{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T05:11:12Z","timestamp":1778821872264,"version":"3.51.4"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Synchronous primary lung cancer and mediastinal thymoma represent a rare clinical entity. While 18F-FDG PET\/CT serves as a cornerstone modality for differentiating benign from malignant thoracic neoplasms, hypermetabolic activity secondary to severe localized inflammation can frequently masquerade as highly aggressive malignancies. Such radiologic-pathologic discordance significantly elevates the risk of misdiagnosis, thereby adding substantial complexity to clinical decision-making and patient management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      A 73-year-old woman with prior tuberculosis and stented coronary artery disease presented with a hypermetabolic right upper lobe (RUL) nodule (2.3\u00a0cm, SUVmax 5.0) and an anterior mediastinal mass (SUVmax 3.0) on PET\/CT. Due to the patient\u2019s cardiovascular comorbidities, the multidisciplinary team (MDT) initially recommended a percutaneous biopsy. As the pathology revealed only adenocarcinoma\n                      <jats:italic>in situ<\/jats:italic>\n                      (AIS) in the context of a persistent cough and a hypermetabolic lesion, empirical broad-spectrum antibiotics were administered. A two-month follow-up HRCT showed substantial shrinkage of the right lung lesion and absorption of its solid component. The patient subsequently underwent elective uniportal video-assisted thoracoscopic surgery (VATS) for a right upper lobe posterior segmentectomy and an anterior mediastinal tumor resection. Intraoperatively, dense pan-pleural adhesions from the prior tuberculosis were evident, compounded by localized adhesions from the recent biopsy. Following sharp adhesiolysis, both lesions were successfully resected. Final pathology revealed a diagnostic masquerade: the true AIS measured only 0.66\u00a0cm, obscured by surrounding organizing pneumonia, occurring synchronously with a B2-B3 thymoma (Ki-67 &amp;gt;30%). The postoperative course was uneventful. The patient was discharged on postoperative day 6 after chest tube removal, and is scheduled for regular radiological follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This report highlights a critical diagnostic pitfall: the \u201chypermetabolic inflammatory trap\u201d on PET\/CT can easily mimic or obscure true micro-carcinomas. In medically high-risk cohorts, leveraging an MDT approach with upfront tissue diagnosis, diagnostic anti-infective management, and dynamic imaging is paramount to avoiding surgical overtreatment. Crucially, we validate that despite the technical hurdles of extensive pleural adhesions, uniportal VATS remains a highly secure and advantageous strategy for resecting synchronous thoracic neoplasms.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1846848","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T04:28:49Z","timestamp":1778819329000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Synchronous lung adenocarcinoma in situ and type B2-B3 thymoma in a frozen hemithorax: a case report and multidisciplinary approach"],"prefix":"10.3389","volume":"16","author":[{"given":"Chenglin","family":"Fan","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, The Affiliated Hospital of Yanbian University (Yanbian Hospital)","place":["Yanji, 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