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Disseminated thymoma in pleural fluid: An unusual case
1Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Diagnostic Cytopathology
|December 16, 2023
Summary
This study reports a rare case of thymoma identified in pleural fluid cytology. The findings highlight a diagnostic challenge, especially when the epithelial component is absent, mimicking reactive lymphocytic effusions.
Area of Science:
- Pathology
- Cytopathology
- Oncology
Background:
- Thymic epithelial tumors (TETs) have distinct fine-needle aspiration cytology features.
- Cytological diagnosis of thymoma in fluid cytology is not well-documented.
- Pleural effusions can occur secondary to thymoma metastasis.
Observation:
- A 77-year-old woman with known B2/B3 thymoma presented with dyspnea due to pleural effusion.
- Pleural fluid cytology revealed numerous small lymphocytes and mesothelial cells, lacking an epithelial component.
- Immunohistochemical staining confirmed immature T-cells (CD3+, CD1a+, TdT+) of thymic origin.
Findings:
- Diagnosis of recurrent/metastatic thymoma was made despite the absence of epithelial cells.
- This represents the second published case of thymoma in pleural fluid.
- It is the first reported case of thymoma in pleural fluid lacking an epithelial component.
Implications:
- This case underscores the importance of considering thymoma in the differential diagnosis of lymphocytic pleural effusions.
- The absence of epithelial cells can be a diagnostic pitfall, potentially leading to misdiagnosis as a reactive effusion.
- Accurate cytological and immunohistochemical analysis is crucial for diagnosing thymoma in effusions, even with atypical presentations.
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