Preoperative Temporal Elevation of Cytokeratin 19 Fragment in Thymoma With Extensive Necrosis: A Case Report

Figures

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  FIGURE 1. Radiological findings. (A) Enhanced computed tomography (CT) showed a cystic mass (orange arrowhead) measuring 54 × 45 mm in the anterior mediastinum, with peripheral enhancement. (B) 18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET) showed the uptake of FDG with a maximum standardized uptake value (SUVmax) of 4.9 (red arrowhead).

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  FIGURE 2. Pathological findings. (A) The cut surface showed the tumor was encapsulated with a white inner area. (B) Hematoxylin and Eosin staining (low power view) showed the necrotic area (*) and few viable cells (arrowhead). Immunohistochemistry demonstrated positivity for (C) terminal deoxynucleotidyl transferase (TdT) and (D) β5t.

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  FIGURE 3. Chronological timeline of the clinical course and serological markers. When the patient initially presented to a primary hospital, the WBC and CRP levels were elevated. At the referral to the tertiary center, these levels had decreased, but the CYFRA level was elevated. Preoperatively, the CYFRA level decreased without any medication. The postoperative course was uneventful, and the transient postoperative elevation of the WBC and CRP levels, induced by surgery, was omitted. Solid lines show the measured values of each marker. Dotted lines of the corresponding color indicate the upper limit of normal. CRP, C‐reactive protein; CYFRA, Cytokeratin 19 fragment; ULN, upper limit of normal; WBC, white blood cell.