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Letter to the Editor
Mediastinal Epithelioid Hemangioendothelioma Mimicking a Teratoma
Hemangioendotelioma epitelioide mediastínico simulando un teratoma
Montserrat Blancoa,
Corresponding author
montseblancoramos@hotmail.com

Corresponding author.
, Pedro Gilb, Patricia Joveb
a Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Vigo, Hospital Xeral-Cíes, Vigo, Pontevedra, Spain
b Servicio de Cirugía General, Complejo Hospitalario Universitario de Vigo, Hospital Xeral-Cíes, Vigo, Pontevedra, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Epithelioid hemangioendothelioma is a vascular tumor of endothelial origin with an intermediate histological and clinical behavior somewhere between that of hemangiomas and angiosarcomas&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its incidence is very low&#44; and its most frequent location is at the hepatic and pulmonary level&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> Its localization in the mediastinum is exceptional&#44; and diagnosis is usually established after surgical treatment&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Our patient is a 56-year-old woman with no medical history of interest who was sent to our consultation with the suspicion of a teratoma after thoracic CT performed due to pain in the right hemithorax&#46; The CT scan revealed a 4-cm mass with fatty density and calcium in its interior located in the mediastinum&#46; Thoracic MRI identified a 4-cm mass in the right anterior mediastinum with intralesional fatty foci and foci of hyposignal in related with calcifications&#46; The mass was in contact with the brachiocephalic artery and with the right subclavian vein with no clear data of invasion &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46; By means of transverse cervicotomy&#44; we proceeded with the exeresis of the mass&#46; Post-operative evolution was satisfactory&#46; The histologic report of the piece described a 5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm mass with different mesenchymal components&#58; mature-looking adipose tissue&#44; fibroblastic fusiform cells&#44; bone tissue with thick trabeculas in anarchic distribution and numerous capillary vessels covered with epithelioid endothelium &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#46; The epithelioid cells showed an endothelial immunophenotype &#40;CD&#160;31 and CD&#160;34&#160;&#43;&#41;&#46; These findings supported the diagnosis of epithelioid hemangioendothelioma with an extensive metaplastic ossification&#46; This result was confirmed by the Pathological Anatomy Department at Brigham and Women&#39;s Hospital in Boston &#40;USA&#41;&#44; reference center for the study of soft tissue tumors&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Epithelioid hemangioendothelioma usually presents in patients around the age of 40&#59; the presentation is asymptomatic and is usually a coincidental radiological finding in half of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In our case&#44; the radiological suspicion was for a teratoma due to the calcifications observed on the imaging studies&#46; Although its most frequent localization is at the hepatic and pulmonary level&#44; other localizations have been reported in the mediastinum&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The histologic diagnosis with routine techniques is difficult&#44; and it is necessary on the majority of occasions to use immunohistochemical techniques&#46; In our case&#44; we observed a large metaplastic ossification with positive epithelioid cells in the immunohistochemical study for CD&#160;31 and CD&#160;34&#44; which coincides with the series by Suster et al&#46; confirming the vascular origin of this type of tumor&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> As for prognosis and treatment&#44; we should mention that it is a tumor with slow growth&#46; The treatment of choice is surgical extirpation&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Blanco M&#44; et al&#46; Hemangioendotelioma epitelioide mediast&#237;nico simulando un teratoma&#46; Arch Bronconeumol&#46; 2011&#59;47&#58;376&#8211;7&#46;</p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Thoracic MRI where the mass is observed at the anterior mediastinal level&#59; &#40;b&#41; macroscopic image of the resected mass&#46; It is a nodular formation&#44; measuring 5<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>4<span class="elsevierStyleHsp" style=""></span>cm<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>3&#46;6<span class="elsevierStyleHsp" style=""></span>cm with a smooth surface and areas of brown-violet coloration&#46;</p>"
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