If the patient truly refuses surgery, they need to undergo a core biopsy to get a tissue diagnosis due to the variety of potential histologies (ranging from thymoma, thymic carcinoma, lymphoma, germ cell tumor, primary lung tumor, etc.) each requiring distinct management stra...

While there are instances, in special circumstances, where I treat patients without pathologic confirmation of malignancy, this would NOT be one of those cases. Depending on the histology of the tumor, the recommendation for treatment might be too different.