Case of the Month May 2014, page 3

Answer: The images show a large heterogeneous anterior and middle mediastinal mass which causes adjacent mass effect on the pulmonary arteries and veins. Low attenuation areas within this mass may represent cystic degeneration, loculation, or central necrosis. The heart itself is not enlarged.  

The mass persists after pericardial fluid was completely drained.

A malignancy is now at the top of the differential, and a biopsy via pericardial window was performed.  A subsequent PET-CT showed the following:

For full-size images, please click: Ardestani 7 and Ardestani 8 .

What are the most likely diagnoses at this point?

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