Synchronous triple thymoma and true thymic hyperplasia simultaneously detected by (18)F FDG PET-CT.

A 56-years-old Caucasian woman was admitted to our Departent for evaluation of mediastinal enlargement detected during nvestigations for angor and long-lasting dyspnoea. A non-contrast nhanced chest CT scan evidenced multiple swellings in the nterior mediastinum making a proper radiological evaluation of he mediastinum unfeasible. Thus, a 18F-FDG PET-CT-scan was erformed and revealed a round-shaped lesion in the upper medistinum (1.8 cm, SUV 4.0, Fig. 1A–D), a lower lesion (3.0 cm, SUV 4.8, ig. 1C–E) and a round irregularly-shaped nodule (1.4 cm) between he two ones (SUV 3.0, Fig. 1B–E). In addition, the thymus gland ptake was increased (SUV of 2.8, Fig. 2) while the 18F-FDG disribution was slightly decreased in the cardiac muscle (due to a ako Tsubo syndrome subsequently confirmed by cardiac examnation). Considering the different mediastinal uptakes, cytology as obtained by fine-needle aspiration biopsy (FNAB) of the upper esion and was suggestive for thymoma. Thus, the patient underent a trans-sternal radical thymectomy plus wedge resection f the left upper lobe. Final pathology characterized the three esions as different nodules of type AB thymoma: in particular, the ower (Fig. 3A) and medium nodule (Fig. 3C) were encapsulated Masaoka-stage I), while the upper one (Masaoka-stage III) invaded he visceral pleura (star, Fig. 3B). Moreover, the thymic parenchyma as consistent with true thymic hyperplasia (TTH, Fig. 3D). Based n the histo-pathological findings, a diagnosis of synchronous triple