L K B R  
 
20 year Female  
 
Main complaint:  
 
Cough with whitish sputum for 6 months. Shortness of breath for 2 months  
Since December 2008, had few episodes of hemoptysis  
 
Investigations done:  
 
CT Scan 26.12.08- Anterior mediastinal cystic mass.  
 
CTScan 2.7.09 –( R) Pnemothorax with partial collapse of ® middle and lower lobes of lung. Minimal effusion see.  
 
Treatment  
 
17.6.09 – Underwent limited posterolateral thoracotomy and excision of ® bronchogenic cyst.  
 
Operative findings: Large cystic mass freed from ® upper lobe . Within cavity of this cyst was another small clear cystic mass. The fluid in the large cavity was milky.  
 
Histopathology report: 18,6.09- Well differentiated neuroendocrine carcinoma.  

hublerm 2009-09-01 10:59	congratulations Beena!!
beena 2009-09-01 11:11	I would appreciate if we could have an opinion on the management of this case, as currently we feel that the tumour has been completely excised and the histology being well diferentiated, that maybe she can be under close observation. Please let me know your opinion on this case.     Thank you,     beena
dalquen 2009-09-02 17:18	The tumour does not look like a typical neuroendocrine carcinoma. The differential diagnosis is an adenocarcinoma or a mucoepidermoid carcinoma arising from the bronchial glands or from salivary glands. I do not think, that a definite diagnosis will be possible without immunohistochemistry: neuroendokrine markers, p63.
rochlitzc 2009-09-15 14:29	Comment by Christoph Rochlitz (Oncologist, Basel)     If the tumor indeed turns out to be a well-differentiated neuroendocrine carcinoma, there is no further therapy to add at the moment (although not mentioned explicitly, I suspect that no distant metastases have been detected on appropriate staging !?).     The same holds true if it's a mucoepidermoid or adenocarcinoma, since adjuvant chemo- and/or radiotherapy would not be considered at such an early stage.     Because of the young age of the patient and the known carcinogenicity of CT-related radiation exposure I would limit the number of CT scans done in the follow-up of this patient.
beena 2009-09-16 06:40	Thank you for the comments. I will check with my pathologist regarding doing furthur tests with markers.     The patient was staged and had no metastases and in view of her age we will keep her under follow up. Once again thank you for your comments.     Dr.Beena devi
hurwitz 2010-07-11 22:48	Please do regard Dr.Devi's comment as the final diagnosis
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