PMC8769203_01
The CT, MRI, and PET/CT images of this patient. (A) A soft tissue density nodule in the mediastinum (red arrow). (B) A nodule in the right side of the pituitary (red arrow). (C, D) The anterior mediastinal nodule with increased 68Ga uptake (red arrow). (E) The anterior mediastinal nodule with increased fluorodeoxyglucose uptake (red arrow).
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The thoracic computed tomography (CT) result suggested a nodule in the left anterior mediastinum, about 1.6 cm in diameter ( Figure 1A ). The enhanced magnetic resonance imaging (MRI) of the pituitary revealed a 3 x 2-mm nodule in the right side of the pituitary after enhancement, which was suspected as pituitary microadenoma ( Figure 1B ). ACTH-secreting tumor, we recommended that the patient finish the positron emission tomography CT (PET/CT) scan. After the 68Ga-DOTATATE-PET/CT and 18F-fluorodeoxyglucose (FDG)-PET/CT were finished, the results showed both 68Ga ( Figures 1C, D ) and glucose ( Figure 1E ) uptake in the anterior mediastinal nodule, which suggested a neuroendocrine tumor.
The immunohistochemical staining pattern of mediastinal mass. Tumor cells show a positivity for adrenocorticotrophic hormone (A) (original magnification, x100), chromogranin A (B) (original magnification, x200), PCK (C) (original magnification, x100), and S100 (D) (original magnification, x200) and synaptophysin (E, F) (original magnification, x100 and x200).
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S100 protein, which is a characteristic of paraganglioma, showed positive staining in the sustentacular cells. So, considering the positive staining of ACTH and PCK and the negative staining of EMA, we took the diagnosis of a paraganglioma with ACTH-secreting function ( Figure 2 ).