대한흉부영상의학회 Weekly Chest Cases

Case No : 1077 Date 2018-06-19

Courtesy of Hyein Yun, Sung Shine Shim, Yookyung Kim, MD. / Ewha Womans University
Age/Sex 61 / F
Chief ComplaintRight shoulder pain

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Diagnosis With Brief Discussion

Diagnosis: Thymic neuroendocrine tumor (carcinoid)
Radiologic Findings: Fig 1. Chest PA shows mass like consolidation in right lower lung zone with right pleural effusion.
Fig 2-4. CT scans reveals an anterior mediastinal mass with invasion to right side of pericardium and heterogeneous enhancement (average HU 80). Pleural effusion without definite enhancement is seen in right hemithorax with passive atelectasis of right lower lobe.
Fig 5. This lesion is measured about 7.7 X 5.6 cm in diameter on coronal image.
Fig 6. Thymectomy was done after embolization of feeding arteries. Hypervascular tumor stain appears on selective angiography of right internal mammary.
Brief Review: Atypical carcinoid tumor is an extremely rare (0.18 per 1,000,000 population) and characterized by a high degree of malignancy and invasiveness without specific clinical features. The clinical manifestation includes no obvious early symptoms(1/3), nonspecific symptoms such as cough, chest pain, breathing difficulties, and other symptoms related to the anterior mediastinal space-occupying lesions, or carcinoid syndrome related to the tumor producing ectopic hormones, such as serotonin(2% of patients) or adrenocorticotropic hormone(25% of patients). This tumor exhibits local recurrence or distant metastasis.
On CT images, a large mass with an irregular or lobulated shape in the mediastinum close to blood vessels or surrounding pericardium and immature blood vessels, and liquefied necrotic area within the tumor may suggest atypical carcinoid tumor. Due to lack of specificity of radiologic finding, histological evaluation is needed for final confirmation. The differential diagnosis of the atypical carcinoid tumor includes all kinds of primary mediastinal tumors, principally lymphoma, germ cell tumors, parathyroid adenoma or carcinoma, pericardial cysts, and metastatic tumors with other origins.
Recommended treatment of resectable atypical carcinoid tumor is completely surgical resection. And for unresectable case, chemotherapy with or without radiation therapy is recommended.
References: 1. Zhu S, Wang Z-T, Liu W-Z, Zong S-X, Li B-S. Invasive atypical thymic carcinoid: three case reports and literature review. OncoTargets and therapy. 2016 Oct; 6171-6176.
2. K.
Keywords: anterior mediastinum, Neoplasm_Malignant,

No. of Applicants : 88

▶ Correct Answer : 9/88, 10.2%

- Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
- Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
- Wuhan Union Hospital , China QIGUANG CHENG
- TB centre kasaragod. , India rikhy krishnan
- , Korea (South) JONGSUN LEE
- Chonnam National University Hospital , Korea (South) YU BIN LEE

▶ Correct Answer as Differential Diagnosis : 9/88, 10.2%

- The University of Kyoto Hospital , Japan TOMOAKI OTANI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
- Other , Korea (South) SEONGSU KANG
- , Korea (South) HYO JAE LEE
- Gifu University Hospital , Japan Yo Kaneko
- Centre Hospitalier Regional de Lanaudiere , Canada MATTHIEU STORME
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1077 Date 2018-06-19

Discussion

No. of Applicants : 88