MEN type 1 associated with mediastinal carcinoid producing parathyroid hormone, calcitonin and chorionic gonadotropin

A 34-year-old Japanese woman was admitted to our hospital with a mediastinal tumor. Laboratory data showed high levels of calcitonin (CT), human chorionic gonadotropin (hCG) and parathyroid hormone (PTH) in the serum. Surgery was performed, but the tumor could not be completely resected. The patient died in the 10th postoperative month due to systemic metastasis and cachexia. At autopsy, diffuse parathyroid hyperplasia and multiple islet cell tumors of the pancreas were found. A pathological diagnosis of multiple endocrine neoplasia (MEN) type 1 associated with mediastinal atypical carcinoid tumor was made. Immunohistochemical study indicated the tumor cells of the mediastinum to be positively stained for hCG beta but not for PTH or CT. The tumor tissue contained significantly high levels of CT, PTH and whole hCG. This is the first case report on MEN type 1 associated with mediastinal carcinoid tumor producing PTH, CT and hCG beta.