Primary pleural epithelioid hemangioendothelioma mimicking as a posterior mediastinal tumor

Our plain-English summary of Primary pleural epithelioid hemangioendothelioma mimicking as a posterior mediastinal tumor, by J. Wethasinghe, J. Sood, R. Walmsley, et al (Respirology Case Reports, 2015).

The study

• Authors: J. Wethasinghe, J. Sood, R. Walmsley, D. Milne, A. Jafer, N. Gordon-Glassford
• Journal: Respirology Case Reports
• Published: 2015;3(2):75-7
• Type of article: Case report
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

A 41-year-old man with no previous asbestos exposure presented with 6 months of dull right lower chest pain and weight loss. The initial computed tomography (CT) scan was reported as showing a soft tissue thickening in the posterior mediastinum with non-specific nodules in the horizontal and oblique fissures. An endoscopic ultrasound-guided fine needle aspiration from the 12 × 25 mm heterogeneous posterior mediastinal mass was suspicious for a ganglioneuroma. The procedure was complicated by a large hemothorax requiring drainage. A subsequent positron emission tomographic CT revealed a moderately fluorodeoxyglucose avid area of pleural thickening extending from the sixth to ninth thoracic vertebral body in the paraspinal region along with nodules along the right horizontal and oblique fissures. A thoracoscopic biopsy of the pleural lesion confirmed a pleural epithelioid hemangioendothelioma. There was a 5-mm reduction in tumor thickness and improvement in his pain following 54 Gy of radiotherapy.

In plain English

This case report described one patient, a 41-year-old South African man, with a rare tumor called primary pleural epithelioid hemangioendothelioma (EHE). It is a cancer of the cells that line blood vessels, here found in the lining around the lung. The article states he had no previous asbestos exposure, and his CT scan showed no asbestos plaques. He had six months of right-sided chest pain and 14 kg of weight loss. Scans showed abnormal tissue beside the spine and a mass at the back of the chest, with nodules along the lung fissures. A needle sample of the mass first suggested a nerve tumor, possibly a ganglioneuroma. Afterwards, 800 mL of blood-stained fluid was drained from his chest. A biopsy taken during thoracoscopy showed the tumor was EHE. He received radiotherapy (54 Gy in 30 fractions). Two months later the main mass had shrunk from 12 to 7 mm and his pain was better controlled. Six months after diagnosis he was well but still had lower chest pain. The authors felt radiotherapy should be the first-line treatment for pain control.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 41-year-old South African man; the authors were from hospital departments in Auckland, New Zealand
• Exposure: No previous asbestos exposure reported. He had served 17 years in the military, worked in information technology, and was a 5 pack-year ex-smoker who quit at age 18.
• Main results:
  • CT showed abnormal right-sided soft tissue beside the spine from the sixth to ninth thoracic vertebrae, a posterior mediastinal mass, and multiple pleural and subpleural nodules in the lung fissures, with no evidence of asbestos plaques.
  • A needle aspiration of the posterior mediastinal mass was first read as suspicious for a neural lesion, possibly a ganglioneuroma.
  • After the aspiration, a pleural effusion developed, and 800 mL of blood-stained fluid was drained.
  • A thoracoscopic biopsy showed a tumor of blood-vessel lining origin consistent with EHE.
  • After radiotherapy of 54 Gy in 30 fractions, the main mass beside the spine shrank from 12 to 7 mm at two months, and his pain was better controlled.
  • Six months after diagnosis, the patient was well but still had lower chest pain.
• The authors' conclusion: The authors felt that radiotherapy, which gave this patient good radiological and symptomatic benefit, should be the first-line treatment for pain control.

Topics

Medical terms in this study, explained in our Lexicon: Epithelioid, Asbestos Exposure, Mediastinum, Ultrasound, Hemothorax, Pleural Thickening, Thoracoscopic Biopsy.

Related studies

• Malignant pleural mesothelioma mimicking the intrapulmonary growth pattern of epithelioid hemangioendothelioma — Y. Muramatsu, K. Isobe, et al. (2014)
• Surgery for invasive primary mediastinal tumors — E.A. Bacha, A.R. Chapelier, et al. (1998)
• Epithelioid hemangioendothelioma of the pleura: clinical and radiologic features — E.J. Crotty, H.P. McAdams, et al. (2000)
• CAMTA1 immunostaining is not useful in differentiating epithelioid hemangioendothelioma from its potential mimickers — Z. Yusıflı, K. Kösemehmetoğlu (2014)
• Biphasic malignant mesothelioma with epithelioid and sarcomatoid components (dedifferentiated mesothelioma) and intrapulmonary growth: a rare entity mimicking desquamative interstitial pneumonia — J. Laforga, A. Gonzalez Garcia (2020)
• Primary thymic epithelial tumours of the pleura mimicking malignant mesothelioma — R.L. Attanoos, F. Galateau-Salle, et al. (2002)

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