Final Diagnosis -- Metastatic Carcinoid Tumor (Anterior Mediastinal Mass)

FINAL DIAGNOSIS:

Anterior mediastinum, mediastinotomy -: Thymic carcinoid, 11.0 cm in diameter.; Parts two and three also contain areas of thymic carcinoid tumor.; Part four shows a microscopic focus of thymic carcinoid in the ectopic parathyroid gland.

Comment:
Immunoperoxidase stains for NSE, synaptophysin and cytokeratin are positive. Stains for chromogranin and ACTH are negative. These stain results support the diagnosis of carcinoid tumor. Twenty to thirty percent of these tumors occur in patients with MEN syndromes and are often associated with an aggressive clinical course. The suspicious area seen on the original frozen section in part 4 (ectopic parathyroid gland) stained positively for synaptophysin. This supports the diagnosis of carcinoid involvement of the ectopic parathyroid gland despite the lack of tumor seen on the permanent section slides.

For further information regarding this case, please see the Clinical Pathology Case of the Month for July, 1995.

Contributed by Jeff Nine, MD and Lina Perry, MD

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