PMC6612705_01
Chest X-ray with right lateral chest wall mass (A). Contrast-enhanced CT; a well-defined mass with heterogeneous enhancement arising in the 5th interspace (B). Tl-weighted image shows a solid mass with a low signal intensity but a little higher compared to that of the adjacent muscles in the right chest wall (C). The fat-suppressed T2-weighted image reveals homogeneous mass with high signal intensity similar to that of fat tissue, which was of high-intensity on fat-suppressed MRI (D). Early phases after administration of contrast, a characteristic heterogeneous enhancement of the tumor (E) that became even more uniform during the delayed phase (F).
gr1.jpg
PMC6612705_01_gr1.jpg
fig0005
Plain chest radiography showed a smooth-walled 6.0 x 3.5 cm homogenous right lateral chest wall mass (Fig. 1A). Computed tomographic (CT) scan revealed right lateral extrapleural soft-tissue mass 6.5 x 4.0 x 5.6 cm in size abutting 5th and 6th ribs and filling the 5th intercostal space (Fig. 1B). Tl-weighted MRI demonstrated a solid mass with a low signal intensity (Fig. 1C), while T2-weighted MRI demonstrated a homogeneous mass with high signal intensity similar to that of fat tissue (Fig. 1D). Early phases after administration of contrast, showed characteristic heterogeneous enhancement of the tumor that became more uniform during the delayed phase (Fig. 1E and F).
Photograph during right VAT shows large mass covered by vascular parietal pleura (A). Thrombosed feeding artery to the tumor (arrow) after embolization (B). Photograph of the chest wall defect after removal of the mass (C). Reconstruction of the chest wall defect performed using PTFE patch (D). Photograph of the specimen shows chest wall mass covered by vascular parietal pleura fixed to 5th and 6th (E). Hematoxylin and eosin stain of chest wall mass, (original magnification 10x and 20x); shows a homogeneous thick and thin-walled blood vessels with proliferating vascular spaces of capillaries of cavernous type with intervening fibrous stroma showing clusters of non-canalizing endothelial cells with no atypia nor malignancy (F).
gr2.jpg
PMC6612705_01_gr2.jpg
fig0010
The patient underwent an exploratory video-assisted thoracoscopy (VAT) through the right 8th intercostal space anterior axillary line (Fig. 2A and B). En bloc resection of the mass involved ribs and the intercostal muscles were performed (Fig. 2C). Gore & Associates) (Fig. 2D). The surgical specimen measured approximately 6 x 4 x 3.5 cm, which included a hemorrhagic, highly vascular, mass that extended from the intercostal muscles to the extra-pleural space (Fig. 2E). Microscopically, there were homogeneous thick and thin-walled blood vessels with proliferating vascular spaces of capillaries of the cavernous type with intervening fibrous stroma (Fig. 2F).