Inflammatory myofibroblastic tumor arising from the ascending aorta mimicking a thymoma
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CASE REPORT
Inflammatory myofibroblastic tumor arising from the ascending aorta mimicking a thymoma Ju Sik Yun1 · Sang Yun Song1 · Kook Joo Na1 · Seok Kim1 · Yoo Duk Choi2 Received: 12 July 2019 / Accepted: 10 October 2019 © The Author(s) 2019
Abstract An inflammatory myofibroblastic tumor originating from the aorta is extremely rare. Here, we report a case involving a 41-year-old female patient with an aortic inflammatory myofibroblastic tumor. Although preoperative imaging showed a mediastinal mass indicative of invasive thymoma, surgical findings revealed that this mass originated from the aorta. The patient underwent partial resection of the aorta, including the mass with patch angioplasty. Based on the postoperative histological findings, the patient was diagnosed with an aortic inflammatory myofibroblastic tumor and is currently under outpatient follow-up. Keywords Inflammatory myofibroblastic tumor · Aortic neoplasm · Thymoma
Introduction
Case
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm consisting of myofibroblastic spindle cells and various inflammatory cells. Although these tumors are usually considered benign, local recurrence and distant metastasis are commonly observed, suggesting the intermediate biological potential of these tumors. Since the first report of a pulmonary IMT, these tumors have been reported mostly in the lungs; however, extrapulmonary lesions, such as in the abdomen, retroperitoneal space, pelvis, and extremities, have also been reported [1].
A 41-year-old female patient was admitted to the department of cardiology at our center, with the chief complaint of chest discomfort. Echocardiography revealed moderate pericardial effusion. Chest computed tomography (CT) revealed a 5.5-cm mass in the anterior mediastinum, along with pericardial effusion (Fig. 1a). The patient’s medical history was unremarkable, and routine preoperative examination findings were normal, except for slight elevation of the white blood cell count (11,900 cells/mm3). Cardiac magnetic resonance imaging (MRI) was performed, and while the boundaries of the mass were relatively clear and distinct, the possibility of its invasion into the aorta and pulmonary artery could not be completely ruled out (Fig. 1b). Based on the preoperative imaging results, we suspected the patient of having invasive thymoma and planned to resect the mass by median sternotomy. However, contrary to our expectation, the mass was confirmed to be located in the intrapericardial space and not in the anterior mediastinal space. Following partial pericardiotomy, we could identify an irregular and solid mass in the upper region of the ascending aorta and proximal main pulmonary artery. The mass was carefully dissected from the right ventricular outflow tract, and we confirmed that it originated in the anterior wall of the aorta. We performed cardiopulmonary bypass through the femoral artery and right atrium to achieve complete resection. With sufficient safety margin
* Sang Yun Song [email protected] 1
Department of Thoraci
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