Case 9

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Abstract
A 66-year-old woman was shown on routine X-ray to have a well-circumscribed anterior mediastinal mass (Fig. 1). The mass was totally excised, and no extension was noted beyond the mediastinum. Grossly, the tumor measured 7.5 × 7.5 × 7.5 cm, weighed 102g, had a firm, gray cut surface, and appeared encapsulated. No further therapy was given. Recurrent disease was noted radiographically in the anterior mediastinum 5 years later. A sternal split revealed three tumor masses situated on the aortic arch, superior vena cava, and right pulmonary hi/us, respectively; the largest measured 10 × 10 × 5 cm, weighed 80 g, and, on section, was brown and firm, with hemorrhagic areas. Tumor was also noted on the visceral pleura of the right lung. A formal thoracotomy, performed 2 months later, identified a 4 × 3 cm anterior mediastinal mass attached to the right middle lobe of the lung and invading the pericardium. Many implants were noted on the posterior and lateral parts of the chest wall. Throughout the course up to this point, the patient had been remarkably asymptomatic; there had been no symptoms or signs suggestive of any activity by the tumor. Three and one-half years following the last thoracotomy, massive local recurrence developed in the mediastinum and pleural spaces, which led to the death of the patient by respiratory insufficiency. There was no clinical evidence of distant metastases. Autopsy was not obtained.
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