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Weekly Chest CasesArchive of Old Cases

Case No : 70 Date 1999-02-27

  • Courtesy of Yun-Hyeon Kim, M.D. / Chonnam National University Hospital
  • Age/Sex 31 / F
  • Chief ComplaintGeneral weakness & edema for 5 months with Hx of DM, hypertension, & Cushing syndrome
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Thymic Carcinoid
Radiologic Findings
Chest radiograph shows a large anterior mediastinal mass. The mass is demonstrated as a well-defined lobulated soft tissue lesion without calcification and necrosis, and homogeneous contrast enhancement on unenhanced and enhanced CT scan. There is no detectable mediastinal or hilar lymphadenopathy, and no metastatic focus.
Brief Review
Thymic carcinoid is a rare neoplasm of neuroendocrine origin, generally hormonally active, with a tendency toward malignant degeneration. Almost 50% of thymic carcinoids are associated with endocrinopathies, usually Cushing syndrome as a result of ACTH secretion, and 19% of the tumor may be associated with other neoplasms, such as parathyroid adenoma, islet cell tumor of the pancreas, and pituitary adenoma when it is part of the multiple endocrine neoplasia(MEN) type I. In case not associated with endocrine dysfunction, the tumor may be detected because of local symptoms or routine chest radiography. The age range of reported patients with thymic carcinoid is nine to 87 years, with the preponderance occurring in middle-aged men, in contrast to the female preponderance of epithelial thymoma. Chest radiographic findings are often normal or equivocal. However, CT scans show an irregular soft-tissue mass with inhomogeneous contrast enhancement. The differential diagnosis of a mass in the anterior mediastinum in a patient without clinical signs and symptoms of an endocrinopathy includes thymoma, lymphoma, and germ-cell tumors, but a non-functioning neuroendocrine tumor, such as thymic carcinoid can not be excluded. Thymic carcinoid have a relatively poor prognosis, and recurrence and extrathoracic metastasis (skin, bone, and lymph nodes) are common. Osteoblastic metastasis is typical of carcinoid. Surgical excision of the primary tumor and of subsequent recurrences seems to be the most effective treatment. However, the length of survival after initial diagnosis is widely variable, from one to 15 years. The presence of an anterior mediastinal mass in patients with clinical signs of Cushing syndrome or other tumors of the MEN I syndrome makes mediastinal carcinoid the most likely diagnosis.
References
1. Adolph J, Kimmig B, Georgi P, zum Winkel. Carcinoid tumors: CT and I-131 meta-iodo-benzylguanidine scintigraphy. Radiology 1987;164:199
2. Llaverias S, Valls C, Picas E, etc. Carcinoid tumor of the thymus (letter). AJR 1994;163:478
Keywords
Mediastinum, Malignant tumor,

No. of Applicants : 24

▶ Correct Answer : 16/24,  66.7%
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▶ Semi-Correct Answer : 5/24,  20.8%
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  • - Vesalius general hospital, Tongeren, Belgium Dr. Rudi Stokmans
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