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Guerrero-Pérez F, Peiró I, Marengo AP, Teulé A, Ruffinelli JC, Llatjos R, Serrano T, Macia I, Vilarrasa N, Iglesias P, Villabona C. Ectopic Cushing's syndrome due to thymic neuroendocrine tumours: a systematic review. Rev Endocr Metab Disord 2021; 22:1041-1056. [PMID: 33961211 DOI: 10.1007/s11154-021-09660-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2021] [Indexed: 12/23/2022]
Abstract
Knowledge of ectopic Cushing's syndrome (CS) due to thymic neuroendocrine tumours (NETs) comes from short series or single cases. Our aim is to perform a systematic review using PubMed, Embase, Scopus, Ovid Medline and Biosis Previews of all cases with ectopic CS due to thymic NETs reported in the last 40 years and describe one illustrative patient attended in our institution. Search of literature: From 162 patients, 58.6% were male and mean age was 34.6 ± 13.9 years-old. Median of symptoms until diagnosis was 6 [2-24] months and 62% had aggressive CS. Imaging was positive in 93.7% (chest X-ray), 97.8% (computed tomography), 80.7% (somatostatin receptor scintigraphy) and median tumour size was 47 [25-68.5] mm. At presentation, 18% had localized disease, 26.2% locally invasive and 55.7% advanced. Eighty-eight present underwent surgery and histological subtypes were atypical (46.7%), typical (30.4%) and carcinoma (21.7%). Tumour persisted or recurred in 70.1%, 63% received radiotherapy and 45.2% chemotherapy. Follow-up median was 26.6 [14.5-57.5] months and mortality was reported in 35.8% with median survival of 38 [19-60] months. MEN-1 mutation was referred in 3.1%. Comparatively, carcinomas had aggressive CS more frequently while atypical showed advanced disease more often. In conclusion, thymic NETs causing ectopic CS are presented as aggressive hypercortisolism in the middle aged population. The disease is commonly extended at diagnosis and persists or recurs after surgery in most patients with a short term high mortality.
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Affiliation(s)
- Fernando Guerrero-Pérez
- Department of Endocrinology, Bellvitge University Hospital, Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Inmaculada Peiró
- Clinical Nutrition Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Unit of Nutrition and Cancer-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Agustina Pia Marengo
- Department of Endocrinology, Bellvitge University Hospital, Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alex Teulé
- Department of Oncology, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Carlos Ruffinelli
- Department of Oncology, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Roger Llatjos
- Department of Pathology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Teresa Serrano
- Department of Pathology, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ivan Macia
- Department of Thoracic Surgery, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- Unit of Human Anatomy and Embryology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences, University of Barcelona, IDIBELL, Barcelona, Spain
| | - Nuria Vilarrasa
- Department of Endocrinology, Bellvitge University Hospital, Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro Iglesias
- Department of Endocrinology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Carles Villabona
- Department of Endocrinology, Bellvitge University Hospital, Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Valeriani M, Agolli L, Falco T, Osti MF, De Sanctis V, Enrici RM. A Case Report of Metastatic Atypical Thymic Carcinoid with Ectopic ACTH Production: Locoregional Control after Adaptive Radiation Treatment. TUMORI JOURNAL 2018. [DOI: 10.1177/030089161209800632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thymic carcinoid is an extremely rare malignancy. This tumor is often associated with endocrine disorders such as Cushing's syndrome, multiple endocrine neoplasia type 1 and superior vena cava syndrome. We describe the case of a 44-year-old Italian woman with metastatic atypical thymic carcinoid secreting ectopic adrenocorticotropic hormone who was treated with adaptive radiation therapy with a curative dose schedule for a symptomatic mediastinal tumor. After 22 months, the patient was in good clinical condition, presenting stable disease without any evidence of local or systemic progression. To our knowledge there are no previously reported data regarding radical radiotherapy in the treatment of thymic carcinoids.
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Affiliation(s)
- Maurizio Valeriani
- Department of Radiation Oncology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Linda Agolli
- Department of Radiation Oncology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Teresa Falco
- Department of Radiation Oncology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Mattia Falchetto Osti
- Department of Radiation Oncology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Vitaliana De Sanctis
- Department of Radiation Oncology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
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Wu X, Qi Y, Yang F, Tan M, Lin J. Spinal Metastasis Resulting from Atypical Thymic Carcinoid: A Case Report. World Neurosurg 2018; 111:373-376. [PMID: 29325948 DOI: 10.1016/j.wneu.2018.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/01/2018] [Accepted: 01/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Thymic carcinoid with spinal metastasis is an extremely rare entity. Clinically, the tumor presents either by its endocrine manifestations or by mechanical compression of surrounding structures. However, no previously published case studies have reported neck pain and neurologic deficit in the initial presentation of an atypical thymic carcinoid. CASE DESCRIPTION A 56-year-old man, a nonsmoker, presented with a 12-month history of intermittent neck pain and a 1-month history of progressive numbness and weakness of the right upper limb. Cervical MRI showed multiple abnormal signals and C2 soft-tissue mass intruding into the vertebral canal. Cervical CT scan showed multiple bone lesions. The diagnosis of thymic carcinoid was obtained by preoperative lymph node biopsy. The patient underwent cervical laminectomy and occipitocervical fixation. Significant alleviation of pain and neurologic improvement were achieved. The postoperative pathological examination confirmed the diagnosis of thymic carcinoid. CONCLUSIONS Neck pain and neurologic deficit could be the first presentation of thymic carcinoid with spinal metastasis. Palliative surgery is an effective method to improve quality of life in patients with thymic carcinoid with spinal metastasis.
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Affiliation(s)
- Xinjie Wu
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, P. R. China; Graduate School of Peking Union Medical College, Beijing, P. R. China
| | - Yingna Qi
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, P. R. China; Graduate School of Beijing University of Chinese Medicine, Beijing, P. R. China
| | - Feng Yang
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, P. R. China
| | - Mingsheng Tan
- Department of Spine Surgery, China-Japan Friendship Hospital, Beijing, P. R. China; Graduate School of Peking Union Medical College, Beijing, P. R. China.
| | - Jie Lin
- Department of Pathology, China-Japan Friendship Hospital, Beijing, P. R. China
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Dixon JL, Borgaonkar SP, Patel AK, Reznik SI, Smythe WR, Rascoe PA. Thymic neuroendocrine carcinoma producing ectopic adrenocorticotropic hormone and Cushing's syndrome. Ann Thorac Surg 2013; 96:e81-e83. [PMID: 24088497 DOI: 10.1016/j.athoracsur.2013.04.140] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/16/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
Abstract
Neuroendocrine carcinoma of the thymus, previously termed thymic carcinoid, is a rare clinical entity. Rarer still are such cases presenting with endocrinopathies. We report a case of thymic neuroendocrine carcinoma presenting with ectopic adrenocorticotroic hormone production and resultant Cushing's syndrome.
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Affiliation(s)
- Jennifer L Dixon
- Scott & White Memorial Hospital & Clinic, Texas A&M Health Science Center, Temple, Texas
| | - Sanket P Borgaonkar
- Scott & White Memorial Hospital & Clinic, Texas A&M Health Science Center, Temple, Texas
| | - Anupa K Patel
- Scott & White Memorial Hospital & Clinic, Texas A&M Health Science Center, Temple, Texas
| | - Scott I Reznik
- Scott & White Memorial Hospital & Clinic, Texas A&M Health Science Center, Temple, Texas; Olin E. Teague Veterans' Center, Temple, Texas
| | - W Roy Smythe
- Scott & White Memorial Hospital & Clinic, Texas A&M Health Science Center, Temple, Texas
| | - Philip A Rascoe
- Scott & White Memorial Hospital & Clinic, Texas A&M Health Science Center, Temple, Texas; Olin E. Teague Veterans' Center, Temple, Texas.
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Visouli AN, Darwiche K, Kourtoglou GI, Zarogoulidis P, Mpakas A, Machairiotis N, Stylianaki A, Christofis C, Katsikogiannis N, Tsakiridis K, Courcoutsakis N, Zarogoulidis K. Primary lung carcinoid, a rare cause of paraparesis: report of a case and review of the literature. J Thorac Dis 2013; 4 Suppl 1:49-55. [PMID: 23304441 DOI: 10.3978/j.issn.2072-1439.2012.s005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 11/23/2012] [Indexed: 11/14/2022]
Abstract
Carcinoids are neuroendocrine tumors mainly involving the gastrointestinal tract, lungs and bronchi. They were considered benign with slow growth, but they can be malignant in a substantial percentage of patients (metastasizing to liver, bones, skin, etc). Endocrine activity results in carcinoid syndrome. Proximal myopathy has been reported in 7% of patients with carcinoid syndrome. Bronchopulmonary and thymic carcinoids producing adrenocorticotropic hormone can cause Cushing's syndrome, a main feature of which is myopathy. There are a few reports of carcinoids associated with paraneoplastic neurological syndromes, including neuropathy. We hereby present an extremely rare case of a primary lung carcinoid presented with paraparesis due to polyneuropathy, and review the relevant literature. To the best of our knowledge there is no similar previous report. Complete resolution of paraparesis after excision of the lung carcinoid suggests paraneoplastic neurological syndrome.
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