THYMUS CARCINOID IN MULTIPLE ENDOCRINE NE OPLASIA TYPE-1

Thrombosis of the left subclavian vein occurred in a 44-year-old man. It was found to be caused by an atypical thymus carcinoid of the anter ior mediastinum without carcinoid syndrome. Primary resection was not possible, but it was removed after three cycles of neoadjuvant chemoth erapy with doxorubicin, cisplatin, vincristin and cyclophosphamide. In creased concentrations of alkaline phosphatase and parathormone were t hen noted. Subtotal parathyroidectomy revealed hyperplastic parathyroi ds. A gastrinoma was suspected from a history of peptic ulcer for many years which had persisted despite a Billroth II gastric resection 10 years ago. Serum gastrin, analysis of gastric secretion and a secretin -stimulating test confirmed the diagnosis. Recurrent episodes of weakn ess and syncope, in the presence of low blood sugar levels and a posit ive C-peptide suppression test, were interpreted as due to an insulino ma. There was no evidence of increased hypophyseal or adrenal function . Finally, in the absence of a family history, multiple endocrine neop lasia type 1 (MEN 1) was diagnosed with co-existing primary hyperparat hyroidism, gastrinoma, insulinoma and thymus carcinoid. Somatostatin-r eceptor scintigraphy provided localization of the MEN 1 with enrichmen t in the thorax and abdomen.