A Case of Distal Pancreatectomy for Pancreatic Metastasis of Thymic Atypical Carcinoid

Masashi Inoue^1, , Masahiro Tanemura², Toshimitsu Irei¹, Yuyo Maeda¹, Megumi Yamaguchi¹, Tatsuya Miyamoto¹, Shingo Seo¹, Toshihiro Misumi¹, Wataru Shimizu¹, Takahisa Suzuki¹, Takashi Onoe¹, Takeshi Sudo¹, Yosuke Shimizu¹, Takao Hinoi¹ and Hirotaka Tashiro¹

¹Department of surgery, Kure Medical Center Chugoku Cancer Center, Kure, Japan

²Department of Surgery, Osaka police Hospital, Osaka, Japan

Cite this paper:
Masashi Inoue, Masahiro Tanemura, Toshimitsu Irei, Yuyo Maeda, Megumi Yamaguchi, Tatsuya Miyamoto, Shingo Seo, Toshihiro Misumi, Wataru Shimizu, Takahisa Suzuki, Takashi Onoe, Takeshi Sudo, Yosuke Shimizu, Takao Hinoi and Hirotaka Tashiro. A Case of Distal Pancreatectomy for Pancreatic Metastasis of Thymic Atypical Carcinoid. American Journal of Medical Case Reports. 2017; 5(12):285-288. doi: 10.12691/ajmcr-5-12-1

Abstract

Background: Thymic atypical carcinoid(AC) tends to have a more aggressive clinical course than typical carcinoid(TC). About 20%-30% of patients with thymic AC experience local recurrence or distant metastasis. Pancreatic metastasis of thymic AC is extremely infrequent. We experienced a case of pancreatic metastasis of thymic atypical carcinoid, in which a distal pancreatectomy was performed. Case presentation: A 50-year-old man underwent thoracoscopic resection of a mediastinal tumor in June 2009. The diagnosis was thymic AC. He also underwent an extended thymectomy in October 2011, thoracoscopic resection in October 2012, and tumor resection of the chest wall in March 2013 for recurrences. During follow up in April 2014, computed tomography (CT) revealed lymph node swelling on the ventral side of the brachiocephalic vein, around the left gastric vein, and on the left side of the celiac artery. Dynamic CT revealed a pancreatic tumor 10 mm in diameter with low enhancement. EUS-guided fine-needle aspiration (EUS-FNA) biopsy revealed the pancreatic tumor was compatible with metastasis of thymic AC. The patient underwent abdominal lymph node resection and distal pancreatectomy in June 2014. Because the lymph node on the ventral side of the branchiocephalic vein was judged as unresectable, 60-Gy radiation therapy was given in September 2014. Per pathological examination and immunohistochemistry, the final diagnosis was pancreatic metastasis of thymic AC. With several chemotherapy courses for recurrences, the patient has remained alive for eight years after the first surgery. Conclusion: AC metastasis to the pancreas is extremely rare. EUS-FNA is useful for diagnosis. Definitive determination of whether the treatment provides a survival benefit awaits further studies.

Keywords:
thymic atypical carcinoid pancreatic metastasis distal pancreatectomy

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References:

[1]	Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. WHO Classification of tumours of the Lung, Pleura, Thymus and Heart. Lyon: International Agency for Research on Cancer,2015
[2]	Fukai I, Masaoka A, Fujii Y, Yamakawa Y, Yokoyama T, Murase T, et al. Thymic neuroendocrine tumor (thymic carcinoid): A clinicopathologic study in 15 patients. Ann Thorac Surg 1999; 67: 208-211.
[3]	de Montpréville VT, Macchiarini P, Dulmet E. Thymic neuroendocrine carcinoma (carcinoid): A clinicopathologic study of fourteen cases. J Thorac Cardiovasc Surg 1996; 111: 134-141.
[4]	Han B, Sun JM, Ahn JS, Park K, Ahn MJ. Clinical outcomes of atypical carcinoid tumors of the lung and thymus: 7-year experience of a rare malignancy at single institute. Med Oncol. 2013; 30: 1-7.
[5]	Ströbel P, Zettl A, Shilo K, et al. Tumor genetics and survival of thymic neuroendocrine neoplasms: a multi-institutional clinicopathologic study. Genes Chromosomes Cancer. 2014; 53: 738-749.
[6]	Wick MR and Rosai J: Neuroendocrine neoplasms of the mediastinum. Semin Diagn Pathol.1991; 8: 35-51.
[7]	Soga J, Yakuwa Y, Osaka M: Evaluation of 342 cases of mediastinal/thymic carcinoids collected from literature: A comparative study between typical carcinoids and atypical varieties. Ann Thorac Cardiovasc Surg.1999; 5: 285-292.
[8]	Öberg K, Hellman P, Ferolla P, Papotti M. Neuroendocrine bronchial and thymic tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2012; 7: 120-123.
[9]	Moran CA, Suster S. Neuroendocrine carcinomas (carcinoid tumor) of the thymus. Am J Clin Pathol. 2000; 114: 100-110.
[10]	Lee YT, Tse GM, Lai PB, Sung JJ. Metastatic thymic neuroendocrine carcinoma presenting as a pancreatic tumor. Endoscopy. 2006; 38: 58-59.
[11]	Varytimiadis K, Kalaitzakis E, Salla C, Ghika E, Pandazopoulou A, Karoumpalis I. Pancreatic metastasis of thymic neuroendocrine carcinoma: Is there a role for endoscopic ultrasound? Report of a case and review of the literature. Pancreas. 2009; 38: 230-232.
[12]	DU Y, Wang Y, Tang J, et al: Pancreatic metastasis resulting from thymic neuroendocrine carcinoma: A case report. Oncol Lett. 2016; 11: 1907-1910.
[13]	Gaur P, Leary C, Yao JC. Thymic neuroendocrine tumors: a SEER database analysis of 160 patients. Ann Surg. 2010; 251: 1117-1121.
[14]	Chaer R, Massad MG, Evans A, Snow NJ, Geha AS. Primary neuroendocrine tumors of the thymus. Ann Thorac Surg. 2002; 74: 1733-1740.
[15]	Hage R, de la Rivière AB, Seldenrijk CA, van den Bosch JM. Update in pulmonary carcinoid tumors: a review article. Ann Surg Oncol. 2003; 10: 697-704.
[16]	Larghi A, Iglesias-Garcia J, Poley JW, Monges G, Petrone MC, Rindi G, Abdulkader I, Arcidiacono PG, Costamagna G, Biermann K, et al. Feasibility and yield of a novel 22-gauge histology EUS needle in patients with pancreatic masses: a multicenter prospective cohort study. Surg Endosc. 2013; 27: 3733-3738.
[17]	Ardengh JC, de Paulo GA, Ferrari AP. EUS-guided FNA in the diagnosis of pancreatic neuroendocrine tumors before surgery. Gastrointest Endosc. 2004; 60: 378-384.
[18]	Chatzipantelis P, Salla C, Konstantinou P, Karoumpalis I, Sakellariou S, Doumani I. Endoscopic ultrasound-guided fine-needle aspiration cytology of pancreatic neuroendocrine tumors: a study of 48 cases. Cancer. 2008; 114: 255-262.
[19]	Mitsuru Sugimoto, Tadayuki Takagi, Takuto Hikichi, Rei Suzuki, Ko Watanabe, Jun Nakamura, et al. Efficacy of endoscopic ultrasonography-guided fine needle aspiration for pancreatic neuroendocrine tumor grading.World J Gastroenterol. 2015; 21: 8118-8124.
[20]	Hage R, de la Rivière AB, Seldenrijk CA, van den Bosch JM. Update in pulmonary carcinoid tumors: a review article. Ann Surg Oncol. 2003; 10:697-704.