Large Cell Neuroendocrine Carcinoma of the Mediastinum with α-Fetoprotein Production Ken Takezawa, MD, Isamu Okamoto, MD, PhD, Junya Fukuoka, MD, PhD,

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Large Cell Neuroendocrine Carcinoma of the Mediastinum with α-Fetoprotein Production Ken Takezawa, MD, Isamu Okamoto, MD, PhD, Junya Fukuoka, MD, PhD, Kaoru Tanaka, MD, Hiroyasu Kaneda, MD, Hisao Uejima, MD, Hyung-Eun Yoon, MD, PhD, Masami Imakita, MD, PhD, Masahiro Fukuoka, MD, PhD, Kazuhiko Nakagawa, MD, PhD Journal of Thoracic Oncology Volume 3, Issue 2, Pages 187-189 (February 2008) DOI: 10.1097/JTO.0b013e3181623359 Copyright © 2008 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Chest computed tomography (CT) findings and serum AFP levels in the patient. A–D, Chest CT findings. A mass in the middle mediastinum was initially detected (A). The tumor had shrunk after three cycles of neoadjuvant chemotherapy (B), but its progression had resumed after the fourth cycle (C). The tumor shrank again in response to second-line chemotherapy (D). E, Time course of the serum concentration of AFP. The AFP level was initially increased, it decreased to within normal limits (dotted line) in association with tumor shrinkage during first-line chemotherapy, but it started to increase again after the third cycle. The serum AFP level again decreased in association with tumor shrinkage during second-line chemotherapy. Journal of Thoracic Oncology 2008 3, 187-189DOI: (10.1097/JTO.0b013e3181623359) Copyright © 2008 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Histology and immunohistochemical analysis of the tumor specimen obtained at surgery. A, Hematoxylin-eosin staining revealed solid tumor nests with areas of necrosis (arrow heads). Note the homogeneous appearance of the tumor. B, High-power magnification of the tumor stained as in (A), showing numerous rosettes (asterisk), abundant cytoplasm, chromatin clearing with occasionally prominent nucleoli, nuclear molding (arrows), and frequent mitosis (arrow heads). C, Immunohistochemical staining for chromogranin A revealed diffuse and intense cytoplasmic staining. D, Immunohistochemical staining for AFP, showing a focus of tumor cells positive for AFP (arrows). Scale bars: 1 mm, 50 μ. Journal of Thoracic Oncology 2008 3, 187-189DOI: (10.1097/JTO.0b013e3181623359) Copyright © 2008 International Association for the Study of Lung Cancer Terms and Conditions