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CT images from case 1. (A) Axial CT revealed a cystic mass with a well-defined edge within the left antero-superior mediastinum. (B) Enhanced CT identified significant enhancement for the left and anterior parts of the cyst wall (white arrow). CT, computed tomography.
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Computed tomography (CT) demonstrated a well-defined cystic mass (5.4x6.9x6.6 cm) in the left antero-superior mediastinum (Fig. 1A). Following contrast (iohexol, 350 mgI/ml, 4-5 ml/s) injection, the left and anterior parts of the wall of the tumor exhibited significant enhancement, while the inside content of the mass did not exhibit any enhancement compared with pre-contrast images (Fig. 1B).
Histopathological section of the hemolymphangioma from case 1 with hematoxylin and eosin staining highlighting the blood and lymphatic vessels. Magnification, x100.
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Hematoxylin and eosin (H&E) staining of the specimen was performed as previously described and revealed dilated lymphatic vessels and blood vessels in the tumor (Fig. 2).
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Imaging of case 2. Enhanced computed tomography reveals a well-defined cystic mass on the right side of the neck with no enhancement following contrast agent injection.
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The CT scan revealed a large cystic mass (8x6x4 cm) occupying the right side of the neck (Fig. 3).
Magnetic resonance imaging results from case 2. A cystic mass was observed on the right side of the neck with (A) hypo-intensity on T1-weighted images (B) and hyper-intensity on T2-weighted images. The tumor demonstrated (C) hypo-intensity on the water-suppression images and (D) significant hyper-intensity on the fat-suppression images.
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T1-weighted images (T1WI; Fig. 4A), homogeneous hyper-intensity on T2-weighted images (T2WI; Fig. 4B) and was well defined. The inferior part of the mass was irregular (Fig. 4C). Water-fat separation MRI of the neck revealed a mass with homogeneous hypointensity on the water-suppression images (Fig. 4C) and significant hyperintensity on the fat-suppression images (Fig. 4D).
Histological results of case 2. Hematoxylin and eosin staining of the tissue supported a diagnosis of hemolymphangioma. Magnification, x100.
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The mass was completely excised and histological analysis (H&E staining) supported a diagnosis of hemolymphangioma (Fig. 5).
PMC5738683_03
CT images from case 3. (A) A lobulated tumor was observed within the mediastinum. The tumor exhibited iso-density with internal scattered calcification. A progressive enhancement of the tumor was observed on post-contrast CT images: (B) Arterial phase and (C) venous phase. The enhancement is stronger in the venous phase compared with the arterial phase.
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CT revealed a lobulated solid mass within the mediastinum, with a size of 3x4x5 cm (Fig. 6A). The mass showed iso-density with internal scattered calcification inside on plain CT images and progressive enhancement on post-contrast CT images (Fig. 6B and C).
CT images from case 3. (A) CT imaging revealed multiple low-density nodules in the spleen. (B) Arterial phase following contrast injection, (C) portal venous phase and (D) delayed phase. Progressive enhancement was observed for the majority of the nodules. The enhancement is gradually intensified from arterial phase to delayed phase following contrast injection. There were a number of nodules that exhibited no enhancement, which were considered to be cysts. CT, computed tomography.
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Progressive enhancement was observed for the majority of nodules on post-contrast (iohexol, 350 mgI/ml) CT images (Fig. 7).
Hematoxylin and eosin staining of the mediastinal tumor from case 3 indicated a diagnosis of hemolymphangioma. Magnification, x100.
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H&E staining of samples from the two surgeries revealed a diagnosis of hemolymphangioma for the mediastinal mass (Fig. 8) and the spleen nodules (Fig. 9).
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Magnetic resonance imaging of case 4. (A) T1WI revealed a tumor with heterogeneous intensities compared with the surrounding muscles. (B and C) The tumor demonstrated hyper-intensity with scattered round-like low intensity on T2WIs following fat-suppression. WI, weighted image.
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MRI revealed an irregular mass on the left forearm, with heterogeneous intensities on T1WI (Fig. 10A) and hyper-intensity on T2WI (Fig. 10B and C). On fat-suppression T2WI, multiple small round-like hypo-intensity was observed inside the tumor (Fig. 10B and C).
Hematoxylin and eosin staining of case 4 supported a diagnosis of hemolymphangioma. Magnification, x100.
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Histopathological features from H&E staining of the mass revealed a hemolymphangioma (Fig. 11).