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Unusual lesions of the mediastinum.

Shamsuddin F, Khadilkar UN, Saha D - Lung India (2015 Nov-Dec)

Bottom Line: Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location.A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Malabar Medical College and Research Center, Kozhikode, Kerala, India.

ABSTRACT

Objectives: To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender pathologic lesions in the mediastinum.

Materials and methods: Of the 65 cases seen, 12 unusual lesion were encountered in a 5½ year period from 2006 to 2011.

Results: Two cases of nodular colloid goiter and one each of the mediastinal cyst, undifferentiated carcinoma, and Langerhans cell histiocytosis (LCH) affected the anterosuperior mediastinum. In the middle mediastinum, one case each of the mesothelioma, malignant gastrointestinal stromal tumor (GIST), squamous cell carcinoma (SCC), solitary fibrous tumor (SFT), and pleomorphic sarcoma (PS) was seen. One case of meningeal melanocytoma (Mme) and primary pleural liposarcoma (PL) involved the posterior mediastinum. Persistent disease was seen in LCH after 2 years. Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.

Conclusion: The cases of primary and SCC, LCH, melanocytoma, liposarcoma and PS, and GIST are unexpected and very rarely have paradigms in the mediastinum. Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location. A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

No MeSH data available.


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(a) Computed tomography scan showing dumb-bell shaped tumor at initial presentation (file picture). (b and c) (H and E, ×100). (d) CT scan of the paraspinal tumor
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Figure 6: (a) Computed tomography scan showing dumb-bell shaped tumor at initial presentation (file picture). (b and c) (H and E, ×100). (d) CT scan of the paraspinal tumor

Mentions: The woman with lower limb weakness had a resected brown black nodular mass measuring 4.5 cm × 3 cm × 2 cm sent for microscopy. A cellular tumor composed of nests and whorls of heavily pigmented meningothelial cells with oval nuclei, granular chromatin, and distinct nucleoli in most of the cells was seen that decolorized with melanin bleach. The morphology was similar to its initial presentation. A reticulin stain done on the earlier tumor showed accentuation of reticulin fibers surrounding the nests of cells. Both the preliminary and the recrudescent tumor exhibited lack of mitoses, necrosis, or neural parenchymal invasion. IHC done on the original tumor demonstrated positivity for S100 and HMB45. Thus, a diagnosis of Mme was delivered [Figure 6]. Relapse of the disease was possibly due to inadequate excision of the primary tumor. After discharge, she was immediately lost to follow-up.


Unusual lesions of the mediastinum.

Shamsuddin F, Khadilkar UN, Saha D - Lung India (2015 Nov-Dec)

(a) Computed tomography scan showing dumb-bell shaped tumor at initial presentation (file picture). (b and c) (H and E, ×100). (d) CT scan of the paraspinal tumor
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663858&req=5

Figure 6: (a) Computed tomography scan showing dumb-bell shaped tumor at initial presentation (file picture). (b and c) (H and E, ×100). (d) CT scan of the paraspinal tumor
Mentions: The woman with lower limb weakness had a resected brown black nodular mass measuring 4.5 cm × 3 cm × 2 cm sent for microscopy. A cellular tumor composed of nests and whorls of heavily pigmented meningothelial cells with oval nuclei, granular chromatin, and distinct nucleoli in most of the cells was seen that decolorized with melanin bleach. The morphology was similar to its initial presentation. A reticulin stain done on the earlier tumor showed accentuation of reticulin fibers surrounding the nests of cells. Both the preliminary and the recrudescent tumor exhibited lack of mitoses, necrosis, or neural parenchymal invasion. IHC done on the original tumor demonstrated positivity for S100 and HMB45. Thus, a diagnosis of Mme was delivered [Figure 6]. Relapse of the disease was possibly due to inadequate excision of the primary tumor. After discharge, she was immediately lost to follow-up.

Bottom Line: Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location.A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Malabar Medical College and Research Center, Kozhikode, Kerala, India.

ABSTRACT

Objectives: To study unusual lesions in the mediastinum, which do not originate from the thymus, lymph nodes, neural tissues or germ cells, and tissues that normally engender pathologic lesions in the mediastinum.

Materials and methods: Of the 65 cases seen, 12 unusual lesion were encountered in a 5½ year period from 2006 to 2011.

Results: Two cases of nodular colloid goiter and one each of the mediastinal cyst, undifferentiated carcinoma, and Langerhans cell histiocytosis (LCH) affected the anterosuperior mediastinum. In the middle mediastinum, one case each of the mesothelioma, malignant gastrointestinal stromal tumor (GIST), squamous cell carcinoma (SCC), solitary fibrous tumor (SFT), and pleomorphic sarcoma (PS) was seen. One case of meningeal melanocytoma (Mme) and primary pleural liposarcoma (PL) involved the posterior mediastinum. Persistent disease was seen in LCH after 2 years. Of all the cases with malignant lesions, only the patient with SCC was alive after 1 year.

Conclusion: The cases of primary and SCC, LCH, melanocytoma, liposarcoma and PS, and GIST are unexpected and very rarely have paradigms in the mediastinum. Radiologic impression and knowledge of the compartment where these lesions arose from hardly assisted in arriving at a definitive opinion as the lesions were not typical of this location. A high index of suspicion and the immunohistochemical profile facilitated the final diagnosis.

No MeSH data available.


Related in: MedlinePlus