대한흉부영상의학회 Weekly Chest Cases

Case No : 978 Date 2016-07-25

Courtesy of Won Jin Choi, Eun-ju Kang, Ki-Nam Lee / Dong-A University Hospital
Age/Sex 67 / M
Chief ComplaintAbnormal radiographic finding on health screening

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Diagnosis With Brief Discussion

Diagnosis: Large cell neuroendocrine carcinoma (LCNEC) of the thymus
Radiologic Findings: Chest radiography (Fig. 1) showed relatively well defined large mass in left central area, obscuring left heart border. Non-enhanced (Fig. 2) and enhanced chest CT scan (Fig. 3-5) showed a well-defined, lobulated, inhomogeneously enhancing mass in left side of anterior mediastinum, abutting pulmonary trunk, left main pulmonary artery, left aspect of aortic arch, left upper pulmonary vein. A satellite small well defined nodule was located between left common carotid artery and left brachiocephalic vein (Fig. 6). showed no evidence of lung parenchymal invasion. PET-CT scan showed heterogenous high FDG uptake in the mass lesion (SUVmax: 8.19, Fig. 7).
The patient underwent surgical mass excision (Fig. 8). The final pathological report showed a large cell neuroendocrine carcinoma (LCNEC) of the thymus. The tumor cells were immunoreactive for the neuroendocrine markers cytokeratin-Pan, synaptophysin, and CD56 on the immunohistochemical stains.
Brief Review: Primary thymic neuroendocrine carcinomas (NECs) are relatively rare neoplasms that may account for approximately 2%
References: 1. Yoon YH, Kim JH, Kim KH, Baek WK, Lee HK, Lee MH, Lee KH, Kim L. Large cell neuroendocrine carcinoma of the thymus: a two-case report. Korean J Thorac Cardiovasc Surg. 2012 Feb;45(1):60-4.
2. Mega S, Oguri M, Kawasaki R, Hazama K, Iwai K, Kondo S. Large-cell neuroendocrine carcinoma in the thymus. Gen Thorac Cardiovasc Surg. 2008 Nov;56(11):566-9.
3. Ogawa F, Iyoda A, Amano H, Nezu K, Jiang SX, Okayasu I, Satoh Y. Thymic large cell neuroendocrine carcinoma: report of a resected case - a case report. J Cardiothorac Surg. 2010 Nov 22;5:115
Keywords: Mediastinum, Malignant tumor,

No. of Applicants : 82

▶ Correct Answer : 3/82, 3.7%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi

▶ Correct Answer as Differential Diagnosis : 2/82, 2.4%

- Kanto Rosai Hospital , Japan Taku Tajima
- Aerospace medical group, Air Force Education and Training Command , Korea (South) Donghwan Kim

▶ Semi-Correct Answer : 14/82, 17.1%

- Otsu Municipal Hospital , Japan Noriatsu Ichiba
- Northern Yokohama Showa university , Japan Kota Watanabe
- ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
- Korea University Guro Hospital , Korea (South) Bit Na Park
- Onomichi municipal hospital , Japan Hirofumi Mifune
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Gifu University Hospital , Japan Yo Kaneko
- Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
- University of Tsukuba, Dept of Radiology , Japan Manabu Minami
- Korea University Guro Hospital , Korea (South) Sun Hong
- University of Tsukuba , Japan Toshitaka Ishiguro
- Korea University Guro Hospital , Korea (South) Hwanseok Yong
- Korea University Guro Hospital , Korea (South) Yoonmi Choi
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 978 Date 2016-07-25

Discussion

No. of Applicants : 82