• Rui Zhang, Junqiu Li, and Hongkai Zhang.
• Department of Pathology.
• Medicine (Baltimore). 2019 Jul 1; 98 (27): e16337.

RationaleThymoma is the most common primary tumor in the anterior mediastinum. All major subtypes of thymoma can be clinically aggressive. However, type A thymoma is usually benign and rarely invasive, let alone invasive to the trachea. There are no published reports of thymoma diagnosed in a "coughed up' tissue". Here, we report an 80-year-old man who coughed up a piece of tissue which was histopathologically diagnosed as type A thymoma.Patient ConcernsAn 80-year-old man who had a history of thymoma for 8 years was admitted in our hospital with his severe cough and dyspnea and his "coughed up" something. He felt much better after coughing up the piece of tissue. He saved the tissue and sent it to the pathology department.DiagnosesThe clinical diagnosis was lung cancer. But the final pathological diagnosis was type A thymoma.InterventionsThe patient refused to get chemotherapy, or surgery, and only would like to get the traditional Chinese medicine.OutcomesThe patient is stable for 19 months after he coughed up some of the tumor tissue.LessonsThe type A thymoma could be slowly aggressive. If left untreated, it would also invade into the trachea. When treat a patient with history of even a benign tumor, we should always bear the rare possibility in mind to avoid misdiagnosis. For an elderly patient, a "wait and see" policy may be acceptable.

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