A cavernous haemangioma typically:
A- Is of low attenuation relative to normal liver on unenhanced CT scan. True
B- Has a poorly defined edge on unenhanced CT scan. x
C- Shows rapid complete enhancement on CT following intravenous contrast administration. x
D- Is hyperechoic on ultrasonography... x (Only 80% is hyperechoic, 10 are hypo- and 10 are heterogeneous).
E- Shows increased uptake on a colloid isotope scan. x
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Mediastinal cavernous hemangioma (HC) is a rare benign vascular tumor of unknown etiology, which occurs most frequently in children and young adults. Preoperative diagnosis by imaging tests is difficult and often does not allow it to be distinguished from a solid malignant tumor, so we must consider the possibility of HC in patients with mediastinal tumors.
A 59-year-old woman who underwent surgery of the cephalic duodenopancreatectomy for ampuloma and lumpectomy in the right breast with axillary lymphadenectomy for infiltrating ductal carcinoma, enters our service referred by the oncology service after a casual finding, in computed tomography (CT), of a mass in the anterior mediastinum of 5 × 4cm in diameter. Complete analysis, arterial blood gas, spirometry, electrocardiogram, chest radiography and bronchoscopy are performed, which are normal. Surgical intervention was decided, resection was performed by means of a highly vascularized middle sternotomy in the prevascular area in intimate contact with the left pleura, with adequate surgical margins, including the thymic tissue. The pathological study of the surgical specimen reveals the presence of a thymic HC. The postoperative course is uncomplicated and the patient has no recurrence after 33 months of follow-up.
Almost 50% of the mediastinal masses are located in the anterior mediastinum, with the thymus being its most frequent origin. Thymoma is the neoplasm that most frequently affects the thymic parenchyma; It represents almost 10% of the mediastinal masses, it is normally benign but it can be locally invasive and confused with infrequent benign vascular mediastinal neoplasms such as HC, so thymic HC is more subsidiary of surgical treatment than other mediastinal hemangiomas. HC can occur in any vascularized tissue and cause symptoms when neighboring structures are infected or compressed. Preoperative diagnosis of mediastinal hemangioma is generally difficult with imaging techniques. The HC can show a characteristic enhancement after the administration of contrast on CT, and is often associated with flebolites on radiography; Magnetic resonance imaging (MRI) shows a typical reticular appearance with a central zone of mixed intensities and a hypointense ring in T2 that, however, can vary depending on the time of bleeding evolution. Angiography is normal in 30-40% of patients, although it is useful for preoperative embolization. CT angiography and MRI angiography are high-resolution tests that can be very useful in the diagnosis of HC and surgical planning. In the majority of cases described in the literature the diagnosis of HC is confirmed by histological study. It is necessary to make a differential diagnosis with other mediastinal vascular tumors, such as angiolipoma, which is a rare benign tumor composed of adipose tissue and blood vessels, usually located in the subcutaneous cellular tissue (although it can occasionally be found in other locations) and more frequent in children. .
Asymptomatic HCs do not require prophylactic treatment in principle, since the morbidity and mortality associated with hemorrhages caused by these lesions is relatively low, although once a first bleeding has occurred, the bleeding rate is relatively high. Surgical treatment in asymptomatic cases would be indicated due to the impossibility of ruling out solid malignant tumor due to doubts in the diagnosis. Cases of HC resolved by thoracoscopy and video-assisted surgery have been described.
Recurrence is directly related to incomplete resection. A meticulous and prolonged clinical and radiological follow-up is recommended for an early diagnosis of recurrences.
A- Is of low attenuation relative to normal liver on unenhanced CT scan. True
B- Has a poorly defined edge on unenhanced CT scan. x
C- Shows rapid complete enhancement on CT following intravenous contrast administration. x
D- Is hyperechoic on ultrasonography... x (Only 80% is hyperechoic, 10 are hypo- and 10 are heterogeneous).
E- Shows increased uptake on a colloid isotope scan. x
-----------------------
Mediastinal cavernous hemangioma (HC) is a rare benign vascular tumor of unknown etiology, which occurs most frequently in children and young adults. Preoperative diagnosis by imaging tests is difficult and often does not allow it to be distinguished from a solid malignant tumor, so we must consider the possibility of HC in patients with mediastinal tumors.
A 59-year-old woman who underwent surgery of the cephalic duodenopancreatectomy for ampuloma and lumpectomy in the right breast with axillary lymphadenectomy for infiltrating ductal carcinoma, enters our service referred by the oncology service after a casual finding, in computed tomography (CT), of a mass in the anterior mediastinum of 5 × 4cm in diameter. Complete analysis, arterial blood gas, spirometry, electrocardiogram, chest radiography and bronchoscopy are performed, which are normal. Surgical intervention was decided, resection was performed by means of a highly vascularized middle sternotomy in the prevascular area in intimate contact with the left pleura, with adequate surgical margins, including the thymic tissue. The pathological study of the surgical specimen reveals the presence of a thymic HC. The postoperative course is uncomplicated and the patient has no recurrence after 33 months of follow-up.
Almost 50% of the mediastinal masses are located in the anterior mediastinum, with the thymus being its most frequent origin. Thymoma is the neoplasm that most frequently affects the thymic parenchyma; It represents almost 10% of the mediastinal masses, it is normally benign but it can be locally invasive and confused with infrequent benign vascular mediastinal neoplasms such as HC, so thymic HC is more subsidiary of surgical treatment than other mediastinal hemangiomas. HC can occur in any vascularized tissue and cause symptoms when neighboring structures are infected or compressed. Preoperative diagnosis of mediastinal hemangioma is generally difficult with imaging techniques. The HC can show a characteristic enhancement after the administration of contrast on CT, and is often associated with flebolites on radiography; Magnetic resonance imaging (MRI) shows a typical reticular appearance with a central zone of mixed intensities and a hypointense ring in T2 that, however, can vary depending on the time of bleeding evolution. Angiography is normal in 30-40% of patients, although it is useful for preoperative embolization. CT angiography and MRI angiography are high-resolution tests that can be very useful in the diagnosis of HC and surgical planning. In the majority of cases described in the literature the diagnosis of HC is confirmed by histological study. It is necessary to make a differential diagnosis with other mediastinal vascular tumors, such as angiolipoma, which is a rare benign tumor composed of adipose tissue and blood vessels, usually located in the subcutaneous cellular tissue (although it can occasionally be found in other locations) and more frequent in children. .
Asymptomatic HCs do not require prophylactic treatment in principle, since the morbidity and mortality associated with hemorrhages caused by these lesions is relatively low, although once a first bleeding has occurred, the bleeding rate is relatively high. Surgical treatment in asymptomatic cases would be indicated due to the impossibility of ruling out solid malignant tumor due to doubts in the diagnosis. Cases of HC resolved by thoracoscopy and video-assisted surgery have been described.
Recurrence is directly related to incomplete resection. A meticulous and prolonged clinical and radiological follow-up is recommended for an early diagnosis of recurrences.
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