title: Thymic carcinoma diagnosed by using endoscopic ultrasound with fine-needle aspiration.
abstract: There is a paucity of literature on the use of endoscopic ultrasound (EUS) for evaluating superior mediastinal structures, especially the thymus gland. We report a case of thymic carcinoma diagnosed by using EUS elastography with strain ratio and fine-needle aspiration (FNA). A 64-year-old woman presented with altered mental status and was diagnosed with autoimmune encephalitis. Further work-up suggested a superior mediastinal mass, for which she underwent EUS. A hypoechoic mass was found in the superior mediastinum at the level of the aortic arch. Real-time EUS elastography showed a predominantly blue hue to the mass concerning for malignancy. FNA of the mass was performed, which revealed numerous large neoplastic cells under a background of a small lymphoid infiltrate. Immunohistochemistry was strongly positive for PAX8, pancytokeratin, and CAM5.2. The pathologic and immunohistochemical stains were consistent with thymic carcinoma.
authors.affiliation: Department of Internal Medicine, University of Texas Health Science Center at Houston, Texas, USA.
authors.forename: Pragnesh
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Gastroenterology and Hepatology, University of Texas Health Science Center at Houston, Texas, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Guider
authors.affiliation: Department of Gastroenterology and Hepatology, University of Texas Health Science Center at Houston, Texas, USA.
authors.forename: Erik
authors.initials: E
authors.lastname: Rahimi
authors.affiliation: Department of Gastroenterology and Hepatology, University of Texas Health Science Center at Houston, Texas, USA.
authors.forename: Sushovan
authors.initials: S
authors.lastname: Guha
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Texas, USA.
authors.forename: Songlin
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Gastroenterology and Hepatology, University of Texas Health Science Center at Houston, Texas, USA.
authors.forename: Nirav
authors.initials: N
authors.lastname: Thosani
keywords: Elastography; endoscopic ultrasound (EUS); fine-needle aspiration (FNA); mediastinum mass; thymic carcinoma