대한흉부영상의학회 Weekly Chest Cases

Case No : 421 Date 2005-11-21

Courtesy of Ki Nam Lee, MD / Dong-A University Hospital, Busan, Korea
Age/Sex 32 / M
Chief ComplaintNo specific chest symptom He was obese and had history of vertebrosplasty for compression fracture of lumbar vertebral bodies last year.

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Diagnosis With Brief Discussion

Diagnosis: Thymic Atypical Carcinoid & Pulmonary Cement Embolism
Radiologic Findings: The patient had suffered from central obesity, hypertension and multifocal compression fractures since last year. His 24hr urine free cortisol was elevated and overnight, low dose, and high dose dexamethasone suppression test were not suppressed. Endocrinologically, ectopic Cushing syndrome was diagnosed. His pituitary MRI and adrenal CT showed no remarkable finding. Even though young aged patient, he has suffered from osteoporosis and vertebral bony collapse. Bone cement applied in multiple collapsed vertebral bodies. Unfortunately, bone cement was embolic materials defined in multiple areas of pulmonary arteries.

Chest radiograph shows multiple linear calcifications in both lower lung fields.CT scan shows a well-defined lobulated soft tissue lesion with homogeneous contrast enhancement. Thymectomy was done. Macroscopically, invasion of surrounding fatty tissue and right mediastinal pleura were noted. Microscopically, the tumor was was positive for CD56, ACTH, NSE, chromogranin stain and confirmed as atypical carcinoid, spindle cell variant.
Brief Review: Thymic carcinoids often invade adjacent mediastinal and other thoracic structures. In fact, approximately 20%?0% of patients with thymic carcinoids have invasive or metastatic disease at the time of presentation. Their aggressive behavior and high propensity for local invasion distinguish these lesions from thymomas. Thus, it has been proposed that these tumors be considered neuroendocrine carcinomas of the thymus and be classified as a subtype of thymic carcinoma.

Diagnostic imaging of patients with thymic carcinoids usually demonstrates a large anterior mediastinal mass. The lesion may be localized or invasive. Some patients with occult or early thymic carcinoids have normal findings at chest radiography. These individuals may present with clinical evidence of ectopic ACTH production. Thoracic CT and nuclear medicine imaging have been recognized as useful studies in the evaluation of these patients. Although few reports of cross-sectional imaging features of thymic carcinoid have been published, these lesions have been described as anterior mediastinal masses indistinguishable from thymomas at CT. Invasion of local structures and calcification within the tumor have both been reported. CT and MR imaging studies may be helpful in the evaluation of patients with occult, hormonally active lesions.
References: Rosado de Christenson ML, Abbott GF, Kirejczyk WM, Galvin JR, Travis WD. Thoracic Carcinoids: Radiologic-Pathologic Correlation. Radiographics 1999;19:707-736.
Keywords: Mediastinum, Vascular, Benign tumor// Embolic, Thromboembolic,

No. of Applicants : 39

▶ Correct Answer : 3/39, 7.7%

- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- China Medical University Hospital,Taiwan Jun-Jun Yeh

▶ Correct Answer as Differential Diagnosis : 2/39, 5.1%

- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi
- Radiologie Guiton, La Rochelle, France Denis Chabassiere

▶ Semi-Correct Answer : 27/39, 69.2%

- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
- Riverside Radiology Associates, Columbus, Ohio, USA Sumit Seth
- Marien Hospital, Germany Davis Chiramel
- Yonsei University Hospital, Korea Eun Hye Yoo
- Kyungpook National University Hospital, Korea Han Young Jung
- Ross University, Portsmouth, Dominica Charles Ambelang
- Busan National University Hospital, Korea Su-mi Shin
- Yonsei University Hospital, Korea Seong Ho Whang
- University of Pennsylvania, USA Lisa Jones
- Maimonides Medical Center; Brooklyn, N.Y., U.S.A Naomi Twersky
- Gwangmyoung Sungae Hospital, Korea Jiyong Rhee
- Annemasse, Polyclinique de Savoie, France Gay-Depassier
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- Apollo FirstMed Hospital, Chennai, India R G Gopinath
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Nizam's Institute of Medical Sciences, Hyderabad, India Umadevi Malladi
- Seoul National University Hospital, Korea Eun JuChun
- Max Hospital, New Delhi, India Vickrant Malhotra
- Ultra care ,Coimbatore ,India Debabrata Das
- Monaldi Hospital, Naples, Italy Gaetano Rea
- Pgimer, Chandigarh, India. Julie Arora
- Samsung Medical Center, Seoul, Korea Ha Young Kim
- Seoul National University Hospital, Korea Kwang Nam Jin
- Seoul National University Hospital, Korea Heesun Park

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 421 Date 2005-11-21

Discussion

No. of Applicants : 39