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Adenocarcinomas of unknown primary (ACUP) of the mediastinum mimicking lymphoma: CT findings at diagnosis and follow-up
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International audience. OBJECTIVE: To describe the computed tomography (CT) features at diagnosis and after treatment of adenocarcinoma of unknown primary (ACUP) mimicking lymphoma of the mediastinum.METHODS: Fifteen patients with pathologically proven ACUP and with primarily mediastinal involvement were initially referred to the Hematologic Department of our institution with a suspected diagnosis of lymphoma, and accounted for our study population. Presenting symptoms and baseline biological values were analyzed. All thoraco-abdominal CT studies were reviewed for the location and size of the mediastinal involvement and associated findings. Follow-up chest CT was performed in 14 patients after radiotherapy, chemotherapy or surgical treatment.RESULTS: The most frequent CT feature was a large anterior and middle mediastinal mass (67\%), with no calcification. Associated findings included the presence of lung nodules (40\%), compression of large mediastinal vessels (33\%) and pleural effusion (27\%). Follow-up CT, performed in 14 cases, suggested partial or complete responses in 7 patients (50\%) 4 weeks after the treatment onset.CONCLUSIONS: Mediastinal ACUP is a differential diagnosis of large mediastinal masses and is frequently associated with lung nodules and mediastinal vascular compression.
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