Eur J Cardiothorac Surg 2002;21:541
© 2002 Elsevier Science NL
Images in cardio-thoracic surgery |
Infiltrative mediastinal hemangioma
Christine Förstera,
Helmut Ostertaga,
Paolo Macchiarinib*
a Department of Pathology, Nordstadt Hospital, Hannover, Germany
b Department of Thoracic and Vascular Surgery, Heidehaus Hospital, Hannover Medical School, Am Leineufer, 70, 30419 Hannover, Germany
Received 24 November 2001;
received in revised form 18 December 2001;
accepted 21 December 2001.
* Corresponding author. Tel.: +49-511-7906290
e-mail: pmacchiarini{at}compuserve.com
A 64-year old woman with a 2 year history of a slow-growing mass in the left infero-posterior mediastinum was admitted for increasing dyspnea on exertion and severe left-sided chest pain. Thorax computed tomography (Fig. 1)
showed a large mass above the left hemidiaphragm surrounding the distal esophagus. Bronchoscopy and esophagoscopy were normal, and transthoracic biopsy was inconclusive. There was no evidence of extrathoracic disease. The patient underwent a left-thoracoabdominal approach and a well-circumscribed lobulated heterogeneous multicystic tumor with a hemorrhagic area of 150x145x50 mm was resected along with a 95 mm long esophagus segment (Fig. 2)
, and reconstruction was made with the stomach. Microscopically, the tumor showed numerous large venous, cavernous and capillary-sized vessels infiltrating the wall of the entrapped esophagus segment whose submucosa and muscularis propria showed ectatic vascular spaces. No cellular atypia or mitoses were observed. The patient is asymptomatic and disease-free 2 years following operation.
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Fig. 1. Thorax computed tomography showing a large mass in the postero-inferior mediastinum between the left atrium ventrally and thoracic vertebrae dorsally and surrounding the esophagus.
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Fig. 2. The completely resected tumor measures 150x145x50 mm, surrounded the distal esophagus, and shows numerous large venous, cavernous vessels. x5, HE.
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