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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.


Related in: MedlinePlus

(a and b) (H and E, ×100, a; ×400, b) Characteristic vacuolated lipoblasts in a loose, myxoid background
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Figure 7: (a and b) (H and E, ×100, a; ×400, b) Characteristic vacuolated lipoblasts in a loose, myxoid background

Mentions: Intraoperatively, a large, fungating mass in the middle mediastinum straddling the lungs and pleura bilaterally could not be totally enucleated in both the sarcomas. In one case, bizarre pleomorphic spindled cells in vague storiform pattern in a myxoid background urged us to afford the diagnosis of PS since the morphology resembled its soft tissue counterpart. In the other, pleomorphic spindled tumor cells, along with numerous lipoblasts were spotted containing single to multiple vacuoles. The background was myxoid and included areas with branched capillaries. A diagnosis of mixed liposarcoma (myxoid with well differentiated areas) was offered [Figure 7]. Both the patients had expired at 3 months follow-up.


Unusual lesions of the mediastinum.

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

(a and b) (H and E, ×100, a; ×400, b) Characteristic vacuolated lipoblasts in a loose, myxoid background
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: (a and b) (H and E, ×100, a; ×400, b) Characteristic vacuolated lipoblasts in a loose, myxoid background
Mentions: Intraoperatively, a large, fungating mass in the middle mediastinum straddling the lungs and pleura bilaterally could not be totally enucleated in both the sarcomas. In one case, bizarre pleomorphic spindled cells in vague storiform pattern in a myxoid background urged us to afford the diagnosis of PS since the morphology resembled its soft tissue counterpart. In the other, pleomorphic spindled tumor cells, along with numerous lipoblasts were spotted containing single to multiple vacuoles. The background was myxoid and included areas with branched capillaries. A diagnosis of mixed liposarcoma (myxoid with well differentiated areas) was offered [Figure 7]. Both the patients had expired at 3 months 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