Ectopic Primary B Cell Lymphoma of the Thyroid Presenting as an Anterior Mediastinal Mass. A Case Report

Ectopic thyroid tumours arising in the mediastinum without connection to the cervical thyroid gland are very rare. Follicular adenoma, papillary carcinoma and follicular carcinoma in the mediastinum has been reported, but primary ectopic thyroid B cell lymphoma has not been reported previously. We report mediastinal primary ectopic thyroid large B cell lymphoma in an 80-year-old man. Differential diagnosis from primary mediastinal large B cell lymphoma and clinicopathologic features are discussed.     

Extended en bloc resection of a primary mediastinal parathyroid carcinoma

Parathyroid carcinoma is a rare endocrine tumor infrequently seen in the mediastinum. This report describes a patient who underwent en bloc resection of a primary mediastinal parathyroid carcinoma. The tumor originated from the thymus and extended from the aortic arch to the thyroid; local invasion suggested malignancy. En bloc resection of this carcinoma with all surrounding tissue provided local control of the tumor and relief of symptomatic hypercalcemia.     

Laparoscopic management of a transitional cell carcinoma arising in a right ectopic ureter

Ectopic ureter is a rare abnormality, so presenting a transitional cell carcinoma (TCC) arising from an ectopic ureter is extremely rare. We report here a case of a man with an invasive transitional cell carcinoma arising from a right ectopic ureter and managed by laparoscopy. To our knowledge, this is the fourth case described in the literature, and the second case of a TCC arising in a right ectopic ureter.     

A fluorodeoxyglucose avid mediastinal parathyroid adenoma masquerading as metastatic bladder cancer

A 64-year old male with a prior medical history of bladder transitional cell carcinoma treated with a cystoprostatectomy and adjuvant platinum-based chemotherapy 10 years earlier underwent a surveillance positron emission tomography (PET) scan that revealed a metabolically active 2-cm nodule in the superior mediastinum, anterior to the origin of the innominate artery. The lesion was removed due to concerns of metastatic disease using a cervical mediastinoscope. Final pathology revealed an ectopic mediastinal parathyroid adenoma. The combination of the rare presentation, uncommon surgical approach and pathology makes this case unique.     

Primary thymic adenocarcinoma coexisting with type AB thymoma: a rare case with long-term survival

Thymic carcinoma is a rare tumor. The most common histological subtype is squamous cell carcinoma, and only a few cases of thymic adenocarcinoma have been reported. A case of papillary adenocarcinoma of thymic origin that coexisted with type AB thymoma as a separate nodule is presented herein. The patient was found to have an abnormal mediastinal shadow on chest X-ray. A computed tomography scan revealed a round, 6.5-cm-diameter mass in the right anterior mediastinum. The preoperative diagnosis was thymoma, and thymothymectomy was performed. On pathological examination, two tumors, which were diagnosed as papillary adenocarcinoma and type AB thymoma, respectively, were present in the thymus without any connection with each other. The patient has been alive without any signs of recurrence for 11 years after surgery. We diagnosed the adenocarcinoma in this case was a primary thymic carcinoma.     

Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing's syndrome

Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing's syndrome is a rare disease. Recent evidence suggests that these tumors form part of a continuous spectrum ranging from well-differentiated carcinomas to small cell carcinomas. We report two new cases and review the 23 cases reported in the literature since 1972. The different diagnostic modalities are discussed, and an algorithm for the diagnosis of ectopic secretion of adrenocorticotropin (ACTH) is presented. In the future, the advent of radiologic and nuclear imaging as well as more accurate workup should help to diagnose these tumors at an earlier stage and improve the long-term outcome.     

Aberrant cervical thymus in children: three case reports and review of the literature

Aberrant migration of thymic tissue occurs with ectopic thymus in the mediastinum, base of the skull, tracheal bifurcation, and cervical region. A recent review of the literature showed a total of 76 reported cases of aberrant thymus or thymic cysts in patients who presented with primary neck masses. We report three additional cases of ectopic cervical thymus. All three patients presented with asymptomatic cervical masses, and preoperative diagnosis included branchial cleft cyst, cervical lymphangioma, and cervical teratoma. All patients underwent complete surgical resection of the masses. Aberrant cervical thymus rarely produces symptoms because it does not invade contiguous strictures. Despite its rarity, it should be considered in the differential diagnosis of asymptomatic neck masses in children.     

Ectopic thyroid masquerading as submandibular tumour: a case report

An ectopic thyroid gland may be present in any location along the path of migration from the foramen caecum to the mediastinum. The most common locations for an ectopic thyroid are the lingual thyroid followed by median cervical cysts. An ectopic thyroid in the submandibular region is extremely rare. We present the case of a 44-year-old patient with ectopic thyroid tissue in submandibular space and a review of the literature related to it.     

Intrapericardial Ectopic Goiter: A Very Unusual Presentation

Mediastinal ectopic goiter is a thyroid tumor that lies entirely below a plane extending from the superior surface of the first thoracic vertebra to the suprasternal notch, and commonly lies in the vicinity of the thymus. Intrapericardial ectopic goiter is extremely rare. We present an extremely rare case of a 63-year-old woman with an intrapericardial ectopic goiter and review the pertinent literature.     

Neurilemoma Originating from the Left Recurrent Nerve in the Superior Mediastinum: Report of a Case

We report a rare case of neurilemoma originating from the left recurrent nerve in the superior mediastinum.     

Malignant fibrous histiocytoma in the anterior mediastinum

The origin of a malignant fibrous histiocytoma in the anterior mediastinum is rare. A 71-year-old man was referred to our department for treatment of a tumor 15 cm in diameter originating in the anterior mediastinum. Malignant fibrous histiocytoma was suspected after a percutaneous needle biopsy. Systemic screening showed no other organ involvement, and the tumor was considered to be a primary mediastinal tumor. The tumor, resected through a median sternotomy, was well encapsulated and resection was complete. The pathological diagnosis was malignant fibrous histiocytoma originating in the anterior mediastinum.     

Squamous cell carcinoma of the thymus. An analysis of eight cases

Eight cases of squamous cell carcinoma of the anterior mediastinum, most likely derived from the thymus, are presented. Seven were male and one female ranging in age from 39 to 65 years; the average was 55.5 years. There were no cases associated with any paraneoplastic syndromes. They possessed common morphological characteristics. Grossly, the tumors resembled malignant thymoma. Invasion of the lung and metastases to regional lymph nodes were frequent. Often observed microscopically were foci of sharply defined keratinization resembling Hassall's corpuscles, no radial arrangement of tumor cells at the periphery of nests, and broad, fibrotic, or hyalinized stroma. Admixture of a few lymphoid cells and some features transitional to thymoma were also observed in some parts of tumors. However, undoubtedly carcinomatous areas were present in some or large parts of all the tumors, where individual cells possessed a vesicular nucleus and a prominent round nucleolus. These features were distinct from those of bronchogenic squamous cell carcinoma and other thymic tumors, although they appeared to be related to thymoma. Treatment of choice is radical surgery and postoperative radiotherapy, because of relatively high radiosensitivity. Prognosis of patients was relatively good. From analyses of cases it is concluded that squamous cell carcinoma of the thymus should be separated from ordinary thymoma of the epithelial type, and that squamous cell carcinoma involving both the thymus and lungs should be carefully examined for the primary site of growth.     

Solid cervical ectopic thymus in an infant

Cervical ectopic thymus presenting as a neck mass is rare in a neonate. Just more than 100 cases have been reported in the literature with less than 10% occurring in infants. We report a case of solid cervical ectopic thymus in an asymptomatic 2-month-old boy. We review the literature and discuss the embryology, pathophysiology, diagnosis, and management of an infantile ectopic thymus.     

Carcinoma showing thymus-like differentiation of the thyroid (CASTLE): a comparative study: evidence of thymic differentiation and solid cell nest origin

Carcinoma showing thymus-like differentiation (CASTLE) is a rare intrathyroidal neoplasm, a member of a tumor family probably arising from ectopic thymus or branchial pouch remnants. Thyroid solid cell nests (SCNs) may also be derived from branchial pouch remnants. SCNs express p63, carcinoembryonic antigen (CEA), and high molecular weight keratin (HMWK). To determine whether CASTLE and SCNs derive from similar embryologic origins/lines of differentiation, and to better differentiate CASTLE from other thyroid neoplasms, we compared p63, CD5, HMWK, and CEA staining of CASTLE and SCNs with other thyroid and thymic lesions. Seven CASTLE, 11 SCNs, 10 thymic carcinoma, 11 invasive thymoma, 12 thymoma, 28 papillary thyroid carcinoma, 4 thyroid squamous cell carcinoma, 2 childhood sclerosing carcinoma, 4 follicular adenoma, 6 follicular carcinoma, 4 poorly differentiated carcinoma, and 20 lymphocytic thyroiditis cases were analyzed. In normal thyroid, only SCNs stained for p63, HMWK, and CEA. The only CD5-positive cells in normal thyroid were T cells. Thymomas and normal thymus stained similarly to SCNs. All CASTLE and thymic carcinomas exhibited diffuse p63 and HMWK staining and all CASTLE cases and the majority of thymic carcinomas were positive for CEA and CD5. In contrast, none of the other thyroid neoplasms examined exhibited consistent staining for all 4 markers studied. These findings provide further evidence that CASTLE is distinct from other thyroid neoplasms, is probably of thymic origin, and may arise from branchial pouch remnants, the thyroid SCNs. Moreover CD5, HMWK, CEA and p63 can be used to help distinguish CASTLE from other thyroid neoplasms.     

Neuroendocrine carcinoma of thymus associated with Cushing’s syndrome — A case report

Neuroendocrine carcinoma (carcinoid) of the thymus associated with Cushing’s syndrome is a rare disease. These tumors behave aggressively with a tendency to invade adjacent structures. Majority of patients present with local recurrence of metastasis within five years after surgery. Surgical resection remains the treatment of choice as adjuvant radiotherapy and/or chemotherapy is controversial. We report a case of neuroendocrine carcinoma of thymic origin associated with ectopic adrenocorticotropin (ACTH) production causing Cushing’s syndrome and present a brief review of literature on this rare clinical condition.     

Collecting (Bellini) Duct Carcinoma of the Kidney — Clinical,Radiologic and Immunohistochemical Findings

We present clinical and radiological findings in a case of collecting (Bellini) duct carcinoma (CDC). This is a rare and aggressive kidney cancer originating from the distal renal tubule. The patient underwent radical nephrectomy and the pathological report showed trabeculopapillary, partially solid adenocarcinoma infiltrating the renal capsule and sinus. Immunohistochemical, as well as mucinocarminic and PAS staining studies are necessary for diagnosis of CDC. Surprisingly, one year follow-up studies were negative for recurrent disease. Chromosomal findings are usually different from most often diagnosed clear cell renal cell cancers. Findings from the literature are briefly discussed.     

Collecting duct carcinoma with acquired cystic disease of the kidney in a long-term hemodialysis patient

Abstract:   We report a very rare case of collecting or Bellini duct carcinoma (CDC) found in a 60-year-old male who had received hemodialysis therapy for 21 years. Screening with ultrasonography revealed a solid tumor originating from the cyst wall in the right kidney with acquired cystic disease of the kidney. Subsequent computed tomography (CT) and angiography could not detect another renal tumor. Right radical nephrectomy was performed. The tumor detected preoperatively was composed of papillary renal cell tumor (RCC) and multiple clear cell carcinoma, pathologically. In addition to the tumors, CDC was revealed in the central medulla with the involvement of regional lymph nodes. Three months later, left nephrectomy was performed because left RCC was suspected during CT. The histological diagnosis was multiple clear cell carcinomas. Peritonitis carcinomatosa appeared and the patient died 13 months later.     

Large B cell lymphoma of the mediastinum. 6 cases

Mediastinal large cell lymphoma with sclerosis (MLCLS) is a recently described entity characterized by its locoregional extension, within the anterior mediastinum, and its B cell origin, although the proliferation arises from the thymus. It has been, in the past, often mistaken for other tumors of the anterior mediastinum: invasive thymoma, Hodgkin's disease, poorly differentiated clear cell carcinoma and seminoma, thus leading to inappropriate therapeutic approaches. We diagnosed 6 cases of MLCLS in 1986 and 1987, in 4 males and 2 females, aged 16 to 44 (mean 27). Five of the 6 patients presented with a compressive anterior mediastinal mass, dyspnea, dysphonia, superior vena cava syndrome and parietal protrusion (3 cases). The CT scan confirmed the invasive and compressive characters of the tumor. Two patients initially had disseminated disease. Microscopically, the proliferation was composed of large clear cells, and segmented by bands of sclerosis. Immunologic studies demonstrated the B origin of the tumor cells. All 6 patients received combination therapy with an intensive CHOP protocol (L N H 84 Lyon). The first patient was initially operated, after a false frozen section diagnostic of thymoma. Resistance to chemotherapy (and rapid death within 2 months) was seen in 2 cases. On patient had a partial remission and 3 entered complete remission, of 5+, 10+ and 11 months duration, respectively, with central nervous system relapse in the latter case. Excavation of the tumor on CT scan imaging seemed to be a poor prognostic factor.(ABSTRACT TRUNCATED AT 250 WORDS)     

胸腔镜胸腺扩大切除加颈部切口治疗重症肌无力

目的 探讨胸腔镜胸腺扩大切除加颈部切口治疗重症肌无力的可行性和术后疗效.方法 2005年1月至2006年2月采用胸腔镜胸腺切除加颈部切口治疗重症肌无力患者41例,其中男性18例,女性23例,年龄18～67岁.病程1个月～3年.术中除完整切除胸腺外,还清除前纵隔区域及颈根部的异位胸腺和脂肪组织.结果 全组41例手术完全在电视胸腔镜下完成,平均手术时间162 min.术后发生肌无力危象7例.术后病理学诊断:4例颈部发现残存胸腺上极,35例患者气管前胸骨上间隙有肿大淋巴结(3～17枚).所有患者均痊愈出院.术后随访观察2年,完全缓解率41.4%,有效率达85.4%.结论 胸腔镜下胸腺切除术治疗重症肌无力能取得较为理想的治疗效果,胸腔镜扩大胸腺切除加颈部切口对于颈根部异位胸腺的清除是一补充.     

Thoracic intrathymic thyroid.

OBJECTIVE: The authors introduce thoracic intrathymic thyroid as a clinical entity. SUMMARY BACKGROUND DATA: Although accessory aberrant thyroid has not been found in other tissues in the mediastinum, a thoracic intrathymic location has not been described previously. It is believed that mediastinal thyroid tissue represents accessory ectopic tissue from the median thyroid anlage. Moreover, the close association of the thymus and thyroid supports the theory that mediastinal ectopic thyroid tissue develops from abnormal descent of these structures during embryogenesis. METHODS: Benign thoracic intrathymic thyroid lesions are described in patients with mediastinal masses. CONCLUSION: Thoracic intrathymic thyroid is a distinct entity. Its occurrence is supported both clinically and embryologically.