Purpose: This study was designed to evaluate ⁶⁸Ga-pentixafor, which targets C-X-C chemokine receptor 4 (CXCR4), in the noninvasive diagnosis of thymomas. Patients and Methods: With institutional review board approval and signed informed consent, 32 patients with thymic masses were enrolled in this study, and all patients underwent ⁶⁸Ga-pentixafor PET/CT scans. Results: Among the 28 patients included in the analysis, 13 patients were diagnosed with thymomas, 9 patients with cysts, and 6 patients with other anterior mediastinal masses. ⁶⁸Ga-pentixafor identified all patients with thymomas (13/13, 100%), and the mean SUV_max in all 13 thymomas lesions was 13.96±8.20, which was significantly higher than that in patients with cysts (1.54±0.88) and other anterior mediastinal masses (2.59±1.68), respectively (P<0.001). Conclusions: The preliminary study indicates the diagnostic utility of ⁶⁸Ga-pentixafor in thymomas and the differential diagnostic ability of ⁶⁸Ga-pentixafor in thymomas, thymic cysts and other benign anterior mediastinal masses.

Background: This study aimed to examine the treatment and prognosis of patients with type B2 + B3 thymoma and compare it with those patients with type B2 and B3 thymoma.Methods: We conducted a retrospective analysis of the results of 39 patients with type B2 + B3 thymoma, 133 patients with type B2 thymoma, and 64 patients with type B3 thymoma. The Kaplan–Meier technique was used to generate survival curves. For multivariate analysis, the Cox proportional hazard model was applied.Results: With a median follow‐up of 60 months (range: 1–128 months), the percentage of patients with tumor, node, metastasis (TNM) stage III and IV disease gradually increased from 19.5% to 25.6% to 35.9% among those with histological subtypes B2, B2 + B3, and B3, respectively, p = 0.045. Twenty‐three patients experienced recurrence or metastasis. The total 10‐year progression‐free survival (PFS) rates were 86.0% overall (85.0% in type B2, 87.2% in type B2 + B3, and 87.5% in type B3). Age, R0 resection, and Masaoka–Koga stage were found to have a significant on PFS in all patients. There was no statistically significant difference in PFS between different histotypes of thymoma, p = 0.650. PFS was predicted by R0 resection in all histotypes and by the Masaoka–Koga stage in the type B2 subgroup.Conclusion: Combining the two staging methods to guide the diagnosis and treatment of patients with B2 + B3 thymoma is recommended. R0 resection is recommended to reduce recurrence. Patients with B2 + B3 thymoma have a prognosis similar to those with a B2 thymoma or a B3 thymoma alone.

Mucosa‐associated lymphoid tissue (MALT) lymphoma is an extranodal low‐grade non‐Hodgkin lymphoma that extremely rarely localises to the mediastinum. A 34‐year‐old female with chronic arthralgia, sicca and rash was found to have a well‐demarcated mediastinal cystic mass with equivocal nodular enhancement within the cystic wall on chest CT during a workup for Sjögren's syndrome. Subsequent ⁶⁸Ga‐Pentixafor‐PET/CT revealed focal uptake increase within the cystic capsule. The patient underwent thoracoscopic resection of the mediastinal lesion, and pathology revealed MALT lymphoma in the wall of a thymic cyst. This case highlights that ⁶⁸Ga‐pentixafor PET/CT could be valuable for the non‐invasive detection of occult thymic MALT lymphoma.Trial Registration: ClinicalTrials.gov. (www.clinicaltrials.gov, NCT06086327)

Background: Metastasis to the thyroid gland from lung adenocarcinoma is rare and challenging to diagnose due to similar histopathological features. This study aimed to analyze the clinicopathological characteristics of and treatment strategies for lung adenocarcinoma metastasis to the thyroid based on 11 years of institutional experience.Methods: A retrospective study included patients with lung adenocarcinoma metastasis to the thyroid at our center from 2010 to 2023. Clinicopathological features and clinical outcomes were analyzed.Results: Among 9714 lung adenocarcinoma patients, nine patients (five females, 55.6%) were diagnosed with thyroid metastasis, presenting primarily with cough symptoms. Most patients (88.9%) had synchronous tumors, whereas a minority (11.1%) had metachronous tumors. The median time from primary tumor diagnosis to metastasis was 4.8 months. Most patients developed bilateral thyroid metastases (88.9%). Diagnosis of thyroid metastasis was primarily through fine‐needle aspiration (FNA), with one case misdiagnosed as papillary thyroid carcinoma. Immunohistochemical staining revealed thyroid transcription factor‐1 (TTF‐1) and novel aspartic proteinase of pepsin family A (Napsin‐A) positivity and paired box 8 (PAX8) negativity. Genetic testing found epidermal growth factor receptor mutations in 71.4% of patients. The individualized comprehensive therapy included surgery, chemotherapy, immunotherapy, and targeted and supportive therapy. The median overall survival was 56.0 months, with a progression‐free survival of 12.7 months. Kaplan–Meier (K–M) analysis suggested improved survival with no advanced symptoms (p = 0.03) and targeted therapies (p = 0.05).Conclusions: Lung adenocarcinoma metastasis to the thyroid is a rare disease, with an incidence of 0.1% among lung adenocarcinoma patients. Early treatment after symptom onset and personalized targeted therapies may improve prognosis. Despite rapid disease progression, favorable outcomes can be achieved with comprehensive treatment.

The accurate intraoperative localization of lung cancers presenting as ground-glass opacities (GGOs) in lung tissue remains challenging. Ultrahigh-frequency ultrasound (UHFUS), which allows for the visualization of micron-scale structures, may help address this issue. This study aimed to evaluate whether UHFUS can serve as a reliable intraoperative tool for real-time detection and localization of GGOs in excised lung specimens. This prospective observational study included patients with suspected lung cancer who underwent surgery between June 2023 and March 2024. Each excised GGO was sequentially detected and localized intraoperatively via palpation and UHFUS (22–38 MHz). The UHFUS features were independently examined and evaluated by two radiologists. Comparisons between localization rate and time consumption were analyzed with the McNemar and Wilcoxon signed-rank tests. In total, 36 patients (55±10 years; 9 males) comprising 58 GGOs were included, of which 50 were small (≤1 cm) and 8 were general (>1 cm) GGOs; when grouped by density, 37 were considered pure and 21 mixed GGOs. UHFUS, as compared to palpation, demonstrated a superior localization rate for both small nodules (UHFUS: n=48, 96.0%; palpation: n=40, 80.0%; P=0.02) and pure GGOs (UHFUS: n=33, 94.3%; palpation: n=25; 71.4%; P=0.02). Even in the micronodule subgroup (≤5 mm), UHFUS showed better localization ability (n=15, 100%) than did palpation (n=12, 80%). For small GGOs, the median localization time of UHFUS [5 s, interquartile range (IQR) 5–8 s] was significantly shorter (P=0.003) than that for palpation (5 s, IQR 5–15 s); this difference was more pronounced (P=0.004) in pure GGOs (UHFUS: median 5 s, IQR 5–10 s; palpation: 12.5 s, IQR 5–20 s). On UHFUS, 83.3% of GGOs appeared as indistinct hypoechoic areas with posterior shadowing. UHFUS could detect new GGOs, and the agreement in diameter between UHFUS and pathology surpassed that between CT and pathology. This prospective observational trial supports the use of real-time, noninvasive, and radiation-free UHFUS for the intraoperative localization of GGOs in lung tissue. It has the potential to enhance the efficiency of lung surgery in detecting small tumors and identify new nodules.