case_images: PMC7227442_01
case_images: Pleural biopsy histological images showing (A) H&E stain, (B) 20xP63 stain (highlighting epithelial cell nuclei), (C) 20xAE1/AE3 stain (highlighting epithelial cell cytoplasm), and (D) 20xCD45 stain (highlighting lymphoid cells).
case_images: fonc-10-00578-g0001.jpg
case_images: PMC7227442_01_fonc-10-00578-g0001.jpg
case_images: F1
case_images: She underwent a left pleural percutaneous needle biopsy the day after delivery and was diagnosed with a WHO type AB (indicating oval/spindle cells admixed with abundant small lymphocytes), Masaoka stage IVA (indicating pleural or pericardial dissemination) thymoma [Figure 1; ].
case_images: Patient timeline.
case_images: fonc-10-00578-g0002.jpg
case_images: PMC7227442_01_fonc-10-00578-g0002.jpg
case_images: F2
case_images: Our patient's health and myasthenia gravis were regularly monitored by a neurologist during the metabolic intervention, which consisted of a periodic fasting regimen (starting with a 12-day, water-only fast followed by a series of 7-day, fluid-only fasts every 1-2 months) combined with a modified ketogenic diet (60% fat, 30% protein, 5% fiber, and 5% net carbohydrate by weight, consisting largely of green vegetables, meats, eggs, nuts, seeds, creams, and natural oils) on feeding days (Figure 2).
case_images: CT chest (coronal and axial views, bulk of tumor circled in red) showing total tumor volumes at diagnosis, 8, 12, 25, and 29 months post-diagnosis.
case_images: fonc-10-00578-g0003.jpg
case_images: PMC7227442_01_fonc-10-00578-g0003.jpg
case_images: F3
case_images: All adverse effects were documented. An oncologist monitored the thymoma with a CT scan every 4-5 months, and a radiologist blinded to treatment simultaneously assessed all CT scans with volumetric analysis at the end of the intervention (Figure 3).