Thymic neuroendocrine carcinoma

Case contributed by Dr Sally Ayesa

Presentation

Chest pain and shortness of breath.

Patient Data

Age: 50 years
Gender: Female
X-ray

Chest X-Ray

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. 

CT

Post contrast CT

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. 

Nuclear medicine

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. 

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Case information

rID: 88208
Published: 29th Mar 2021
Last edited: 31st Mar 2021
System: Oncology, Chest
Inclusion in quiz mode: Included
Institution: Gosford Hospital

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