Atypical carcinoid: A rare finding of a man with mediastinal mass: A case report

Xuan,Wei‑Xia; Li,Jin‑Jin; Shi,Yu‑Jie; Zhang,Xiao‑Ju

doi:10.3892/mco.2020.2001

Atypical carcinoid: A rare finding of a man with mediastinal mass: A case report

Authors:
- Wei‑Xia Xuan
- Jin‑Jin Li
- Yu‑Jie Shi
- Xiao‑Ju Zhang
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Affiliations: Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital (People's Hospital of Zhengzhou University), Zhengzhou, Henan 450003, P.R. China
Published online on: February 19, 2020 https://doi.org/10.3892/mco.2020.2001
Pages: 325-328
Copyright: © Xuan et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The present case report describes a case of mediastinal atypical carcinoid and a favorable outcome linked with the treatment. Mediastinal atypical carcinoid is a rare and aggressive type of neuroendocrine tumor. A 56‑year‑old man was admitted at the Respiratory Department due to intermittent tightness of the chest for 1 month. An initial diagnosis of a mass in the left anterior mediastinum was conducted using CT scan and immunohistochemistry. Laboratory data revealed the following values: Neuron Specific Enolase of 62.13 ng/ml (reference range, 0‑40 ng/ml); CYFRA21 of 3.01 ng/ml (reference range, 0‑3.3 ng/ml); CEA of 4.22 (0‑6.5) ng/ml; SCC of 0.5 (0‑1.5) ng/ml; CA125 of 67.24 (0‑35) U/ml; AFP of 23 (0‑25) U/ml; CRP of 96.7 (0‑10) mg/l; PCT <0.05 (0‑0.05) ng/ml; and ESR of 48 (0‑20) mm/h. Tissue pathology revealed tumor cells with small cell pattern, and cell proliferation activity was 10%. Combined chemotherapy with bevacizumab (0.4 g, qd, once every 21 days) and capecitabine (0.15 g, Bid, Po) and timozolamine (0.34 mg, qd, po) was administered for 6 cycles. After the patient was given chemotherapy, the symptoms and CT exhibited improvement. On March 11, 2018, the lesion progressed into the lymph and pleura. The patient was commenced on radiotherapy and new chemotherapeutic regimen etoposide (0.5 g)‑carboplatin (0.4 g)‑bevacate (0.4 g). Another CT scan was performed after a month which revealed a substantial decrease in tumor size. Hence, a CT scan was performed for this patient who further revealed a decrease in tumor size. Currently patients are treated with bevacizumab maintenance therapy. Further studies of conservative treatment of chemotherapy and radiotherapy may provide a treatment to improve atypical carcinoid.

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1	Melosky B: Advanced typical and atypical carcinoid tumours of the lung: Management recommendations. Curr Oncol. 25:S86–S93. 2018.PubMed/NCBI View Article : Google Scholar
2	Rindi G, Klersy C, Inzani F, Fellegara G, Ampollini L, Ardizzoni A, Campanini N, Carbognani P, De Pas TM, Galetta D, et al: Grading the neuroendocrine tumors of the lung: An evidence-based proposal. Endocr Relat Cancer. 21:1–16. 2013.PubMed/NCBI View Article : Google Scholar
3	Ventura L, Gnetti L, Silini EM, Rindi G, Carbognani P, Rusca M and Ampollini L: Primary atypical carcinoid tumor of the mediastinum: A very rare finding. J Thorac Dis. 9:367–372. 2017.PubMed/NCBI View Article : Google Scholar
4	Strosberg JR, Berry MF and Tanzelaar HD: Thymic neuroendocrine (carcinoid) tumors. UpToDate. https://www.uptodate.com/contents/thymic-neuroendocrine-carcinoid-tumors. Jul 23, 2019.
5	Gielda BT, Peng R, Coleman JL, Thomas CR and Cameron RB: Treatment of early stage thymic tumors: Surgery and radiationtherapy. Current treatment options in oncology. 9:259–268. 2008.PubMed/NCBI View Article : Google Scholar
6	Wick MR, Scott RE, Li CY and Carney JA: Carcinoid tumor of the thymus: A clinicopathologic report of seven cases with a review of the literature. Mayo Clin Proc. 55:246–254. 1980.PubMed/NCBI
7	Tiffet O, Nicholson AG, Ladas G, Sheppard MN and Goldstraw P: A clinicopathologic study of 12 neuroendocrine tumors arising in the thymus. Chest. 124:141–146. 2003.PubMed/NCBI View Article : Google Scholar
8	Vinik AI, Silva MP, Woltering EA, Go VLW, Warner R and Caplin M: Biochemical testing for neuroendocrine tumors. Pancreas. 38:876–889. 2009.PubMed/NCBI View Article : Google Scholar
9	Lin FCF, Lin CM, Hsieh CC, Li WY and Wang LS: Atypical thymic carcinoid and malignant somatostatinoma in type I multiple endocrine neoplasia syndrome: Case report. Am J Clin Oncol. 26:270–272. 2003.PubMed/NCBI View Article : Google Scholar
10	John LC, Hornick P, Lang S, Wallis J and Edmondson SJ: Giant thymic carcinoid. Postgrad Med J. 67:462–465. 1991.PubMed/NCBI View Article : Google Scholar
11	Fukai I, Masaoka A, Fujii Y, Yamakawa Y, Yokoyama T, Murase T and Eimoto : Thymic neuroendocrine tumor (thymic carcinoid): A clinicopathologic study in 15 patients. Ann Thorac Surg. 67:208–211. 1999.PubMed/NCBI View Article : Google Scholar
12	Dutta R, Kumar A, Julka PK, Mathur SR, Kaushal S, Kumar R, Jindal T and Suri V: Thymic neuroendocrine tumour (carcinoid): Clinicopathological features 188 of four patients with different presentation. Interact Cardiovasc Thorac Surg. 11:732–736. 2010.PubMed/NCBI View Article : Google Scholar
13	Gal AA, Kornstein MJ, Cohen C, Duarte IG, Miller JI and Mansour KA: Neuroendocrine tumors of the thymus: A clinicopathological and prognostic study. Ann Thorac Surg. 72:1179–1182. 2001.PubMed/NCBI View Article : Google Scholar
14	Garg R, Bal A, DAS A, Singh N and Singh H: Proliferation marker (Ki67) in sub-categorization of neuroendocrine tumours of the lung. Turk Patoloji Derg. 35:15–21. 2019.PubMed/NCBI View Article : Google Scholar
15	Caplin ME, Baudin E, Ferolla P, Filosso P, Garcia-Yuste M, Lim E, Oberg K, Pelosi G, Perren A and Rossi RE: Pulmonary neuroendocrine (carcinoid) tumors: European neuroendocrine tumor society expert consensus and recommendations for best practice for typical and atypical pulmonary carcinoids. Ann Oncol. 26:1604–1620. 2015.PubMed/NCBI View Article : Google Scholar
16	Filosso PL, Guerrera F, Evangelista A, Welter S, Thomas P, Casado PM, Rendina EA, Venuta F, Ampollini L and Brunelli A: Prognostic model of survival for typical bronchial carcinoid tumours: Analysis of 1,109 patients on behalf of the European Association of Thoracic Surgeons, (ESTS) Neuroendocrine Tumours Working Group. Eur J Cardiothorac Surg. 48:441–447. 2015.PubMed/NCBI View Article : Google Scholar
17	Franco R, Marino FZ and Giordano A: The Mediastinal Mass-A multidisciplinary approach: 2018. Springer Link.
18	Fazio N, Grana C, Pelosi G, Torrisi R, Di Meglio G, Tradati N, Lorizzo K and De Braud F: Successful chemotherapy and 90Y-DOTATOC in a patient with mediastinal highly aggressive neuroendocrine carcinoma. Acta Oncol. 45:627–629. 2006.PubMed/NCBI View Article : Google Scholar
19	Furuta M, Hayakawa K, Kato S, Mitsuhashi N, Nakajima T and Niibe H: Malignant neuroendocrine tumor presenting a huge mediastinal mass controlled with radiation therapy. Lung cancer. 22:55–58. 1998.PubMed/NCBI View Article : Google Scholar
20	Kriegsmann M, Muley T, Harms A, Tavernar Goldmann T, Dienemann H, Herpel E and Warth A: Differential diagnostic value of CD₅ and CD₁₁₇ expression in thoracic tumors: A large scale study of 1,465 non-small cell lung cancer cases. Diagn Pathol. 10(210)2015.PubMed/NCBI View Article : Google Scholar