Paper # 004 Versión en Español Versión en Español

Epithelioid hemangioendothelioma in posterior mediastinum. Presentation of a case.

C. González del Rey, P. Menéndez, J.A. Manjón, A. Ribas, A.Sanpedro.

Department de Pathology. II. Hospital Central de Asturias. Hospital Monte Naranco. Oviedo. Spain.
Address: Julián Clavería s/n
Oviedo. Spain


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Vascular tumors of the mediastinum represents less than 1-1.5% of all tumors in this location. Most of them are benign and they are usually hemangiomas and vascular malformations. Epithelioid hemangioendothelioma was first described in soft tissue by Weiss and Enzinger (1982), as a vascular tumor with intermediate clinical and histological features between a hemangioma and a angiosarcoma. Mortality in this tumor is more dependent of the site of origin (lung, liver) and its multifocallity; however, the presence of necrosis, mitosis, and cellular pleomorphism are histological criteria of potential malignancy.

We preset a 26 years old male that was diagnosed, on a routine chest x-ray film, of a mass in posterior mediastinum. The excised tumor was 13 cm, encapsulated, and it showed microscopically cystic areas filled with blood intermingled with areas of prominent vascular pattern of small and medium size, and cells of round, oval or slightly fusiform nuclei, with a diffuse chromatin, small nucleoli, and eosinophilic cytoplasms. There were also cells with intracytoplasmic vacuoles, some of them with intraluminal red blood cells, and a large amount of multinucleated osteoclastic giant cells, and foci of osseous metaplasia. The immunohistochemical study showed a strong positivity with vimentin and CD34, and a weak and occasional reaction with FVIII and actin, and it was negative with keratins, desmin, and S-100.

The interest of this case relies not only in the rarity of mediastinal vascular tumor, but also in the fact that all epithelioid hemangioendotheliomas described in mediastinum are anterior in location.

Key Words: Epithelioid hemangioendothelioma, Mediastinum

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