PMC4118155_01
Preoperative radiographic view. (A) Lateral projection of the thorax reveals significant accumulation of pleural effusion. (B) Ventrodorsal projection of the thorax reveals a widened cranial mediastinum with increased soft-tissue density.
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F1
Lateral and ventrodorsal radiographic projections of the thorax revealed significant accumulation of pleural effusion and widening of the cranial mediastinum with increased soft-tissue density (Figure 1A and B).
Preoperative sagittal computed tomography post-contrast image. A mass effect is present in the cranial mediastinum, adjacent to the heart. The mass is approximately 9 cm in height, 8 cm in width and 12 cm in length.
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F2
A thoracic ultrasound and CT scan revealed a mass effect in the cranial mediastinum adjacent to the heart (Figure 2).
Intraoperative photograph. A pedunculated mass located in the cranial mediastinum is attached to the surrounding organs including the esophagus, trachea, brachiocephalic trunk, left subclavian artery and cranial vena cava.
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F3
A pedunculated mass located in the cranial mediastinum was attached to the surrounding organs including the esophagus, trachea, brachiocephalic trunk, left subclavian artery and cranial vena cava without attachment to the right atrium, right auricular appendage, pericardium and heart base (Figure 3).
Cranial mediastinal hemangiosarcoma. (A) The sample consists of residual fat with some fibrous stroma and there are multifocal, extensive areas of hemorrhage. Surrounding areas of hemorrhage are composed of nests of neoplastic endothelial cells, 50X H&E stain objective. (B) The cells are tightly packed with minimal amphophilic cytoplasm and hyperchromatic plump oblong nuclei with coarsely stippled chromatin and a single nucleolus, 200X H&E stain objective. (C) CD31 immunohistochemistry shows immunoreactivity of cells lining vascular channels. Atypical spindle cells are positive for CD31, 20X CD31 stain objective. (D) Factor VIII immunohistochemistry shows immunoreactivity of cells lining vascular channels. Atypical spindle cells are positive for factor VIII, 20X factor VIII stain objective.
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F4
The cells were tightly packed with minimal amphophilic cytoplasm and hyperchromatic plump oblong nuclei with coarsely stippled chromatin and a single nucleolus (Figure 4A and B). Atypical spindle cells were positive for CD31 and factor VIII, which supported HSA, as described above (Figure 4C and D).The thoracostomy tube was removed 8 days post-operatively when the amount of serosanguineous fluid production was 1.7 ml/kg/day.
Postoperative radiographic view at 6 months. Lateral (A) and ventrodorsal (B) projections of the thorax reveal no pleural effusion and no evidence of increased soft-tissue density associated with widening of the cranial mediastinum.
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F5
At 6 months, lateral and ventrodorsal radiographic projections of the thorax revealed no pleural effusion and no evidence of increased soft-tissue density associated with widening of the cranial mediastinum (Figure 5A and B).