Presentation
Worsening shortness of breath, particularly on exertion. Unable to lie supine or left lateral decubitus due to dyspnea.
Patient Data
There is a large anterior mediastinal mass with mediastinal/tracheal deviation to the right. The mass occupies the majority of the retrosternal space.
There is a large anterior soft tissue mediastinal mass abutting the left heart border and the anterior pleural surface.
The heart is globally normal in size and morphology, though it deviated to the right hemithorax due to the mass effect from the mediastinal mass.
Case Discussion
This is a case of a pleomorphic sarcoma of the mediastinum.
The patient underwent a resection of the anterior mediastinal mass. Gross pathologic examination revealed a >1 kg pink-red mass with attached yellow adipose tissue. The surface of the mass showed multiple bulging nodules. There were focal areas of hemorrhage and tan-yellow necrosis. Within the mass, there was a large area of nodular, circumscribed, myxoid area. Histopathologic analysis revealed a malignant spindle cell neoplasm. Overall, the tumor showed histologic findings consistent with a high-grade pleomorphic sarcoma.
Co-author:
Camille Dumas, DO
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