1. CASE 1: type A thymoma
83 year old woman. CT images show well defined mass with homogeneous enhancement that contains lobules. Note also fatty plane between tumor and mediastinal structures
CT guided biopsy compatible with low grade thymoma (type A).
Tumor was not surgically resected

2. CASE 2:TYPE AB THYMOMA
66 year old woman. CT shows a mass divided into lobules with smooth margins. Note also fatty plane with mediastinal structures .
PA CHEST X-RAY

3. CASE 2:TYPE AB THYMOMA
Fine –needle aspiration: Compatible with low grade thymoma (epithelial cells and no lymphocytes)

4. CASE 3: TYPE AB thymoma
68 year old woman. CT shows a with well circunscribed mass with homogeneous enhancement .Note also calcified granuloma.
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5. CASE 4: type AB Thymoma Asymptomatic 66 year old woman.
PA and lateral Chest X-Ray: mass overlying the right heart border.

6. CASE 4: type AB Thymoma
CT scan show a mass with smooth margins and well definded enhancing nodules inside .
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7. CASE 4:type AB Thymoma
Mr : Tumor is clearly separated into lobules and surrounded by fat.
Axial T1
Axial T1
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Coronal STIR
Coronal STIR
* MR is superior to CT in the depiction of capsule, septum and hemorrhage

8. CASE 4:type AB Thymoma Biopsy (Hematosilin – Eosin) HE X 20 HE X 40
Organotypic area
Ephitelial cells predominant with lymphocytes

9. CASE 5: TYPE AB thymoma
75 year old man .CT shows anterior mediastinal mass with smooth contours
and heterogeneous enhancement. High attenuation lines divide the mass into multiple lobules.
Note also lung cancer in RUL (mediastinal and hilar adenopathy)

10. CASE 5: TYPE AB thymoma Biposy HE X4
Epithelial cells forming nodules into a rich lymphocyte tissue

11. CASE 6: TYPE AB THYMOMA
60 year old woman with myasthenia gravis. CT scan shows a smoothly marginated mass with relatively homogeneus enhacement with areas of low atenuattion. Note clear fatty plane with mediastinal structures
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12. CASE 7: TYPE B2-B3 THYMOMA
30 year old woman. Axial CT scan shows anterior homogeneous mediastinal mass with well defined margins (not clear fat plane with mediastinal structures).
Coronal CT reformations depicts a right upper lobe atelectasis and small endobronchial metastases (yellow arrow) in the origin of RUL. On the second image note pleural involvement (drop metastases ).
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13. CASE 7: TYPE B2-B3 THYMOMA
Polygonal epithelial cells with a heavy lymphocytic infiltration (B2)
Epithelial cells with slight atypia and a minor componente of lymphocytes (B3)
HE X20
HE X40
Treatment
Surgery:Total excision of the tumor , resection of pleural metastases and superior right lobectomy.
Neoadjuvant- CHEMOTHERAPY
CHEMOTHERAPY and RT postoperative

14. CASE 8: INVASIVE THYMOMA (TYPE B2)
68 year old man. CT depicts a large heterogenous mass with areas of necrosis and irregular and lobulated contours. Note encasement of mediastinal structures, pericardial invasion with effusion, pleural implants (pink arrow) and punctate calcifications. *

15. CASE8: TYPE B2THYMOMA
CT shows good response after treatment (Chemotherapy + RADIOTHERAPY)

16. CASE 9: TYPE B3 THYMOMA
74 years old man. PA and lat chest x ray: It depicts an anteriror mediastinal mass with coarse calcifications, preesternal soft tissue mass, and lung nodule in LUL. Note also sclerosis of the sternum .
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17. CASE 9:TYPE B3 THYMOMA
CT images show an heterogenous mediastinal mass with calcifications that invades the anterior chest wall. Note sclerosis of the sternum with integrity of its cortical and lung metastases in the LUL.

18. CASE 9: TYPE B3 THYMOMA
Biopsy guided by ultrasound. (H E x 20)
Poligonal epithelial cells with a heavy infiltration of lymphocytes

19. CASE 10:TYPE B2-B3 THYMOMA
33 year old man with dyspnea. CT scan shows an slightly hereogeneous mediastinal mass with lobulated contours and not fatty plane with vascular structures.

20. CASE 10: TYPE B2-B3 THYMOMA Treatment
Surgery. Surgical findings: Mediastinal left pleural invasion, phrenic nerve involvementet and lymphogeneous mediastinal metastases (stage IV).Total excision of the tumor.
CHEMOTHERAPY and RT postoperative
Follow up CT
Poligonal epithelial cells with a heavy lymphocytic infiltration
HE X 20

21. CASE 11 TYPE B2- B3 INVASIVE THYMOMA
66 year old man.
CT scan shows a large mass with heterogeneus enhancement (necrotic or cystic component). Note obliteration of fat planes with mediastinum, pleural and pericardial effusion.

22. CASE 11: TYPE B2- B3 THYMOMA
Biopsy guided by CT compatible with B2. Surgical biopsy demonstrated B2-B3 thymoma. Surgical resection of the tumor was incomplete.
HEx10:Epithelial cells with a rich lymphocytic background

23. CASE 12: THYMIC CARCINOMA
47 year old woman. CT images show a well defined lobulated mass with encasement of mediastinal structures.

24. CASE 12:THYMIC CARCINOMA
CT scan show a reduction in size of the mass after therapy (radiotherapy and chemotherapy). Tumor was completly resected with free margins .

25. CASE 13: THYMYC CARCINOMA
77 year old man. CT images show a prevascular mass with irregular margins, central dotlike calicifications and invasion of great vessels and pericardium. Note also pleural implants (pink arrow)
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