Massive Posterior Chest Wall Tumor

Bibhusan Basnet, MD and Ashok Polu Reddy, MD

April 3, 2018

A 48- year-old Caucasian male presented with a posterior chest wall mass, which had developed over a period of approximately 20 years. He was evaluated at various medical centers throughout the United States but his surgery was deferred because of the high risk of surgical complications. His medical history included hypertension, hyperlipidemia, venous thromboembolism, total splenectomy after traumatic rupture and obesity. He had no cardiovascular or pulmonary symptoms at presentation. 

He was hemodynamically stable and he had a normal cardiovascular examination. Pulmonary exam revealed decreased air entry to left lung field. On examination, the patient had an ovoid mass on the right posterior chest wall extending to the left upper posterior chest wall (See Image 1). The findings on a computed tomography of the chest and abdomen revealed a right posterior thoracic extensive vascular malformation measuring approximately 25 x 20 x 9 cubic centimeters  (See Image 2). He underwent prolonged surgical excision without surgical complications. Histopathological examination of the biopsy specimen revealed variable-sized haphazardly arranged veins that stained positive for elastin, without evidence of atypical nuclei or spindle cell components (See Image 3). He was discharged home in stable condition.

What is the most likely diagnosis?

A. Hemangioma
B. Angiosarcoma
C. Benign arterio-venous vascular malformation
D. Lymphangioma

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Reference:

1. Marler JJ, Mulliken JB. Current management of hemangiomas and vascular malformations. Clinics in plastic surgery. 2005; 32: 99-116.

About the authors:

Bibhusan Basnet is a resident physician at the department of Internal medicine at Presence St. Joseph Hospital, Chicago, USA. 

Ashok Polu Reddy was a preliminary intern at the department of Internal medicine at Presence St. Joseph Hospital, Chicago, USA.