A 53-year-old otherwise healthy woman with a two-month history of facial swelling, unintentional weight gain, hirsutism, and easy bruising was referred to Endocrinology for further evaluation. An elevated morning cortisol level was found at 44ug/dL, and ACTH was at 240pg/ml. Cortisol level was not suppressed by dexamethasone suppression test. A diagnosis of ectopic Cushing's syndrome was made. Computed tomography (CT) scan of the chest demonstrated an anterior mediastinum mass densely adhered to the innominate vein. Grossly, the tumor measured 4.4 cm in greatest dimension with a solid cut surface. Representative H&E images are shown here:
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Xiaotun Zhang, M.B.
Resident, Anatomic Pathology Residency
Joanne (Eunhee) Yi, M.D.
Consultant, Division of Anatomic Pathology
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine