CTICasesThymic Carcinoma with Initial Regression and Subsequent Recurrence/Growth
Imaging findings
A woman presented with a relatively dense, 5.5 cm anterior mediastinal lesion, concerning for a thymic epithelial tumor. A few months later, it dramatically decreased in size; volumetric analysis showed reduced volume, though attenuation was unchanged. Over subsequent months, the mass remained unchanged, but then a few months later, it reappeared as a large, ugly mass. The patient also developed lung metastases. Biopsy confirmed thymic carcinoma.
Key takeaways
Thymic carcinoma is an aggressive malignancy that can metastasize to the lungs, unlike most other thymic tumors. While unusual, initial regression of a thymic lesion (possibly due to hemorrhage) followed by dramatic recurrence and growth can occur. Persistence of a mediastinal mass, even after apparent transient regression, especially with aggressive features or the development of distant metastases, warrants careful follow-up and biopsy.
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