Yobita Shogo, Iizuka Shuhei, Otsuki Yoshiro, Nakamura Toru
Departments of General Thoracic Surgery and Pathology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu-city, Shizuoka, 430-8558, Japan.
Int J Surg Case Rep. 2021 Mar;80:105674. doi: 10.1016/j.ijscr.2021.105674. Epub 2021 Feb 23.
Mediastinal hemangiomas are a rare entity frequently developing in the anterior mediastinum. They may exhibit an infiltrating appearance into the surrounding tissue, and extensive surgery is often required despite its benign nature. We report a case of a mediastinal hemangioma mimicking an invasive tumor growth requiring a combined resection of the lung and diaphragm.
An asymptomatic 73 year-old-man presented with a 50 mm-sized mass on his chest radiography. A combined resection of the mediastinal mass with the part of the lower lobe of left lung and diaphragm not necessitating a patch repair was performed. The pathological findings were compatible with a diagnosis of a mediastinal hemangioma. Only fibrous adhesions were observed between the tumor and resected lung and diaphragm without any histological invasion.
While imaging examinations play a key role in determining a preoperative diagnosis, mediastinal hemangiomas may pose a diagnostic challenge mainly due to its rarity. With a clinical suspicion of a hemangioma during the diagnostic work up, a dynamic CT might be helpful.
In mediastinal hemangiomas, a preoperative diagnosis is essential in order to avoid extensive surgery. A hemangioma should be raised as a differential diagnosis for anterior mediastinal tumors, especially in cases with an infiltrative appearance that suggests the necessity for a combined resection of the surrounding organs.
纵隔血管瘤是一种罕见的病变，常发生于前纵隔。它们可能表现出向周围组织浸润的外观，尽管其性质为良性，但通常仍需要进行广泛的手术。我们报告一例纵隔血管瘤，其表现类似侵袭性肿瘤生长，需要联合切除肺和膈肌。
一名73岁无症状男性胸部X线检查发现一个50毫米大小的肿块。对纵隔肿块连同左肺下叶部分及膈肌进行了联合切除，无需补片修复。病理结果符合纵隔血管瘤的诊断。肿瘤与切除的肺和膈肌之间仅观察到纤维粘连，无任何组织学侵犯。
虽然影像学检查在确定术前诊断中起关键作用，但纵隔血管瘤因其罕见性可能带来诊断挑战。在诊断过程中临床怀疑血管瘤时，动态CT可能会有帮助。
对于纵隔血管瘤，术前诊断至关重要，以避免进行广泛的手术。对于前纵隔肿瘤，尤其是那些具有浸润外观提示需要联合切除周围器官的病例，应将血管瘤作为鉴别诊断之一。
