Giant coronary fistula aneurysm presenting as a progressing left-sided asymptomatic mediastinal mass with systolic dominant Doppler flow: a case report

Background Cases of giant coronary artery aneurysms associated with coronary fistula are rarely reported, and they present with various symptoms, including coronary steal syndrome. We report an uncommon case of an asymptomatic giant coronary fistula aneurysm presenting as a progressing left-sided mediastinal mass that has been tracked for years. Case summary A 67-year-old healthy asymptomatic woman was referred to our hospital because of an abnormal shadow on her chest radiography revealing a left-sided mediastinal mass that had progressed in size over the past 4 years. Computed tomography revealed mass progression from 4 cm to 5 cm in diameter within 2 years. Coronary computed tomography and coronary angiography identified a giant coronary artery aneurysm in a coronary fistula originating in the left anterior descending artery and draining into the main pulmonary artery. Transthoracic Doppler echocardiography revealed a unique systolic-dominant flow. She underwent coronary artery aneurysmectomy and fistula ligation. The patient has been in good health without any events for 10 months since her discharge. Discussion A giant coronary artery aneurysm in a coronary fistula can present as an asymptomatic left-sided mediastinal mass that has progressed in size for years in older adults. Echocardiography can provide clues of the steal phenomenon in coronary artery fistula. A close investigation of mediastinal abnormalities can facilitate the detection of coronary aneurysms.

Malignant Transformation of Metaplastic Thymoma into High-Grade Sarcomatoid Carcinoma: A Case Report

The correlation of histogenesis between metaplastic thymoma and thymic sarcomatoid carcinoma is unclear. We report a case of metaplastic thymoma transformed into high-grade sarcomatoid carcinoma. A 64 × 54 × 32 mm anterior mediastinal mass in a 61-year-old woman microscopically consisted mainly of classic metaplastic thymoma, with the center dominated by high-grade sarcomatoid carcinoma. In some areas, both epithelial and spindle cell components of the metaplastic thymoma showed increased cellular atypia, mitotic activity, and focal necrosis and gradually transformed into the polygonal/pleomorphic and spindle cell components of sarcomatoid carcinoma. Immunohistochemically, the characteristics of the polygonal/pleomorphic sarcomatoid cells were similar to those of the epithelial component of metaplastic thymoma, while the spindle sarcomatoid cells were more similar to the spindle cells component of metaplastic thymoma. The Ki-67 index was less than 5% in the metaplastic thymoma areas but up to 70% in the sarcomatoid carcinoma area. Radical operation and postoperative radiotherapy were performed. Multifocal relapses at the pleura occurred 13 months after surgery.

A 28-Year-Old Man With Mediastinal Seminoma Treated With BEP

Highlight:A 28-year-old male suffered chylothorax and mediastinal seminoma.The patient received bleomycin, etoposide and cisplatin chemotherapy for the management of mediastinal seminomas but he died beforeundergoing 5th cycle chemotherapy. Abstract:Seminoma is a type of germ cell tumor. In this case presentation, a rare primary germ cell tumor was reported in the form of mediastinal seminoma. A 28-year-old man with symptoms of shortness of breath, chest pain, swelling in the right upper extremity, enlarged lymph nodes in the colli region. Thoracic physical examination revealed signs of pleural fluid in the right hemithorax. After obtaining the results of radiological and pathological investigations, a mediastinal mass was obtained, then BEP chemotherapy was given. After 3 cycles of chemotherapy, a partial response was obtained. Patients with mediastinal seminoma treated with BEP base chemotherapy gave a partial response.