Thoracic Hemangiomas: Imaging via CT, MR, and PET Along With Pathologic Correlation

Subcutaneous fibroblastoma resembling hemangioma: A case of benign tumor of the chest wall

Key Clinical Message

Desmoplastic fibroma presents similar to other soft tissue tumors to such an extent that even a gold standard investigation can miss.

Abstract

This is to report a mass in a 47-year-old male arising from the chest wall, which was first thought to be a hemangioma but was later diagnosed as a case of desmoplastic fibroblastoma with the help of a biopsy.

Dual-Time-Point 18 F-FDG PET/CT for Differentiating a Chest Wall Hemangioma From a Malignant Metastasis

ABSTRACT

Dual-time-point 18 F-flluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) can be used to differentiate benign vascular tumors from other malignant growths. We present the case of a 70-year-old woman with a history of cervical carcinoma who was referred for PET/CT to examine a left chest wall tumor noted on CT, which involved the adjacent rib and pleura, thus raising the suspicion of metastasis. The chest wall tumor demonstrated moderate FDG uptake and further decreased uptake at the delayed-phase scanning, corresponding to biodistribution of FDG in the blood pool. These findings indicated a benign hemangioma rather than a metastasis.

Cavernous mediastinal hemangioma presenting with persistent cough: a rare case report and review of literature

BACKGROUND

Cavernous hemangioma is a rare benign tumor which can sometimes mimic the clinical presentation and radiological findings of malignant tumors. Here we present a rare presentation of cavernous hemangioma in the mediastinum (CHM), along with a literature review among the main databases.

CASE PRESENTATION

We present a 48-year-old male who had suffered from persistent cough as the sole symptom of an anterior CHM. Computed tomography scan demonstrated a 12.5 × 10.8 cm mass in the anterior mediastinum. The mass was surgically resected, and histopathological evaluation established the diagnosis of CHM. The patient was discharged in good condition, in which during his four-month follow-up period, no recurrence of the tumor has been observed.

CONCLUSION

Although cavernous hemangioma rarely present in the mediastinum, it should be considered in the differential diagnosis of mediastinal tumors. However, our review of literature demonstrated a female dominance and average age of 40 years, with a 52% mortality rate based on previous reports.

OUP accepted manuscript

Benign vascular tumors of the mediastinum are rare, representing only 0.5% of all mediastinal masses. Given their rare presentation, they are infrequently considered in the workup of a middle mediastinal mass. We present a unique case describing the clinical, imaging and pathologic characteristics of a middle mediastinal cavernous hemangioma which was initially misdiagnosed as a bronchogenic cyst and ultimately required surgical resection with the use of veno-venous extracorporeal membrane oxygenation.

Mediastinal hemangioma mimicking an invasive tumor growth: A case report

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Mediastinal hemangiomas may exhibit an infiltrating appearance.

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Extensive surgery is often required due to an inaccurate preoperative diagnosis.

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A hemangioma should be raised as a differential diagnosis to avoid extensive surgery.

Introduction and importance

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.

Case presentation

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.

Clinical discussion

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.

Conclusions

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.

Benign lesions of the mediastinum: A review with emphasis on cytology and small biopsy specimens

This review focuses on the diagnosis of select benign processes, ranging from reactive entities to heterotopic tissues to neoplasms, which may occur in the mediastinum. Currently, the mediastinum can be evaluated and biopsied with endoscopic procedures. Therefore, cytopathology specimens, fine needle aspirations, and small biopsies play an important role in the diagnosis of these lesions. In this review, an emphasis is given to relevant clinical presentations, histologic and cytologic findings, differential diagnoses, ancillary testing, and interpretation. Pitfalls are reviewed and discussed in each section. It is important for both surgical pathologists and cytopathologists to be familiar with these entities and their cytologic and histologic features that may be helpful in reaching a diagnosis.

Mediastinal hemangiomas: Spectrum of CT and MRI findings - retrospective case series study and systematic review of the literature

PURPOSE

To analyze the imaging manifestations of mediastinal hemangioma (MH) by CT and MRI to aid in its successful diagnosis and preoperative evaluation.

METHODS

Seventeen cases of MH diagnosed by histopathology combined with CT and MRI were retrospectively collected; and their CT and MRI features, including the lesions' site and range, shape, size, margin, density or signal, enhancement pattern, mass-cardiovascular interface, mass-pulmonary interface, and other characteristics were evaluated.

RESULTS

The anterior, middle, and posterior mediastinum were involved in 13, 13, and 8 cases, respectively. The masses size varied from 20 to 233 mm. Irregular, dumbbell-like, and oval masses were found in 13, 2, and 2 cases, respectively, while with pampiniform growth in 16 cases and expansive growth in 1 case. Mixed density, homogeneous density solid masses, and heterogeneous density masses with dominant fat were found in 9, 5, and 3 cases, respectively, showing mild or significant enhancement in aortic phase while no or mild enhancement in pulmonary artery phase. Draining veins were found in 16 cases and feeding arteries in 10 cases. Phleboliths were detected in 10 cases, splenic hemangiomas in 6 cases, and left lateral-chest-wall hemangioma in 1 case. In MRI sequences, mixed signal was found on T₁WI and heterogeneous hypersignal with nodular or linear hyposignal on T₂WI in 5 cases, mild or significant enhancement in 4 cases, draining veins in 2 cases, and no feeding arteries or phleboliths were seen.

CONCLUSION

Presence of phleboliths, pampiniform growth pattern, and aberrant draining veins are relatively specific characteristics in diagnosing MH.

CT and MRI manifestations of mediastinal cavernous hemangioma and a review of the literature

BACKGROUND

The cavernous hemangioma of mediastinum (CHM) is a rare benign lesion caused by congenital vascular dysplasia. However, its incidence is extremely low, and patients often lack relevant clinical symptoms. So we analyzed retrospectively some cases to investigate the imaging features of cavernous hemangioma of mediastinum (CHM) and improve the diagnostic accuracy.

METHODS

The CT/MRI imaging features and clinical information of 19 patients with CHM were analyzed retrospectively.

RESULTS

The lesions of 18 CHM patients were single. Twelve cases in the anterior mediastinum and 8 in the posterior mediastinum. The diameter of CHM ranges from 2.0 to 7.0 cm. Thirteen cases were oval-shaped or round, 4 cases were lobulated, and 2 cases were irregular. Phleboliths or nodular calcification were identified in four cases. High signal of T2WI lipid suppression in two cases and blood vessel shadows were observed in two cases. After contrast-enhanced scan, the nodular enhancement of arteries were identified in 14 cases and contrast agent was further filled of the venous phase, where "fast in and slow out" feature was performed. One case showed inhomogeneous enhancement, one case performed "fast in and slow out" feature of multiphase-enhanced MRI. Besides, aberrant veins can be seen in or around the lesion among five cases.

CONCLUSIONS

CHM is more frequently located at the anterior mediastinum than at the posterior mediastinum. The performance of phleboliths, high signal on T2WI fat suppression and DWI, the nodular enhancement of the artery, venous and delayed phase filling, enhanced "fast in and slow out," and aberrant veins in the lesion are helpful for the diagnosis and differential diagnosis. Multiple period contrast-enhanced CT and MRI scan is helpful for the diagnosis of CHM.

A Novel Adaptive PET/CT Image Fusion Algorithm

Background:

Lung cancer is one of the common malignant tumors. The successful diagnosis of lung cancer depends on the accuracy of the image obtained from medical imaging modalities.

Objective:

The fusion of CT and PET is combining the complimentary and redundant information both images and can increase the ease of perception. Since the existing fusion method sare not perfect enough, and the fusion effect remains to be improved, the paper proposes a novel method called adaptive PET/CT fusion for lung cancer in Piella framework.

Methods:

This algorithm firstly adopted the DTCWT to decompose the PET and CT images into different components, respectively. In accordance with the characteristics of low-frequency and high-frequency components and the features of PET and CT image, 5 membership functions are used as a combination method so as to determine the fusion weight for low-frequency components. In order to fuse different high-frequency components, we select the energy difference of decomposition coefficients as the match measure, and the local energy as the activity measure; in addition, the decision factor is also determined for the high-frequency components.

Results:

The proposed method is compared with some of the pixel-level spatial domain image fusion algorithms. The experimental results show that our proposed algorithm is feasible and effective.

Conclusion:

Our proposed algorithm can better retain and protrude the lesions edge information and the texture information of lesions in the image fusion.

Vascular chest wall lesion mimicking a breast tumor on screening mammograms: Report of a case

Vascular lesions in the chest wall muscles are extremely rare and can cause diagnostic difficulties on screening mammograms. We describe a case of venous malformation of the pectoralis muscle, diagnosed during routine screening, in a 60-year-old woman. The mammograms showed a mass over the chest wall, projecting in the breast parenchyma. The ultrasound was not diagnostic. The definite diagnosis was made using MRI, and to our knowledge, only 1 similar case has been reported so far, but this is the only asymptomatic case depicted during screening services.

Castleman Disease of the Thorax: Clinical, Radiologic, and Pathologic Correlation: From the Radiologic Pathology Archives

Castleman disease is a complex lymphoproliferative disease pathologically divided into two subtypes, the hyaline vascular variant (HVV) and the plasma cell variant (PCV). The HVV is the most common, is thought to represent a benign neoplasm of lymph node stromal cells, and is treated with surgical resection. It is most commonly found in the mediastinum, where it classically appears as a unicentric, avidly enhancing mass at computed tomography (CT) and magnetic resonance imaging. This appearance can mimic other avidly enhancing mediastinal masses, and location, clinical history, laboratory data, and nuclear medicine single photon emission CT (SPECT) and positron emission tomography (PET) studies can help narrow the differential diagnosis. Multicentric Castleman disease (MCD), which in the majority of cases is composed of the PCV, is an aggressive lymphoproliferative disorder associated with human herpesvirus infection, interleukin 6 dysregulation, and other systemic disorders. While it can be difficult to differentiate MCD from lymphoma, the presence of avidly enhancing lymph nodes can suggest the diagnosis. The purpose of this article is to review the clinical, immunologic, and pathologic findings associated with both unicentric Castleman disease and MCD and discuss how the imaging findings correlate with the pathophysiology of the disease.

Sudden death in a child caused by a giant cavernous hemangioma of the anterior mediastinum

A 4-year-old girl who had been treated for asthma since the age of 2 years had a severe coughing fit and died suddenly. The patient had a history of occasional severe coughing fits, and these fits had been worsening in severity during the week before her death. Prior to death, she was taken to a clinician, and thymic hypertrophy was suspected based on chest X-ray findings. The clinician recommended that she visit a general hospital at a later date; however, she died that night. Postmortem radiology and autopsy revealed a large mass in the anterior mediastinum compressing the heart and airway, and no other findings attributable to sudden death were observed. Therefore, we concluded that the patient's death was attributable to acute respiratory and cardiac circulatory failure secondary to the pressure induced by the mass. Microscopically, the mass showed a cavernous structure composed of cystically dilated, thin-walled large vessels filled with blood. The final diagnosis was a cavernous hemangioma. Hemangiomas are the most common benign vascular anomalies seen in young children; however, mediastinal hemangiomas are rare and can cause life-threatening complications because of their size and location. Therefore, forensic pathologists should include hemangioma as a differential diagnosis in children with anterior mediastinal masses.

F-18 fluorodeoxyglucose positron emission tomography for differential diagnosis and prognosis prediction of vascular tumors

The spectrum of vascular tumors ranges from hemangioma (HEM), to epithelioid hemangioendothelioma (EHE) and to angiosarcoma (AS). To the best of our knowledge, the usefulness of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) for vascular tumors has never been comprehensively studied. The present study investigated the usefulness of FDG-PET for pathologically diagnosed vascular tumors. The present study included 26 patients with vascular tumor (male:female, 17:9; age, 60.9±14.4 years; 7 HEM, 6 EHE and 13 AS) who underwent FDG-PET between January 2007 and May 2014 at the Seoul National University Bundang Hospital (Seongnam, Korea) and Konkuk University Medical Center, (Seoul, Korea). Representative FDG uptake was measured as the maximum standardized uptake value (SUVmax) over the lesion with the highest FDG uptake. Disease progression was clinically defined as the aggravation of known lesions or novel lesion development during follow-up on computed tomography, magnetic resonance imaging, or FDG-PET. FDG-PET revealed multi-organ involvement only in AS (6/13 [46.2%]), whereas HEM and EHE involved a single organ. Tumor SUVmax was significantly greater in AS (6.32±4.84) compared with EHE (3.10±2.68) and HEM (2.33±0.76) (P=0.0284). There was no difference in tumor SUVmax between HEM and EHE (P>0.05). Disease progression was primarily noticed in AS (9/13 [69.2%]). Only 1 patient with EHE (1/6=16.7%) and no patients with HEM (0/7=0%) experienced disease progression. Mortality was reported only in patients with AS (4/13 [30.8%]). Using the cutoff SUVmax of 3.0, the two-year progression-free survival rate of 14 patients with tumor SUVmax <3.0 (75.0%) was significantly higher compared with that of 12 patients with tumor SUVmax ≥3.0 (0%) (P=0.0053). In conclusion, FDG-PET is useful for the differential diagnosis and prognosis prediction of vascular tumors.

Cavernous hemangioma of the ilium mimicking aggressive malignant bone tumor with increased activity on (18)F-FDG PET/CT

Osseous hemangioma is a benign vascular tumor, and it usually occurs in the vertebrae and the skull. However, hemangiomas of flat bones are rare, and there are very few reports that describe the radiologic findings of osseous hemangioma of the ilium. We report a unique case of large cavernous hemangioma mimicking a chondrogenic malignant bone tumor originated from the ilium in a 22-year-old female. The mass showed stippled calcifications, heterogeneous enhancement with thick septa and enhanced soft tissue components on CT and MR, and also this mass demonstrated heterogeneous 2-fluoro [fluorine-18]-2-deoxy-D-glucose (¹⁸F-FDG) uptake on ¹⁸F-FDG PET/CT.

Atrial masses on multidetector computed tomography

Incidental atrial filling defect on multidetector computed tomography (MDCT) is an important radiological finding, as irrespective of its nature, it may nevertheless be of considerable importance for correct diagnostic workup. MDCT is not the first-line imaging technique of choice for characterization of intra-atrial masses, but is a commonly performed examination and hence offers the opportunity to pick up hitherto unsuspected atrial lesions. This review highlights key CT imaging features that help to differentiate normal variants and artefacts from a true abnormality, distinguish benign from malignant intra-atrial tumours, and characterize non-neoplastic atrial masses.

Review of chest wall tumors: a diagnostic, therapeutic, and reconstructive challenge

Chest wall tumors are a heterogeneous group of lesions that provide an interesting diagnostic and therapeutic challenge for surgeons. They make up less than 5% of thoracic malignancies and vary widely in pathology as they arise from all anatomic structures of the chest wall. In general, treatment is wide local excision, the margins for malignant disease are necessarily wider, and adjuvant radiation is typically given for those with positive margins. Chemotherapy is rarely effective. Local control is the most important prognostic factor. Disease-free survival for malignant disease is limited by positive margins; therefore full oncologic resection with 4-cm margins should be attempted. For small lesions, the resection and reconstruction is usually straightforward. For more advanced disease or those lesions that require significant functional loss, preoperative planning using a multidisciplinary approach, incorporating thoracic surgery, plastic surgery, neurosurgery, radiation medicine, oncology, and physical medicine and rehabilitation, may be essential.

Hemangioma de mama simulando metástase no PET-CT

Hemangioma de mama é um tumor benigno raro que apresenta pouca ou nenhuma captação de 18F-flúor-2-deoxi-Dglicose (FDG) na tomografia por emissão de pósitrons (PET). Relatamos um nódulo mamário compatível, patologicamente, com hemangioma, em uma mulher cuja PET scan demonstrou captação elevada de FDG (simulando tumor maligno). Também fizemos breve revisão das causas que levam a resultados falso-positivos e falso-negativos pela PET.

Mediastinal vascular malformation presenting with stroke

The mediastinum is an uncommon location for vascular malformations. We describe an unusual case of a young patient with a large, extensive mediastinal vascular malformation and draining vein to the left atrium who presented with recurrent ischaemic episodes.