Resection of a Giant Neuroblastoma Misdiagnosed as Atypical Mediastinal Carcinoid Eleftherios Chalvatzoulis, MD, Jeremias Wohlschlaeger, MD, Thomas Hager,

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Resection of a Giant Neuroblastoma Misdiagnosed as Atypical Mediastinal Carcinoid Eleftherios Chalvatzoulis, MD, Jeremias Wohlschlaeger, MD, Thomas Hager, MD, Danjouma Cheufou, MD, Wilfried Eberhardt, MD, Georgios Stamatis, MD, PhD, Stefan Welter, MD Journal of Thoracic Oncology Volume 9, Issue 1, Pages 132-134 (January 2014) DOI: 10.1097/JTO.0b013e3182a71c02 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Magnetic resonance imaging (A, B) and posteroanterior chest radiograph (C) demonstrating an extensive tumor mass occupying the anterior mediastinum. The tumor extends from the upper thoracic aperture cranially almost to the diaphragm caudally (A), with shifting of the major vessels posteriorly (B). Postoperative posteroanterior chest radiograph after successful tumor resection (D). Journal of Thoracic Oncology 2014 9, 132-134DOI: (10.1097/JTO.0b013e3182a71c02) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 A, Tumor overview (hematoxylin and eosin staining; red bar = 100 μm): extended areas of necrosis in the center of the tumor. Parts of the connective tissue capsule and some fat tissue in the periphery. B, Tumor (higher magnification; hematoxylin and eosin staining): relatively small tumor cells with hyperchromatic nuclei are partially arranged in single files. A neuropil-like matrix can be noted in the background embedding the tumor cells. C, Immunohistochemistry (synaptophysin): positive reaction of the neuropil-like matrix, but not of the tumor cells, vessels, the fibrous capsule, and adipose tissue. D, Immunohistochemistry (neuron-specific enolase): faint reactivity of the neuropil-like matrix and a weak positivity of the tumor-cell cytoplasms. E, Immunohistochemistry (chromogranin A): strong reactivity of the neuropil-like Matrix, but not of the tumor cells, vessels, the fibrous capsule, and adipose tissue. Focally, tumor invasion of the surrounding adipose tissue is observed (arrow). F Immunohistochemistry (CD 56): strong reactivity of the neuropil-like matrix and single tumor cells. Journal of Thoracic Oncology 2014 9, 132-134DOI: (10.1097/JTO.0b013e3182a71c02) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Immunohistochemical profile of neuroblastoma and possible differential diagnoses. (Annotation: “−” negative, “+” positive, “±” variable positive or negative [“−” to “++++” describes the relative quantity of cases featured in the literature but not the strength of staining]). NSE, neurone specific enolase; PNET, primitive neuroectodermal tumor. Journal of Thoracic Oncology 2014 9, 132-134DOI: (10.1097/JTO.0b013e3182a71c02) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions