Thymic neuroendocrine (carcinoid) tumors are a rare neoplasm of the anterior mediastinum. The tumors frequently exhibit a wide spectrum of histology and appear to follow a more aggressive behavior than their nonthymic counterparts. Given the differing clinicopathologic manifestations, thymic neuroendocrine tumors may also possess different cytogenetic abnormalities from those that occur in foregut carcinoid tumors. In this study, we employed comparative genomic hybridization to detect genomic instability in 10 sporadic thymic neuroendocrine tumors and one multiple endocrine neoplasia type 1 (MEN1)-associated case. Gross chromosomal imbalances were found in nine cases, including gains of chromosomal material on regions X, 8, 18 and 20p and losses on 3, 6, 9q, 13q and 11q. We did not observe deletion at locus 11q13 where the MEN1 gene is located. These findings were essentially dissimilar to those reported in sporadic and MEN1-associated foregut carcinoid tumors. Consequently, we consider that a distinctive cytogenetic mechanism is at work in the development of thymic neuroendocrine tumors, which is different from that of foregut carcinoid tumors. The term thymic carcinoid tumor was first introduced by Rosai and Higa 1 to denote a group of thymic neoplasms that histologically resemble the carcinoid tumors of other systems. Later series of studies demonstrated that this group of neoplasms frequently displays a diversity of morphologic features ranging from typical carcinoid as those seen in the bronchopulmonary and digestive tracts, to poorly differentiated small-cell carcinoma. In addition, many such tumors behave more aggressively than the conventional nonthymic carcinoid tumors. Reportedly around half of the cases invaded the surrounding mediastinal structures, and 30-40% metastasized.2-4 Consequently, Moran and Suster 3 proposed to designate the entity as thymic neuroendocrine carcinoma with a threetiered (low, intermediate and high) grading system, which is roughly equivalent to the classic carcinoid, atypical carcinoid and small-cell undifferentiated carcinoma of the World Health Organization (WHO) classification.
5Owing to differing pathologic and clinical presentation, we postulate a different cytogenetic oncogenesis between the thymic and foregut neuroendocrine tumors. Nevertheless, few cytogenetic studies specifically addressing the thymic neuroendocrine tumors are available. So far, only a total of 12 cases in three reports of multiple endocrine neoplasia type 1 syndrome (MEN1)-associated thymic neuroendocrine tumors were examined by using loss of heterozygosity (LOH) study at the 11q13 locus where MEN1 gene is located.6-8 The cytogenetic and molecular events underlying the development of thymic neuroendocrine tumor remain largely unknown. In this study, we aim to characterize the chromosomal aberrances in thymic neuroendocrine tumors with comparative genomic hybridization (CGH) analysis and compare our findings with those of previous reports.
Materials and methods
Case SelectionWe retrieved 11 cases of ...