This is a 69 year old female who is a Jehovas Witness. She is an active smoker, smoking half a pack a day for 55 years. Her past medical history includes a right upper lobe non-small cell lung cancer and a multinodular goiter. She presented with dyspnea on exertion and a chest X-ray was performed. A mass was found incidentally in her mediastium, and it was confirmed to be a 6 cm lobulated anterior mediastinal mass. Due to her religious beliefs, the patient refused surgery but agreed to a fine needle aspiration biopsy, which confirmed a thymoma.

Differential Diagnosis:

Thymoma, lymphoma, metastatic adenocarcinoma from lung primary