Presentation
Chest pain and shortness of breath.
Patient Data
On the frontal CXR, there is a large lobulated opacity projected over the medial right mid-lower zone, which silhouettes the mediastinal contour. There is loss of the retrosternal clear space (inferiorly) on the lateral projection. Small bilateral pleural effusions.
There is a large heterogenously enhancing mass in the right anterior mediastinum. There is mass effect on the vessels at the posterior aspect, including the SVC which is narrowed, and heart medially. Several nodules at the superior aspect of the mass, and prominent nodes in the superior mediastinum and right axilla (not enlarged by size criteria). No pulmonary, pleural or upper abdominal masses to suggest metastases.
Following biopsy, the patient went on to a Ga68 DOTATATE PET-CT for staging. The large right anterior mediastinal mass has peripheral avidity (reflecting somatostatin receptor expression), and central photopaenia (?necrosis). Uptake in small lymph nodes in the superior mediastinum in keeping with local nodal metastases.
No avid metastatic disease.
Case Discussion
The large anterior mediastinal lesion was confirmed as a large cell thymic neuroendocrine carcinoma on biopsy. The patient went on to have surgical resection of the tumor and local nodes.