Giant mediastinal carcinoid.

A 25-year-old male was presented with cough. Computed tomography (CT) scan showed anterior mediastinal mass [Figure 1] encasing the aortic arch and left brachiocephalic vein with compression of the superior vena cava. CT-guided biopsy showed neuroendocrine tumor staining with chromogranin, synaptophysin, and neuron specific enolase. Postchemoradiotherapy positron emission tomography-CT scan revealed static disease [Figure 2]. At surgery, the mass could be dissected off the major vessels; the thrombosed left brachiocephalic vein was resected. Good collaterals obviated the need for vascular reconstruction. The patient recovered after a stormy postoperative course. Histopathology report showed neuroendocrine carcinoma, mitotic rate of 10/10 HPF, and MIB-1 proliferation index of 8-10%. On 5-year follow-up, the patient is asymptomatic and disease-free on CT scan.

Figure 1

Anterior mediastinal mass encasing arch aorta, left brachiocephalic vein, and compressing superior vena cava

Figure 2

Static disease post chemoradiotherapy

Thymic carcinoids are rare, accounting for 2% of all carcinoids; often invading locally and metastasizing distantly. Complete surgical resection is potentially curative. Prognosis is correlated with the degree of differentiation and completeness of resection.