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Cavernous Hemangioma of the Posterior Mediastinum

2010; Elsevier BV; Volume: 90; Issue: 6 Linguagem: Inglês

10.1016/j.athoracsur.2010.08.026

1552-6259

Luca Ampollini, Paolo Carbognani, L Cattelani, Rocco Bilancia, Michele Rusca,

Meningioma and schwannoma management

A 71-year-old nonsmoking woman, with no significant past medical history, except for mild osteoporosis currently treated with calcium and vitamin D, was admitted for an incidental radiologic finding of a left paravertebral pulmonary opacity. Magnetic resonance imaging highlighted a 45 × 30 mm well-defined, oval-shaped lesion, placed in the left costovertebral space in contact with the ascending aorta (Fig 1; T2-weighted contrast-enhanced sections showing marked hyperintensity of the mass; [A] coronal section; [B] sagittal section; [C] transversal section). A minimally invasive resection was proposed. A 7-mm incision was made vertically over the fifth rib along the mid-axillary line and a 30° rigid thoracoscope was placed. During exploration, a brownish, well-circumscribed lesion was found (Fig 2A ). Two additional 7-mm ports were placed at the anterior–axillary line in the fourth intercostal space and at the posterior axillary line in the fifth intercostal space. The mass was easily resected and the sample was intact extracted in an Endo-Bag (United States Surgical, Division of Tyco Healthcare Group LP, Norwalk, CT) prolonging one Trocar incision. The intercostal muscles or the ribs were not invaded by the tumor. Grossly, the tumor was capsulated and measured 50 × 30 × 25 mm in size. Histopathology of the specimen revealed a cavernous hemangioma (Fig 2B; microscopic view showing vascular lacunas with flattened endothelium. No cellular atypia was present; 20×). The patient's postoperative course was uneventful. No recurrence was noted after a 5-year period.Fig 2View Large Image Figure ViewerDownload (PPT)Cavernous hemangiomas of the chest wall or intercostal hemangiomas are extremely rare vascular tumors [1Shimizu K. Yamashita Y. Hihara J. Seto Y. Toge T. Cavernous hemangioma of the rib.Ann Thorac Surg. 2002; 74: 932-934Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 2Hashimoto H. Oshika Y. Obara K. Takeshima S. Sato K. Tanaka Y. Intercostal venous hemangioma presenting as a chest wall tumor.Gen Thorac Cardiovasc Surg. 2009; 57: 228-230Crossref PubMed Scopus (4) Google Scholar, 3Winchester D.J. Victor T.A. Fry W.A. Intercostal hemangioma presenting as a chest wall tumor.Ann Thorac Surg. 1992; 54: 145-146Abstract Full Text PDF PubMed Scopus (14) Google Scholar]. Complete resection is the treatment of choice [2Hashimoto H. Oshika Y. Obara K. Takeshima S. Sato K. Tanaka Y. Intercostal venous hemangioma presenting as a chest wall tumor.Gen Thorac Cardiovasc Surg. 2009; 57: 228-230Crossref PubMed Scopus (4) Google Scholar]. A 71-year-old nonsmoking woman, with no significant past medical history, except for mild osteoporosis currently treated with calcium and vitamin D, was admitted for an incidental radiologic finding of a left paravertebral pulmonary opacity. Magnetic resonance imaging highlighted a 45 × 30 mm well-defined, oval-shaped lesion, placed in the left costovertebral space in contact with the ascending aorta (Fig 1; T2-weighted contrast-enhanced sections showing marked hyperintensity of the mass; [A] coronal section; [B] sagittal section; [C] transversal section). A minimally invasive resection was proposed. A 7-mm incision was made vertically over the fifth rib along the mid-axillary line and a 30° rigid thoracoscope was placed. During exploration, a brownish, well-circumscribed lesion was found (Fig 2A ). Two additional 7-mm ports were placed at the anterior–axillary line in the fourth intercostal space and at the posterior axillary line in the fifth intercostal space. The mass was easily resected and the sample was intact extracted in an Endo-Bag (United States Surgical, Division of Tyco Healthcare Group LP, Norwalk, CT) prolonging one Trocar incision. The intercostal muscles or the ribs were not invaded by the tumor. Grossly, the tumor was capsulated and measured 50 × 30 × 25 mm in size. Histopathology of the specimen revealed a cavernous hemangioma (Fig 2B; microscopic view showing vascular lacunas with flattened endothelium. No cellular atypia was present; 20×). The patient's postoperative course was uneventful. No recurrence was noted after a 5-year period. Cavernous hemangiomas of the chest wall or intercostal hemangiomas are extremely rare vascular tumors [1Shimizu K. Yamashita Y. Hihara J. Seto Y. Toge T. Cavernous hemangioma of the rib.Ann Thorac Surg. 2002; 74: 932-934Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 2Hashimoto H. Oshika Y. Obara K. Takeshima S. Sato K. Tanaka Y. Intercostal venous hemangioma presenting as a chest wall tumor.Gen Thorac Cardiovasc Surg. 2009; 57: 228-230Crossref PubMed Scopus (4) Google Scholar, 3Winchester D.J. Victor T.A. Fry W.A. Intercostal hemangioma presenting as a chest wall tumor.Ann Thorac Surg. 1992; 54: 145-146Abstract Full Text PDF PubMed Scopus (14) Google Scholar]. Complete resection is the treatment of choice [2Hashimoto H. Oshika Y. Obara K. Takeshima S. Sato K. Tanaka Y. Intercostal venous hemangioma presenting as a chest wall tumor.Gen Thorac Cardiovasc Surg. 2009; 57: 228-230Crossref PubMed Scopus (4) Google Scholar].