Ann Thorac Surg 2002;73:1653-1654
© 2002 The Society of Thoracic Surgeons
Case report
Mediastinal angioleiomyoma
Hidehito Matsuoka, MDa,b,
Wataru Nishio, MDa,b,
Toshihiko Sakamoto, MDa,b,
Hiroaki Harada, MDa,b,
Terumasa Sashikata, MDa,b,
Noriaki Tsubota, MD*a,b
a Department of Thoracic Surgery, Hyogo Medical Center for Adults, Akashi City, Japan
b Department of Pathology, Hyogo Medical Center for Adults, Akashi City, Japan
Accepted for publication September 10, 2001.
* Address reprint requests to Dr Tsubota, Department of Thoracic Surgery, Hyogo Medical Center for Adults, Kitaoji-cho 13-70, Akashi City, Hyogo 673-8558, Japan
e-mail: n-tsubo{at}sanynet.ne.jp
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Abstract
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We report a case of a mediastinal angioleiomyoma. The patient was a 64-year-old previously healthy man. Computed tomographic scan revealed a well-circumscribed tumor with a diameter of approximately 2 cm in the right anterior mediastinum. We removed the tumor through a midline sternotomy. Microscopic examination revealed a highly vascular mesenchymal tumor without cellular dysplasia or mitotic figures.
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Introduction
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Angioleiomyoma is a benign tumor that frequently occurs in the lower extremities of middle-aged women. We describe a patient with a rare mediastinal asymptomatic angioleiomyoma.
A 64-year-old previously healthy man presented with no symptoms. He had no history of trauma such as traffic accidents. He was incidentally found to have an abnormal shadow in the right middle lung area on a chest roentgenogram during a medical checkup. There were no particular findings on physical examination. Biochemical and hematological blood analysis revealed no abnormalities. Computed tomographic (CT) scan revealed a well-circumscribed homogeneous tumor with a diameter of approximately 2 cm in the right anterior mediastinum (Fig 1).
CT scan also showed no connection of the tumor with the right lung or any other mediastinal organs. No other intrathoracic abnormalities were found.
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Fig 1. Computed tomography shows a well-circumscribed homogeneous tumor with a diameter of approximately 2 cm in the right anterior mediastinum (arrow).
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We suspected the tumor to be a thymoma and decided to remove it operatively. Needle biopsy was not performed before operation due to patient refusal. The area was exposed through a midline sternotomy. As soon as we had ligated the feeding artery of the tumor originating from the aorta prior to resection, the color of the tumor became milky white. We removed the tumor with the right lobe of the thymus only because intraoperative frozen-section histopathological examination revealed that the tumor was not a thymoma but an angioleiomyoma. The removed tumor had a smooth surface and a diameter of 1.5 cm. It weighed 26 gram. Microscopic examination revealed a highly vascular mesenchymal tumor without cellular dysplasia or mitotic figures (Fig 2);
there was no definite capsule or other characteristics of malignancy. The tumor was diagnosed a benign angioleiomyoma.
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Fig 2. Microscopic examination shows a highly vascular mesenchymal tumor without cellular dysplasia or mitotic figures. (Hematoxylin and eosin stain; original magnification, x400.)
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The patient had an uneventful postoperative recovery. A CT scan disclosed no residual tumor 1 year later. The patient has survived without recurrence for 5 years.
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Comment
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Leiomyoma is divided into four classes: multiple piloleiomyoma, solitary piloleiomyoma, solitary genital leiomyoma, and angioleiomyoma [1]. Angioleiomyoma is formed by proliferation of smooth muscle cells in the vascular wall. Almost 90% of such tumors are subcutaneous or appear as skin nodules in the extremities, and 70% of such extremity angioleiomyomas occur in the lower extremities [2]. Angioleiomyoma occuring in deep organs is rare. There are a few case reports of intrapelvic tumor [3] and diaphragmatic tumor [4].
Regarding the growth of angioleiomyomas, theories include an estrogen theory, traumatic theory, and congestive theory [2]. We believe that the tumor in the present case resulted from thymic vascular congestion, because the patient was male and had no history of trauma.
Treatment of such tumors should involve surgical excision especially to relieve symptoms and to obtain tissue for a definitive intraoperative histologic analysis. If the mass recurs, the possibility of leiomyosarcoma should be explored [5].
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References
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Lever W.F., Shaumburg-Lever G. Histopathology of the skin, 7th ed. Philadelphia: Lippincott, 1990:728.
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Durhig J.T., Ayer J.P. Vascular leiomyoma; a study of sixty-one cases. Arch Pathol 1959;68:425-430.
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Shimizu T., Muranaka T., Fukushima K., et al. A case report of intrapelvic vascular leiomyoma. Jpn J Clin Radiol 1999;44:315-318.
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van Rijn A.B.B., van Kralingen K.W., Koelma I.A. Angioleiomyoma of the diaphragm. Ann Thorac Surg 2000;69:1928-1929.[Abstract/Free Full Text]
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Hanft J.R., Carbonell J.A., Do H.Q. Angioleiomyoma of the lower extremity. J Am Podiatr Med Assoc 1997;87:388-391.[Abstract]
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Abstract
Introduction
