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A rare case of primary thymic adenocarcinoma mimicking small cell lung cancer.

Cho EN, Park HS, Kim TH, Byun MK, Kim HJ, Ahn CM, Chang YS - Tuberc Respir Dis (Seoul) (2015)

Bottom Line: A 36-year-old male patient presented with hoarseness over the past 3 months.The patient received four cycles of systemic chemotherapy, consisting of etoposide and cisplatin, with concurrent radiotherapy (6,000 cGy/30 fractions) to the mediastinal lesion and the metastatic brain lesion (4,200 cGy/12 fractions).A follow-up chest CT scan and brain MRI showed a decrease in the size of the left upper mediastinal mass and brain lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Primary thymic adenocarcinoma is a very rare malignancy of the anterior mediastinum with no standardized treatment. A 36-year-old male patient presented with hoarseness over the past 3 months. A chest computed tomography (CT) scan showed an infiltrative mass to the proximal vessels and aortic arch in left upper mediastinum (4.1×3.1×5.4 cm). Brain magnetic resonance imaging (MRI) showed focal lesions, suggesting metastasis in the left frontal lobe. A thoracoscopic biopsy of the mediastinal mass confirmed a primary thymic adenocarcinoma forming a glandular structure with atypia of tumor cells. The patient received four cycles of systemic chemotherapy, consisting of etoposide and cisplatin, with concurrent radiotherapy (6,000 cGy/30 fractions) to the mediastinal lesion and the metastatic brain lesion (4,200 cGy/12 fractions). A follow-up chest CT scan and brain MRI showed a decrease in the size of the left upper mediastinal mass and brain lesion. We report a rare case of the primary thymic adenocarcinoma with a literature review.

No MeSH data available.


Related in: MedlinePlus

Histopathological findings of the thymic tumor for the diagnosis of primary thymic adenocarcinoma. (A) H&E staining showed an infiltrative tumor forming an adenomatous structure with atypia of tumor epithelial cells in mediastinal lymph nodes and mediastinal mass using light microscopy (×200). Immunohistochemical staining revealed CD5, thymus cell marker, positive in this tumor (B) and negative finding of alveolar cell marker TTF-1 and Napsin A (C) (B and C, ×400). Taken together, these tumors were adenocarcinomas originating from the thymus.
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Figure 2: Histopathological findings of the thymic tumor for the diagnosis of primary thymic adenocarcinoma. (A) H&E staining showed an infiltrative tumor forming an adenomatous structure with atypia of tumor epithelial cells in mediastinal lymph nodes and mediastinal mass using light microscopy (×200). Immunohistochemical staining revealed CD5, thymus cell marker, positive in this tumor (B) and negative finding of alveolar cell marker TTF-1 and Napsin A (C) (B and C, ×400). Taken together, these tumors were adenocarcinomas originating from the thymus.

Mentions: Initial chest CT scan (Figure 1A) showed an infiltrative mass in the left upper mediastinum (4.1×3.1×5.4 cm), encircling the left common carotid artery and left subclavian artery. Brain magnetic resonance imaging (MRI) with contrast (Figure 2B) revealed focal enhancing lesion in the left frontal lobe suggesting metastasis. Torso positron emission tomography (PET)/CT presented about 1.6-cm hypermetabolic lesion in left paravertebral region of thoracic spine two (T2) level and 3.9-cm-sized hypermetabolic mass in the left upper mediastinal region just above the aortic arch which seems the same lesion observed with chest CT. Those radiologic imaging study were suggestive small cell lung cancer. Elevated plasma levels of carcinoembryonic antigen (CEA) and neuron specific enolase (NSE) were also supportive evidence for suggesting small cell lung cancer (CEA, 6.0 ng/mL [0.2-5.0 ng/mL]; NSE, 12.9 ng/mL [7.5-12.5 ng/mL]). However, thoracoscopic biopsy of the mediastinal mass showed unexpected results at all; presence of carcinoma suggestive of adenocarcinoma was reported. To conclude this finding, multiple mediastinoscopic biopsies of the left upper mediastinal side of the infiltrative mass and lymph nodes around the mass were performed. Pathologic results showed an adenomatous feature with glandular formation and immunoreactive for cytokeratin, CEA, and CD5 (Figure 2A, B) which means this tumor is adenocarcinoma originated from the thymus. IHC staining for TTF1 and napsin A (Figure 2C) were negative and was able to exclude tumors derived from the lung. The patient diagnosed as primary thymic adenocarcinoma (conventional subtype) and staged as Masaoka stage IV. A complete resection was not performed due to the invasion of the proximal vessel and aortic arch.


A rare case of primary thymic adenocarcinoma mimicking small cell lung cancer.

Cho EN, Park HS, Kim TH, Byun MK, Kim HJ, Ahn CM, Chang YS - Tuberc Respir Dis (Seoul) (2015)

Histopathological findings of the thymic tumor for the diagnosis of primary thymic adenocarcinoma. (A) H&E staining showed an infiltrative tumor forming an adenomatous structure with atypia of tumor epithelial cells in mediastinal lymph nodes and mediastinal mass using light microscopy (×200). Immunohistochemical staining revealed CD5, thymus cell marker, positive in this tumor (B) and negative finding of alveolar cell marker TTF-1 and Napsin A (C) (B and C, ×400). Taken together, these tumors were adenocarcinomas originating from the thymus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4388894&req=5

Figure 2: Histopathological findings of the thymic tumor for the diagnosis of primary thymic adenocarcinoma. (A) H&E staining showed an infiltrative tumor forming an adenomatous structure with atypia of tumor epithelial cells in mediastinal lymph nodes and mediastinal mass using light microscopy (×200). Immunohistochemical staining revealed CD5, thymus cell marker, positive in this tumor (B) and negative finding of alveolar cell marker TTF-1 and Napsin A (C) (B and C, ×400). Taken together, these tumors were adenocarcinomas originating from the thymus.
Mentions: Initial chest CT scan (Figure 1A) showed an infiltrative mass in the left upper mediastinum (4.1×3.1×5.4 cm), encircling the left common carotid artery and left subclavian artery. Brain magnetic resonance imaging (MRI) with contrast (Figure 2B) revealed focal enhancing lesion in the left frontal lobe suggesting metastasis. Torso positron emission tomography (PET)/CT presented about 1.6-cm hypermetabolic lesion in left paravertebral region of thoracic spine two (T2) level and 3.9-cm-sized hypermetabolic mass in the left upper mediastinal region just above the aortic arch which seems the same lesion observed with chest CT. Those radiologic imaging study were suggestive small cell lung cancer. Elevated plasma levels of carcinoembryonic antigen (CEA) and neuron specific enolase (NSE) were also supportive evidence for suggesting small cell lung cancer (CEA, 6.0 ng/mL [0.2-5.0 ng/mL]; NSE, 12.9 ng/mL [7.5-12.5 ng/mL]). However, thoracoscopic biopsy of the mediastinal mass showed unexpected results at all; presence of carcinoma suggestive of adenocarcinoma was reported. To conclude this finding, multiple mediastinoscopic biopsies of the left upper mediastinal side of the infiltrative mass and lymph nodes around the mass were performed. Pathologic results showed an adenomatous feature with glandular formation and immunoreactive for cytokeratin, CEA, and CD5 (Figure 2A, B) which means this tumor is adenocarcinoma originated from the thymus. IHC staining for TTF1 and napsin A (Figure 2C) were negative and was able to exclude tumors derived from the lung. The patient diagnosed as primary thymic adenocarcinoma (conventional subtype) and staged as Masaoka stage IV. A complete resection was not performed due to the invasion of the proximal vessel and aortic arch.

Bottom Line: A 36-year-old male patient presented with hoarseness over the past 3 months.The patient received four cycles of systemic chemotherapy, consisting of etoposide and cisplatin, with concurrent radiotherapy (6,000 cGy/30 fractions) to the mediastinal lesion and the metastatic brain lesion (4,200 cGy/12 fractions).A follow-up chest CT scan and brain MRI showed a decrease in the size of the left upper mediastinal mass and brain lesion.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Primary thymic adenocarcinoma is a very rare malignancy of the anterior mediastinum with no standardized treatment. A 36-year-old male patient presented with hoarseness over the past 3 months. A chest computed tomography (CT) scan showed an infiltrative mass to the proximal vessels and aortic arch in left upper mediastinum (4.1×3.1×5.4 cm). Brain magnetic resonance imaging (MRI) showed focal lesions, suggesting metastasis in the left frontal lobe. A thoracoscopic biopsy of the mediastinal mass confirmed a primary thymic adenocarcinoma forming a glandular structure with atypia of tumor cells. The patient received four cycles of systemic chemotherapy, consisting of etoposide and cisplatin, with concurrent radiotherapy (6,000 cGy/30 fractions) to the mediastinal lesion and the metastatic brain lesion (4,200 cGy/12 fractions). A follow-up chest CT scan and brain MRI showed a decrease in the size of the left upper mediastinal mass and brain lesion. We report a rare case of the primary thymic adenocarcinoma with a literature review.

No MeSH data available.


Related in: MedlinePlus