Journal Thoracic Oncology

Abstracts Journal of Thoracic Oncology • Volume 12 Issue S1 January 2017
organs, mimicking malignancy and can be present simultaneously or
metachronously. The fact that IgG4-RD lung disease can be asymptomatic
with only abnormal imaging findings or can manifest with non-specific
clinical symptoms can delay the diagnosis. Methods: A 41-year-old man
was presented with subsequent back pain after rotator cuff injury. There
were no signs in chest physical examination. In terms of medical history, he
had a 20-pack year history of smoking and there was no relevant history.
A computed tomography and a MRI of the chest and the abdomen was
performed revealing a 3 cm right lower lobe paravertebral soft tissue
density mass lesion, invading into the adjacent pleural surface with frank
destruction of the right T6 costovertebral joint. The CT guided biopsy
was not diagnostic. After multidisciplinary meeting, a right 3 ports VATS
biopsy of the mediastinal mass was performed. The postoperative course
was unremarkable. Results: The macroscopic description characterized by
multiple fragments of firm dark brown and cream coloured nodular tissue.
In terms of the microscopic description, sections of lung parenchyma
and adjacent fibrous tissue showed a dense lymphoplasmatic infiltration
predominantly located in the lung parenchyma with suggestion of obliterate
phlebitis . The alveolar spaces showed occasional pneumocyte metaplasia
with no atypia. Immunohistochemistry showed, inflammatory infiltration
of CD138 positive plasma cells along with moderate amount of CD3 positive
T-lymphocytes and scattered CD20 positive B-lymphocytes. Most plasma
cells were express IgG and a large proportion of these are co-express IgG4. The
IgG4 positive plasma cells, in areas were noted to amount up to more than
150 cells per field and amount up to more than 40% of the total plasma cells
present. CK7 and TTF-1 highlight the pulmonary parenchymal architecture,
which was in areas distorted due to marked inflammatory component.
Serum IgG4 levels were also elevated (3,95 g/l) and overall IgG was within
range of normality. A diagnosis of IgG4-related lung disease was made
considering the lymphoplasmatic inflammatory infiltrate of the lesion, the
laboratory findings and the radiological image.Conclusion: This case report
demonstrated the existence of a posterior mediastinal IgG4-RD lesion
extending to the adjacent pleural surface and vertebrae. To the best of our
knowledge there has not been reported a similar case.
tumor considering its vascular origin and the high expression of VEGF from
it. Radiotherapy has been considered ineffective and has just been used to
reduce the pain of bone involment. Regular follow up with no active therapy
has been used for asymptomatic patients with diffuse lesions.
Keywords: chemotherapy, haemangioendothelioma, lung, mediastinal mass
Keywords: IgG4-RD, lung, pseudotumor, IgG4
PUB151 THE INTRICATE MANAGEMENT OF THE EPITHELIOD
HAEMANGIOENDOTHELIOMA
Michail Athanasopoulos 1 , Aspasia Antonopoulou 2 , Domniki Iatropoulou 3 ,
Davide Patrini 4 , Nikolaos Panagiotopoulos 4 , Efstratios Koletsis 2 , David
Lawrence 4
1 University of Thessaloniki, Piraeus/Greece, 2 Cardiothoracic Surgery, University of
Patras, Patras/Greece, 3 University of Ioannina, Ioannina/Greece, 4 Thoracic Surgery,
University College Hospitals, London/United Kingdom
Background: Epithelioid haemangioendothelioma (EH) is a very rare
tumor with vascular origin and an epithelioid or histiocytoid appearance.
It originates from medium-sized or large veins. In this case the neoplasm
thought to be a teratoma and diagnosed postoperatively as an epithelioid
haemangioendothelioma with metaplastic bone formation and extra
medullary haematopoiesis. Methods: Pulmonary function tests as well as
Alpha-fetoprotein and Beta hCG were normal. A decision for a robotic excision
of the mediastinal mass was made. The procedure was uncomplicated/
successful. Results: Macroscopical examination revealed an anterior
mediastinal mass covered by adipose tissue contained separate lymph nodes
with no lymphovascular invasion, weighting 75g and measuring 72 x 50 x
38mm, with infiltrated areas and calcification. Microscopic examination
showed fibro fatty tissue that was diffusely infiltrated by a cellular tumor.
The tumor was characterized as uncapsuled, with poorly defined margins
and with a predominant cell population of large epitheliod and spindledshaped
cells. These cells formed nodular areas and contained a glassy
cytoplasm, which was in areas vacuolated and a prominent pseudonuclear
inclusion. There was a low mitotic count and a low proliferative index (Ki67: