Perhimpunan Dokter Paru Indonesia - Giant mediastinal atypical carcinoid tumor
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Giant mediastinal atypical carcinoid tumor

Recep Demirhan, Hatice Eryigit, Altug Kosar and Mehmet Tukel
Thoracic Surgery, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey

Fifty-one years old male with shortness of breath increased by effort since one year. The patient was smoking 30 packs of cigarette per year. Inspiration sounds were decreased on the left hemithorax. Pulmonary function test results were; FEV1: 2.21 L (60%), FVC: 3.22 L (70%), PEF: 3.71 L (42%), FEV 1/FVC: 68.6%. The computerized thorax tomography, showed a 155x127 mm soft tissue mass on the left anterior mediastinal region, pressing vascular structures, and heart, and causing atelectasis on the upper lobe. Incisional biopsy was taken from the mass via mediastinotomy at a differenet hospital; the pathology result was malignant diffuse lymphoma. PET-CT was applied for staging. 2R mediastinum hypermetabolic lymph node station, with 14.5 mm diameter was detected (SUV max: 5.4). The mass SUV max: was 8.7. Chemotherapy was applied to the patient with diagnose of lymphoma. However, due to lack of regression of mass, biopsy slides were reexamined; the diagnosis was changed to be carcinoid tumor. The mass was decided to be surgically removed by median sternotomy. The mass was quite vascular, and had tight adhesions between the lung and pericardium. The result of frozen section of the mass was reported to be atypical carcinoid tumor. The mass was removed totally. Mesh was placed instead of excised pericardium. The mass weight was 1300gr, size was 17.5x 15x 9.5 cm. No tumor was detected within surgical margins. Chromogranin, Synaptofizin, CK, and CD 56 was positive at the immunohistochemical panel. Microscopic findings were confirmed atypical carcinoid tumor. In conclusion, mediastinal carcinoid tumors are very rare. Their origin of tumor is difficult to determine. Surgery is the current treatment method.

PDPI Jatim. 19/04/17.

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