PMC8339196_01
Echocardiogram pre-operatively showing a 32 x 66 mm heterogeneous mass (arrow) located in the left atrioventricular groove.
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F1
The abnormal structure was heterogeneous with fractional acoustic enhancement and had gelatinous materials (Figure 1, arrow).
Computed tomography pre-operatively in coronal view (A), four-chamber view (B), sagittal view (C), three-dimensional volume-rendered image, and (D) shows a tumor-like structure located in the left atrioventricular groove (arrow) with a fountain sign from the posterior wall of the left atrium to the abnormal mass. Cardiac magnetic resonance imaging (E,F) pre-operatively showing a heterogeneous mass with the posterior wall of the left ventricle involved.
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F2
CT scan detected a fountain sign from the left atrium's posterior wall to the abnormal mass (Figures 2A-D, arrow). Cardiac MRI (Figures 2E,F, arrow) was also performed, which further confirmed the left ventricular posterior wall involvement as detected by the contrast-enhanced CT scan; nonetheless, no other metastatic mass was detected.
Post-operative histological examination with hematoxylin-eosin staining showing the proliferation of fibrous tissue in cyst wall (A); hyalinosis (B,C), lymphocyte infiltration (B,C); and the immuohistochemical staining showing the positive expression of Ki-67, Vim, SMA, MC, and partial positive of D2-40 (D), CK5/6 (E), CR (F), CD34, CD31, and WT-1, but negative of CK, EMA, MOC31, and Des (100X, scale bar = 50 mum).
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F3
The results also indicated that the cells were positive for Ki-67, Vim, SMA, MC and partially positive for CR, CK5/6, CD34, CD31, D2-40, and WT-1, but negative for CK, EMA, MOC31, and Des (Figure 3).
A 2- (A) to 4-year (B) post-operative computed tomography showing no evidence of remnant lymphangiohemangioma progression with the same size of 10 x 15 x 30 mm (arrow).
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F4
Cardiac CT 2- and 4-years post-surgery showed no evidence of remnant lymphangioma progression (Figure 4, arrow).