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Incidental localized (solitary) mediastinal malignant mesothelioma

E Erdogan, MD ¹ F B Demirkazk, MD ¹ M Gulsun, MD ¹ M Aryurek, MD ¹ S Emri, MD ² and S D Sak, MD ³

Departments of ¹ Radiology and ² Chest Diseases, Hacettepe University School of Medicine, 06100 Ankara, Turkey and ³ Department of Pathology, Ankara University, Ankara, Turkey

View larger version (141K): [in a new window]   Figure 1. A lobulated paramediastinal soft tissue density in the right mid and lower chest was observed on chest radiography.

View larger version (39K): [in a new window]   Figure 2. (a) Contrast enhanced thorax CT showed a 6 cm x 5 cm x 4 cm mass with a predominant cystic component The cyst was surrounded by a smooth, well defined wall of uniform thickness. (b) A solid component of soft tissue attenuation with borders that were not separable from the ascending aorta was also observed. (c) At the level of left atrium, the mass appears to have no solid component at all.

View larger version (55K): [in a new window]   Figure 3. (a) Haematoxylin and eosin staining of the tumour revealed atypical epithelial cells with vesicular nuclei and prominent nucleoli forming papillary and glandular structures and sheets. (b, c) Mesothelin staining of the tumour showing membraneous staining with apical accentuation.

View larger version (82K): [in a new window]   Figure 4. (a, b) CT obtained 3 months after total tumour excision shows a smaller contrast enhancing mass of soft tissue attenuation without remarkable cystic component at the same location as the original tumour. Biopsy from this mass revealed tumour recurrence. (c) Post contrast T1 weighted, (b) T2 weighted axial, and (e) pre-contrast T1 weighted sagittal images obtained within few days as the CT in (a, b) demonstrate the recurrent contrast enhancing anterior mediastinal tumour.