Thymic Hyperplasia after Treatment of ACTH-Dependent Cushing’s Syndrome Can Be Mistaken for a Thymic Epithelial Tumor Jaydira Del Rivero, MD, Chul Kim,

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Thymic Hyperplasia after Treatment of ACTH-Dependent Cushing’s Syndrome Can Be Mistaken for a Thymic Epithelial Tumor Jaydira Del Rivero, MD, Chul Kim, MD, MPH, Mary Eid, MD, Mark A. Ahlman, MD, Lynnette K. Nieman, MD, Arun Rajan, MD Journal of Thoracic Oncology Volume 12, Issue 4, Pages e29-e32 (April 2017) DOI: 10.1016/j.jtho.2016.11.2215 Copyright © 2016 Terms and Conditions

Figure 1 Indium 111–labeled pentetreotide (Octreoscan [Mallinckrodt]) single-photon emission computed tomogragphy (SPECT) scan with a focus of elevated uptake in the anterior mediastinum corresponding to a mixed soft- and fat tissue density shown on computed tomography (CT) scan suggestive of neuroendocrine tumor. (A) SPECT maximum intensity projection, (B) axial SPECT scan at the level of the superior mediastinum, (C) SPECT/CT scan fusion (SPECT in orange), and (D) CT scan. Journal of Thoracic Oncology 2017 12, e29-e32DOI: (10.1016/j.jtho.2016.11.2215) Copyright © 2016 Terms and Conditions

Figure 2 Microscopic findings of the mediastinal mass sampled at two independent times. (A and B) Images of sections from procedures 1 and 2, respectively. Typical hematoxylin and eosin staining shows normal appearing thymus, mainly composed of lymphocytes (thymocytes) and epithelial cells with a Hasall’s corpuscle (original magnification ×400). (C and D) Results of adrenocorticotropic hormone immunohistochemical staining on sections (A) and (B), respectively are negative. Journal of Thoracic Oncology 2017 12, e29-e32DOI: (10.1016/j.jtho.2016.11.2215) Copyright © 2016 Terms and Conditions

Figure 3 Four months after thymectomy: Indium 111–labeled pentetreotide and computed tomography (CT) scans of the chest with negative results. Single-photon emission computed tomogragphy (SPECT) maximum intensity projection (A), axial SPECT at the level of the superior mediastinum (B), SPECT/CT scan fusion (SPECT in orange) (C), and CT (D). Surgical staples now seen in the superior mediastinum on CT. Journal of Thoracic Oncology 2017 12, e29-e32DOI: (10.1016/j.jtho.2016.11.2215) Copyright © 2016 Terms and Conditions