case_images: PMC11401132_01
case_images: A) Lateral view, and B) supine view of the patient. The thoracic radiographs shows a thymoma and pleural effusion in the cranial mediastinum.
case_images: vrf-15-439-g001.jpg
case_images: PMC11401132_01_vrf-15-439-g001.jpg
case_images: F1
case_images: In the supine position scan, a large amount of fluid was seen in the thorax (Fig. 1).
case_images: Thoracic ultrasound revealed, A) a mild hypo-echoic mass at the right para-sternal apex with the size of 63.00 x 48.10 mm, and B) a large amount of pleural effusion in the thoracic cavity.
case_images: vrf-15-439-g002.jpg
case_images: PMC11401132_01_vrf-15-439-g002.jpg
case_images: F2
case_images: Ultrasound examination using MyLab  6 Ultrasound imaging system (Esaote, Genoa, Italy) showed pleural effusion and intra-thoracic mass (Fig. 2). 
case_images: Cytological smear analysis. A) pleural fluid, and B) thoracic mass. Large numbers of round cells were found in pleural fluid sediment cytology, mainly small lymphocytes, as well as moderate numbers of neutrophils and small numbers of large lymphocytes. Thoracic mass aspiration cytology shows a large number of round cells, mainly small lymphocytes, and a small number of large lymphocytes having obvious nucleoli. In addition, eosinophils were occasionally seen, and no obvious pathogenic micro-organisms were found (Diff Quik staining, 100x).
case_images: vrf-15-439-g003.jpg
case_images: PMC11401132_01_vrf-15-439-g003.jpg
case_images: F3
case_images: The results show a large number of round cells, mainly small lymphocytes, as well as a moderate number of neutrophils and a small number of large lymphocytes; but no obvious pathogenic micro-organisms were found (Fig. 3A). Pleural mass aspiration cytology also showed a large number of round cells, mainly small lymphocytes, and a small number of large lymphocytes; the nucleolus was obvious (Fig. 3B).
case_images: Histopathological analysis. A) Pleural granulation tissue (arrow) in the lung sample, and B) lympho-plasmacytic cells (arrow) in the thymic mass, (Hematoxylin and Eosin staining, bars = 100 microm).
case_images: vrf-15-439-g004.jpg
case_images: PMC11401132_01_vrf-15-439-g004.jpg
case_images: F4
case_images: There was a focal cystic region and moderate granulation tissue along the pleural surface (Fig. 4A). There were mild mesothelial cell hypertrophy and multi-focal mixed inflammation, being predominantly lympho-plasmacytic (Fig. 4B).