PMC6526992_01
Axial thorax computerized tomography showed a macrolobulary mass (white arrow) with irregular border and calcification, invasion to brachio-cephalic vein and pathological size paratracheal, subcarinal, and hilar lymphadenopathy.
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F1
Since he had upper mediastinal widening, thorax computerized tomography (CT) was performed and showed a macro lobular mass in size of 67 mm x 49 mm with irregular border and calcification, and also invasion to brachiocephalic vein and paratracheal, subcarinal and hilar lymphadenopathy in size up to 45 mm were detected (Fig. 1).
(A) Atypical carcinoid. Uniform tumor cells with nested, trabecular and rosette-like growth patterns. Polygonal tumor cells have moderate eosinophilic granular cytoplasm, round to oval nuclei, "salt and pepper" chromatin and inconspicuous nucleoli (H&E staining, x200 magnification) H&E x200. (B) Immunohistochemical staining with adrenocorticotropic hormone (ACTH) (ACTH staining, x400 magnification) ACTH x400. (C) Immunohistochemical staining with synaptophysin (Synaptophysin staining, x400 magnification) synaptophysin x400.
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F2
Polygonal tumor cells have moderate eosinophilic granular cytoplasm, round to oval nuclei, "salt and pepper" chromatin and inconspicuous nucleoli (Fig. 2). Tumor cells were positive with immune histochemical ACTH, synaptophysin, and chromogranin staining (Fig. 2).