case_images: PMC3161649_01
case_images: Chest X-ray showing superior mediastinal mass.
case_images: cmo-2-2008-477f1.jpg
case_images: PMC3161649_01_cmo-2-2008-477f1.jpg
case_images: f1-cmo-2-2008-477
case_images: African American man with a 75 pack-year tobacco history presented with intermittent nocturnal anterior chest and non-productive cough. A chest x-ray showed a density adjacent to the aortic arch (Fig. 1).
case_images: Chest CT demonstrating mass with involvement of aortic arch.
case_images: cmo-2-2008-477f2.jpg
case_images: PMC3161649_01_cmo-2-2008-477f2.jpg
case_images: f2-cmo-2-2008-477
case_images: Chest CT revealed an 8 x 2.3 cm anterior mediastinal mass located superiorly which extended from the inner margin of the sternum along the aortic arch and encased the left subclavian and left common carotid arteries (Fig. 2).
case_images: Hematoxylin-Eosin stain of primary tumor (40x).
case_images: cmo-2-2008-477f3.jpg
case_images: PMC3161649_01_cmo-2-2008-477f3.jpg
case_images: f3-cmo-2-2008-477
case_images: He underwent mediastinoscopy with partial thoracotomy (Chamberlain procedure) and biopsy which showed poorly differentiated thymic carcinoma (Fig. 3) with immunohistochemistry positive for AE1/AE3, CD5, and vimentin (Fig. 4).
case_images: PET-CT demonstrates uptake in mediastinal mass, and two foci close to proximal small intestine.
case_images: cmo-2-2008-477f5.jpg
case_images: PMC3161649_01_cmo-2-2008-477f5.jpg
case_images: f5-cmo-2-2008-477
case_images: There was also uptake with SUV of 8.5 in a region close to the proximal intestine (Fig. 5).
case_images: Endoscopic photograph of ulcerated mass in distal duodenum.
case_images: cmo-2-2008-477f6.jpg
case_images: PMC3161649_01_cmo-2-2008-477f6.jpg
case_images: f6-cmo-2-2008-477
case_images: This revealed a large fungating and ulcerated mass in the 4th (horizontal) part of the duodenum, about 3 cm in diameter (Fig. 6).
case_images: Endoscopic ultrasound of duodenal mass.
case_images: cmo-2-2008-477f7.jpg
case_images: PMC3161649_01_cmo-2-2008-477f7.jpg
case_images: f7-cmo-2-2008-477
case_images: EUS showed an ulcerated intramural lesion, involving deep mucosal layer, submucosa, muscularis propria and serosal (Fig. 7).
case_images: Biopsy of duodenal mass; immunohistochemistry positive for AE1/3 (epithelial marker).
case_images: cmo-2-2008-477f8.jpg
case_images: PMC3161649_01_cmo-2-2008-477f8.jpg
case_images: f8-cmo-2-2008-477
case_images: The duodenal biopsy showed an ulcerated duodenal mucosa with an infiltrating epithelial neoplasm, composed of large polygonal cells, with abundant cytoplasm (Fig. 8).