• Almost always fatal

• 42 year old man with multiple lung, bone, and brain metastases (Acta Neurol Taiwan 2010;19:41)
• 52 year old man with complaints of left anterior chest pain (Kyobu Geka 2003;56:509)

• Angular nests of malignant squamous cells in desmoplastic stroma
• No intercellular bridges, no eosinophilic cytoplasm, no keratin pearls
• No internal fibrous septae

Clear-cut features of malignancy; usually lack immature T lymphocytes

• Thymoma: fibrous septae

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