Recurrence of thymic neuroendocrine carcinoma 24 years after total excision: A case report

Abstract

A 77-year-old male presented with chest pain in March 2012. The individual had undergone surgery for an anterior mediastinal tumor 24 years earlier and the pathological diagnosis was that of a thymoma. The patient underwent a medical check-up every 6 months for the next 20 years. However, ∼3 years following the final check-up, sudden chest pain was reported and the patient was referred again. Computed axial tomography revealed a mediastinal mass adjacent to the left lung, pericardium and sternum. There was no apparent invasion to the adjacent structures. The patient underwent surgical resection following a diagnosis of recurrent thymoma. A posterolateral thoracotomy was performed under video-assisted thoracoscopy. Severe adhesions were observed around the tumor, which appeared to invade the left lung and pericardium, but not the chest wall. The tumor was extirpated in combination with partial resection of the left lung and pericardium. The pathological diagnosis of the tumor was of a well-differentiated neuroendocrine carcinoma (NEC) of the thymus. The specimen that was excised 24 years earlier was re-examined by a pathologist and was reported to exhibit the same histology. Primary NECs of the thymus are rare among anterior mediastinal tumors and the 5-year survival rate is ∼30%. The present case study reports a case of a thymic NEC and describes the pathological and clinical features.

Keywords: long-term survival; recurrence; surgery; thymic neuroendocrine carcinoma.

Figure 1.

Imaging observations. (A) CT revealing an anterior mediastinal tumor with a maximum size of ∼3 cm. (B) PET/CT scan revealing abnormal uptake of ¹⁸F-fluorodeoxyglucose in the tumor. CT, computed tomography; PET, positron emission tomography.

Figure 2.

Macroscopic appearance of the cut sections of the tumor revealing a yellowish-white mass invading the left upper lobe (arrow).

Figure 3.

Microscopic features and immunohistochemical observations. (A) HE staining demonstrating that the tumor consisted of atypical carcinoid cells proliferating in sheets or small nested patterns accompanied by necrosis (arrow). (B) Immunoreactivity to chromogranin A. (C) HE staining and (D) immunohistochemistry of the specimen that was resected 24 years earlier demonstrating the same pathological observations of necrosis (arrow) and immunoreactivity to chromogranin A (original magnification, ×200). HE, hematoxylin and eosin.