PMC3432386_01
(a) Chest X-ray shows enlargement of the mediastinum. (b) Chest computed tomography image demonstrates a large inhomogeneous mass with calcifications in the anterior mediastinal compartment. The tumor is in close relationship with the ascending aorta and the common trunk of the pulmonary artery, with apparent preservation of a cleavage plane.
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fig1
Chest X-rays revealed an abnormal enlargement in the mediastinum (Figure 1(a)). CT scan showed a large solid inhomogeneous mass originating in the anterior mediastinum and abutting into the left pleural space (about 10 x 8 x 7 cm, Figure 1(b)), as well as a nodular lesion in the 3rd liver segment (suspicious for hepatocarcinoma, HCC, already detected in a scan two years before), but was negative at the encephalic level.
(a) The tumor shows a lobular architecture made of small uniform cells, with indistinct cell borders, hyperchromatic nuclei, fibrillary matrix material, and scattered large cells with eosinophilic cytoplasm. (b) The tumor is strongly positive for NSE immunostaining.
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fig2
Microscopically, the tumor showed a lobular architecture made of small uniform cells, with indistinct cell borders, hyperchromatic nuclei, fibrillary matrix material, and scattered large cells with eosinophilic cytoplasm (Figure 2(a)). At immunohistochemistry tumor cells were positive for neuroendocrine markers: CD56, neuron specific enolase (NSE), synaptophysin, and chromogranin A (Figure 2(b)).