Multimodality Therapy for Large Cell Neuroendocrine Carcinoma of the Thymus Naoko Ose, MD, Masayoshi Inoue, MD, Eiichi Morii, MD, Yasushi Shintani, MD,

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Multimodality Therapy for Large Cell Neuroendocrine Carcinoma of the Thymus Naoko Ose, MD, Masayoshi Inoue, MD, Eiichi Morii, MD, Yasushi Shintani, MD, Noriyoshi Sawabata, MD, Meinoshin Okumura, MD The Annals of Thoracic Surgery Volume 96, Issue 4, Pages e85-e87 (October 2013) DOI: 10.1016/j.athoracsur.2013.04.107 Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Radiographic images before treatment. (A) Chest computed tomography scan shows the anterior mediastinal tumor, 10.0 cm × 5.3 cm in size, invading the aorta and pulmonary trunk. (B) 2-[18F] Fluoro-2-deoxyglucose positron emission tomography– computed tomography shows significant uptake in the tumor. The Annals of Thoracic Surgery 2013 96, e85-e87DOI: (10.1016/j.athoracsur.2013.04.107) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Histopathologic findings of the thymic tumor for the diagnosis of large cell neuroendocrine carcinoma. (A) Hematoxylin and eosin staining shows large neoplastic cells including anaplastic giant cells (original magnification ×400). Immunohistochemical staining is positive for (B) chromogranin A (original magnification ×400) and (C) neuron-specific enolase (original magnification ×400). More than 10 mitoses per 2 mm2 (10 high-power fields) are observed. (D) The Ki 67 labeling index is approximately 60% (original magnification ×400). The Annals of Thoracic Surgery 2013 96, e85-e87DOI: (10.1016/j.athoracsur.2013.04.107) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Radiographic images after induction treatment with chemoradiation therapy. (A) The size of the tumor has decreased to 4.5 cm × 2.8 cm on the chest computed tomography scan. (B) Uptake of 2-[18F] fluoro-2-deoxyglucose has diminished to the background level on the positron emission tomography–computed tomography scan. The Annals of Thoracic Surgery 2013 96, e85-e87DOI: (10.1016/j.athoracsur.2013.04.107) Copyright © 2013 The Society of Thoracic Surgeons Terms and Conditions