhancing margins, internal lobulation and septation, and few calcific spots.

Subsequently, a CT-guided percutaneous biopsy (14 G cutting needle) of the mass in the right hemithorax was performed. Histopathological examination revealed a tissue made-up by bands of sclerosis and average size lymphocytes with T-immature phenotype (precursor T cell, CD3+, CD5+/−, CD4+, CD8+, TdT+), associated also with irregular oval shape epithelial cells (CKAE1-AE3+, Calretinin-).

The above-mentioned histological findings are consistent with thymoma type B2 (cortical). After a definitive diagnosis of thymoma and disease staging, the patient chose to receive treatment in another Institute and was lost to follow-up.

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