Jee, Seungyun; Bang, Seongsik; Kim, Hyunsung; Paik, Seung Sam
Department of Pathology, Hanyang University College of Medicine, Seoul, South Korea
Address for correspondence: Dr. Seung Sam Paik, Department of Pathology, Hanyang University College of Medicine, 222, Wangsimri-ro, Seongdong-gu, Seoul 04763, South Korea. E-mail: [email protected]
Received April 21, 2021
Accepted September 17, 2021
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Dear Sir,
A 73-year-old woman was referred to the department of thoracic surgery at our institution for evaluation of an anterior mediastinal mass incidentally discovered on a chest computed tomography (CT) scan, which was originally performed for investigation of epigastric pain due to gastritis. A 3-cm soft tissue mass with lobulated contour and peripheral calcification was present in left thymus with suspicious invasive behavior due to obliteration of the adjacent ascending aorta and fat tissue [Figure 1a]. The impression was thymic epithelial tumor, and she underwent surgery for removal of the mass. The resected specimen measured 7 x 4 cm in cross diameter. The cut surface revealed a 3-cm-sized, well-defined, brownish-red soft mass consisting of multicystic spaces filled with fresh blood. The remaining soft tissue was unremarkable. Microscopically, a vascular tumor was present within the thymic tissue. The tumor consisted of thick-walled dilated veins lined by endothelial cells, which showed positivity for CD34 immunohistochemical staining [Figure 1b]. The final diagnosis was cavernous hemangioma. After the operation, the patient is doing well without any evidence of recurrence or metastasis for 4 years.
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Figure 1: (a) Chest CT scan demonstrating a soft tissue mass with peripheral calcification in the left thymus (arrow). (b) Intrathymic tumor consisting of thick-walled dilated vessels with lining endothelial cells positive for CD34 immunohistochemical staining (inset). (B: hematoxylin and eosin, x100; inset: CD34, x100)
Cavernous hemangioma is a congenital venous malformation with the potential to develop in all parts of the body; however, the incidence in the thymus is very low.[1] To the best of our knowledge, there are only 10 reported cases of cavernous hemangiomas arising in mediastinal thymus in the English literature.[1,2] Zheng et al.[2] reported a case of cavernous hemangioma of the thymus with a review of the literature. They reviewed nine cases of mediastinal thymic cavernous hemangioma and described the characteristics of patients. Recently, Joobeur et al.[1] described a case of cavernous hemangioma of the thymus. The reported patients were five males and five females with no gender predominance. The mean age of patients was 47.2 years, ranging from 27 to 71 years. The mean size of tumors was 3.9 cm. Interestingly, in all 10 cases, it was characteristically located at the left lobe of the thymus. In our case, the patient was a 73-year-old woman and the tumor size was 3 cm located at the left thymus. Both invasive and noninvasive modes of examination usually fail to distinguish cavernous hemangioma from other tumors of the thymus, and it is not possible to determine whether a thymic mass is benign or malignant by imaging examinations alone.[3,4] Shen et al.[3] described a case of thymic cavernous hemangioma misdiagnosed as thymoma. In our case, the mass was mistakenly interpreted as thymic epithelial tumor on the chest CT scan. Although the incidence is very rare, cavernous hemangioma should be considered in the differential diagnosis in patients with a thymic mass.
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REFERENCES
1. Joobeur S, Ben Saad A, Migaou A, Njima M, Achour A, Fahem N, et al Rare case of cavernous hemangioma of the thymus Respir Med Case Rep. 2019;29:100986
2. Zheng C, Zhang F, Tu S, Zhang X, Zhao C. Cavernous hemangioma of the thymus: A case report and review of the literature Medicine (Baltimore). 2018;97:e11698
3. Shen C, Liang Y, Xu H, Liu L, Che G. Cavernous hemangioma of thymus misdiagnosed as thymoma: A case report World J Surg Oncol. 2014;12:323
4. Ose N, Kobori Y, Takeuchi Y, Susaki Y, Taniguchi S, Maeda H. Cavernous hemangioma in the thymus: A case report Surg Case Rep. 2016;2:10
