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Case Reports
. 2013 Feb 20:2013:bcr2012007527.
doi: 10.1136/bcr-2012-007527.

Mediastinal leiomyosarcoma concurrent with intra-aortic thrombosis

Masayoshi Yoshida  1 , Shin-ichi Ando, Yoshiki Naito, Hirohisa Yano
Affiliations
Case Reports

Mediastinal leiomyosarcoma concurrent with intra-aortic thrombosis

Masayoshi Yoshida et al. BMJ Case Rep. .

Abstract

We report a case of a large intra-aortic thrombosis in an 83-year-old woman concurrent with metastatic mediastinal leiomyosarcoma. Imaging studies incidentally detected a mediastinal malignant tumour metastasising to bilateral adrenals and an extensive intra-aortic mass that was suspected to be intra-aortic thrombosis. One month later massive embolism developed in the lower limb and her condition deteriorated rapidly resulting in death. Autopsy revealed diffused proliferation of highly pleomorphic atypical cells accompanied by necrosis in the mediastinum tumours and bilateral adrenal glands. Leiomyosarcoma metastasising to bilateral adrenals was confirmed by the results of immunostaining. The intra-aortic mass suggested that the fragmented thrombus might be the cause of a sudden lower-limb embolism. Microscopic examination showed that the mass lesion in the aortic arch was composed of a blood clot containing neutrophils. We report this case because leiomyosarcoma arising from the mediastinum and, especially, associated with an extraordinarily large intra-aortic thrombosis is very rare.

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Figures

Figure 1
Figure 1
Chest contrast-enhanced CT findings: an intra-aortic mass extending from the aortic arch to descending aorta and intra-aortic thrombosis was highly suspected. A mediastinal tumour, 45×40 mm, low-attenuation mass which was enhanced by contrast was also demonstrated.
Figure 2
Figure 2
Contrast-enhanced MRI findings: (A) mediastinal tumour was a high-intensity mass at the diffusion-weighted image and (B) mediastinal tumour was low apparent diffusion coefficient value which was enhanced by contrast.
Figure 3
Figure 3
Macroscopic findings: the tumour showed a white and well-circumscribed solid lesion with focal necrotic change, and no extension into lung, trachea, oesophagus and aorta. L: lung; T: trachea; E: oesophagus; A: aorta.
Figure 4
Figure 4
Microscopic findings: (A) the tumour was composed of highly pleomorphic and spindle cells and (B) the tumour showed necrotic changes (A, B: H&E ×200).
Figure 5
Figure 5
Immunohistochemical findings: the tumour cells expressed positive for vimentin and α-smooth muscle actin (SMA) (A: vimentin ×200, B: α-SMA ×200).
See this image and copyright information in PMC

References

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