CTICasesMetastatic Thymoma Mimicking Lymphoma
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Imaging findings
Chest CT over a multi-year period reveals a cystic anterior mediastinal mass with peripheral calcification and adjacent radiation fibrosis, alongside slowly progressive, PET-avid pleural-based masses extending deep into the posterior costophrenic recesses. Percutaneous biopsy of the pleural lesions, initially misdiagnosed as lymphoblastic lymphoma due to inadequate clinical history, was corrected to metastatic thymoma (drop metastases).
Key takeaways
Thymomas are notorious for slow, indolent growth and a propensity to spread via 'drop metastases' along the pleural and diaphragmatic surfaces, sometimes years after initial resection. Accurate pathologic diagnosis of mediastinal and pleural tumors heavily relies on complete clinical and surgical history, as thymomas rich in immature T-lymphocytes can easily be misdiagnosed as T-cell lymphoblastic lymphoma.
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