Ann Thorac Surg 2010;89:e1. doi:10.1016/j.athoracsur.2009.10.074
© 2010 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Malignant Mesenchymoma Surrounding the Esophageal Hiatus
Dianbo Cao, MD, PhDa,*,
Wei Liu, MD, PhDb,
Liang Guo, MDc
a Department of Radiology, The First Hospital of JiLin University, Chang Chun, China
b Department of Thoracic Surgery, The First Hospital of JiLin University, Chang Chun, China
c Department of Pathology, The First Hospital of JiLin University, Chang Chun, China
* Address correspondence to Dr Cao, Department of Radiology, The First Hospital of Jilin University, 1XinMinZhu St, Chang Chun, 130021, China (Email: caotianbo{at}126.com).
A 63-year-old man was admitted to our hospital with complaints of abdominal distention and back pain for 2 weeks. He presented with a 2-month history of shortness of breath and chest tightness with exertion. Physical examination was normal. A chest computed tomography scan demonstrated a large, inhomogeneous mass of different intensity, which referred to adipose tissue, solid tissue, and tissue calcification in the posterior mediastinum and abdominal cavity. A computed tomography reconstruction showed that the mass continuously surrounded the esophageal hiatus (Fig 1).
At operation, the lesion was found in both the thoracic and abdominal cavities with one complete envelope; however, the esophageal hiatus had not been significantly dilated. The thoracic part size of the tumor was 7 x 8 cm and abdominal part was 13 x 14 cm. Nine solid lumps were removed and weighed 2400 grams altogether.
Histopathologic examination of the specimen revealed three types of well-differentiated sarcomatous tumors: leiomyosarcoma, liposarcoma, fibrosarcoma (Fig 2). Immunohistochemistry showed positive for vimentin, actin, and Ki-67 (60%), but was negative with S-100 protein (diaminobenzidine). A diagnosis of malignant mesenchymoma was made. The patient was dismissed with an uneventful hospitalization and was well, without tumor relapse, at the 2-year follow-up.
Malignant mesenchymoma typically occurs in the retroperitoneum or the thigh, but uncommonly occurs in the mediastinum. This patient had the rare presentation of malignant mesenchymoma surrounding the esophageal hiatus, which was represented in both the thoracic and the abdominal cavity.
