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Using the World Health Organization Classification of Thymic Epithelial Neoplasms to Describe CT Findings

Noriyuki Tomiyama1, Takeshi Johkoh2, Naoki Mihara2, Osamu Honda2, Takenori Kozuka2, Mitsuhiro Koyama2, Seiki Hamada2, Meinoshin Okumura3, Mitsunori Ohta3, Tadaaki Eimoto4, Masao Miyagawa1, Nestor L. Müller5, Junpei Ikezoe6 and Hironobu Nakamura2

1 Department of Radiology, Ehime National Hospital, 366, Yokogawara, Shigenobu, Ehime, 791-0281, Japan.
2 Department of Radiology, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
3 Division of General Thoracic Surgery, Department of Surgery (E-1), Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
4 Second Department of Pathology, Nagoya City University Medical School, Kawasumi, Mizuho-ku, Nagoya, 467-8601, Japan.
5 Department of Radiology, Vancouver General Hospital and University of British Columbia, 855 W. 12th Ave., Vancouver, B. C., V5Z 1M9, Canada.
6 Department of Radiology, Ehime University Medical School, Shizugawa, Shigenobu, Ehime, 791-0295, Japan.



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  		Fig. 1A. —Type A tumor in 57-year-old woman. Contrast-enhanced CT scan (5-mm collimation) obtained at level of azygos arch shows homogeneous anterior mediastinum mass with smooth contours and round shape. Mass was confirmed histopathologically as noninvasive thymoma (stage I, encapsulated thymoma).

 


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  		Fig. 1B. —Type A tumor in 57-year-old woman. Photomicrograph of histopathologic specimen shows spindle tumor cells (arrows) with no nuclear atypia (spindle cell type). Note small number of lymphocytes. (H and E, x200)

 


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  		Fig. 2A. —Type AB tumor in 55-year-old woman. Contrast-enhanced CT scan (3-mm collimation) obtained at level of aortic arch shows oval mass in anterior mediastinum. Mass shows homogeneous enhancement with slightly higher attenuation than that of chest wall muscles.

 


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  		Fig. 2B. —Type AB tumor in 55-year-old woman. Photomicrograph of histopathologic specimen shows lymphocyte-rich tumor with spindle (arrows) to oval (arrowheads) tumor epithelial cells (mixed type). Mass was confirmed histopathologically as noninvasive thymoma (stage I, encapsulated thymoma). (H and E, x200)

 


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  		Fig. 3A. —Type B1 tumor in 26-year-old woman. Contrast-enhanced CT scan (7-mm collimation) obtained at right main pulmonary artery level shows mass at anterior mediastinum. Note smooth contours and oval shape of mass, which enhances heterogeneously with low attenuation.

 


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  		Fig. 3B. —Type B1 tumor in 26-year-old woman. Photomicrograph of histopathologic specimen shows predominance of lymphocytes and scattered tumor epithelial cells (arrows), resembling thymic cortex (lymphocyte-rich type). Mass was confirmed histopathologically as noninvasive thymoma (stage I, encapsulated thymoma). (H and E, x200)

 


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  		Fig. 4A. —Type B2 tumor in 35-year-old man. Contrast-enhanced CT scan (5-mm collimation) obtained at carinal level shows slightly heterogeneous anterior mediastinum mass with plaque shape. Mass contains punctate peripheral calcification (arrow). Invasion of pericardium was confirmed at surgery (stage III, invasive thymoma).

 


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  		Fig. 4B. —Type B2 tumor in 35-year-old man. Photomicrograph of histopathologic specimen shows moderate lymphocyte infiltration and plump tumor cells (arrows) with vesicular nuclei and distinct nucleoli (cortical type). (H and E, x200)

 


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  		Fig. 5A. —Type B3 tumor in 74-year-old man. Contrast-enhanced CT scan (7-mm collimation) obtained at carinal level shows lobulated contour mass at anterior mediastinum. Mass shows heterogeneous enhancement with multiple areas of decreased attenuation. Invasion of left lung and pericardium was confirmed at surgery (stage III, invasive thymoma).

 


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  		Fig. 5B. —Type B3 tumor in 74-year-old man. Photomicrograph of histopathologic specimen shows sheet of tumor epithelial cells (arrows) with small number of lymphocytes and perivascular space (arrowhead) (well-differentiated thymic carcinoma). (H and E, x200)

 


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  		Fig. 6A. —Type C tumor in 73-year-old man. Contrast-enhanced CT scan (3-mm collimation) obtained at carinal level shows heterogeneous anterior mediastinum mass with irregular contour. Note enlarged lymph node in right hilum (arrow). Invasion of right lung and pericardium and metastasis to right hilar node were confirmed at surgery (stage III, invasive thymoma).

 


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  		Fig. 6B. —Type C tumor in 73-year-old man. Photomicrograph of histopathologic specimen shows nests of thymic carcinoma cells with atypical nuclei and with some squamous differentiation (i.e., intercellular bridges [arrows]) (thymic carcinoma). (H and E, x200)

 

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