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Weekly Chest CasesCases by Disease Category

Case No : 1347 Date 2023-08-16

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  • Courtesy of Youkyung Lee / Hanyang University Guri Hospital
  • Age/Sex 72 / M
  • Chief ComplaintChest X-ray abnormality
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8 years ago

Diagnosis With Brief Discussion

Diagnosis
Atypical carcinoid
Radiologic Findings
Fig. 1-3. On CT images of 8 years ago, a 1.9 cm enhancing ovoid nodule is in the left anterior mediastinum at the aortic arch level.
Fig. 4. On chest X-ray of 5 years ago, the left anterior mediastinal mass is not seen.
Fig5-8. Current. Chest X-ray and CT images show a 9.8 cm enhancing mass in the left anterior mediastinum. The mass has multiple non-enhancing portions. On the superior medial side of the mass, there are hypertrophied adjacent and intra-tumoral vessels. The mass compresses the inferior portion of left innominate vein. There is no definite adjacent structure invasion.


Thymus, total thymectomy, Neuroendocrine tumor, grade 2, (Atypical carcinoid)
partially capsulated and focally invasive; slightly increased mitotic activity: about 5 mitotic counts/50 HPFs; no necrosis present, multifocal hemorrhage, and cystic change; clear but abutting resection margin
Brief Review
Thymic neuroendocrine neoplasms account for 2-5% of all thymic neoplasms and only 0.4% of all neuroendocrine neoplasms. All thymic neuroendocrine neoplasms share a propensity for recurrence, lymph node or distant metastasis, and tumor-associated death, with increasing risk from low-grade to high-grade tumors. (typical carcinoids-> atypical carcinoids->large cell neuroendocrine carcinoma
References
Neuroendocrine tumors, p391-394 In: Thoracic Tumours. 5th ed. WHO classification of tumours series. 5. WHO Classification of Tumours Editorial Board. International Agency for Research on Cancer, Lyon, France 2021

Mandegaran R, David S, Screaton N. Cardiothoracic manifestations of neuroendocrine tumours. Br J Radiol 2016; 89: 20150787.

Kan, Xiaojing MD*; Wang, Pengming MD*; Gong, Zhiquan MD; Gao, Feifei MD*; Zhang, Yuxia MD*; Ge, Yinghui MD, PhD*. Investigation on Computed Tomography Features of Primary Thymic Atypical Carcinoid Tumors. Journal of Computer Assisted Tomography 41(6):p 990-994, 11/12 2017. | DOI: 10.1097/RCT.0000000000000615
Keywords

No. of Applicants : 83

▶ Correct Answer : 17/83,  20.5%
  • - , Japan KYOKO NAGAI
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Other , Korea (South) SEONGSU KANG
  • - OITA UNIVERSITY , Japan FUMIKA ISHITOBI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KENTARO KOTANI
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Korea University Guro Hospital , Korea (South) LEE DAKYONG
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 16/83,  19.3%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - , Japan HIROAKI ARAKAWA
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Chonnam National University Hospital , Korea (South) HYUNJIN KIM
  • - The University of Tokyo Hospital , Japan WATARU GONOI
  • - Osaka University , Japan AKINORI HATA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - Fukuoka university , Japan KEISUKE SATO
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
▶ Semi-Correct Answer : 1/83,  1.2%
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
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