Given the recent case report by NEJM (Pallais JC, Fenves AZ, Lu MT, Glomski K. Case 18-2018: A 45-Year-Old Woman with Hypertension, Fatigue, and Altered Mental Status. N Engl J Med. 2018;378:2322-2333.), I wonder whether thymic neuroendocrine tumor is clinically and pathologically malignant.

The pathological examinations often show the collective tumor cell migration into the lymphatic vessels, which strongly implies the possibility of latent relapse and distant metastasis.

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