CTICasesThymic Carcinoma Invading the Sternum and Anterior Chest Wall
Imaging findings
Chest radiograph shows contours projecting beyond the aortic arch, suggesting an upper mediastinal abnormality. Cross-sectional imaging demonstrates a large, irregular anterior mediastinal mass extending through the sternum into the anterior chest wall and abutting the pectoral muscle. Following chemotherapy and radiotherapy the lesion is larger than before, with a substantial necrotic centre, residual activity around its periphery, and dramatic bone destruction. Sagittal images show the tumour passing directly through into the anterior chest wall. There is no pleural involvement; the spread is by direct local extension.
Key takeaways
Thymic carcinoma is aggressive, but sternal invasion is an unusual route of spread — these tumours more typically reach the pleura quickly or metastasise elsewhere. The main differential is a primary bone lesion such as chondrosarcoma extending in the opposite direction; the deciding feature is that the bulk of the mass is centred in the anterior mediastinum rather than in bone. The patient underwent chemoradiotherapy followed by resection.
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