Thymic carcinoma is a rare type of cancer, which arises from the thymic epithelium and accounts for ~1–4% of anterior mediastinal tumors in the USA. It rarely occurs in children, and is rarer among adults. Thymic lymphoepithelioma-like carcinoma (LELC) is an uncommon subtype of thymic carcinoma in children, however, it is one of the common histological subtypes of thymic carcinoma in adults. In the present study, a 14-year-old male patient presented to the Tokyo Metropolitan Cancer and Infectious diseases Center, Komagome Hospital (Tokoyo, Japan) with chest pain due to a large anterior mediastinal mass. The patient was histologically diagnosed with thymic LELC via a needle biopsy specimen, which was obtained from the primary site and indicated the Epstein-Barr virus infection, whose markers are also associated with oncogenesis. Immunohistochemical analysis demonstrated positive staining for keratin (AE1/AE3), epithelial membrane antigen, and latent membrane protein-1 and negative staining for cluster of differentiation 5. Thus, the patient was diagnosed with metastatic thymic LELC. First-line chemotherapy comprising of a cisplatin- and adriamycin-based chemotherapy regimen achieved a partial response, however, the patient succumbed within 10 months of the initial diagnosis due to rapid disease progression and refractory to subsequent cycles of chemotherapy. Thus, the current study, as well as previously reported cases, demonstrates that pediatric patients with thymic LELC continue to have a poor prognosis.

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An asymptomatic 67-year-old man was referred to our clinic because of an abnormal shadow found on a chest Xray (Picture 1). Chest computed tomography showed the gloved finger sign, thus suggesting mucoid impaction (Picture 2). The lesion was diagnosed to be malignant melanoma by transbronchial lung biopsy (Picture 3). The patient was diagnosed to have malignant melanoma of unknown origin with lung, gastric, and bone metastases. The FDGuptake was also shown in the lung metastasis on positron emission tomography (Picture 4). Multiple nodules (1), and solitary nodules with a miliary pattern, and a lymphangitic carcinomatosis pattern (2), have also been reported as the imaging findings associated with lung metastases of malignant melanoma. However, the gloved finger sign, as observed in this case, is rare. In the present case, metastasis may have occurred via the lumen of the bronchus and then progressed lengthwise, thus resulting in such an image, but no abnormality in the bronchial mucosa was seen on bronchoscopy.