犬血管肉瘤ppt课件.ppt

Primarycranialmediastinalhemangiosarcomainayoungdog Hun YoungYoon1 Hye MiKang2andMi YoungLee31DepartmentofVeterinarySurgery CollegeofVeterinaryMedicine KonkukUniversity Seoul143 701 SouthKoreaFulllistofauthorinformationisavailableattheendofthearticle Primarycranialmediastinalhemangiosarcomasareuncommontumors A30 kg 2 year old intactfemaleGermanshepherdwaspresentedforevaluationofcachexiaandrespiratorydistressofafewdays duration Lateralradiographicprojectionofthethoraxrevealedsignificantpleuraleffusion Computedtomographyrevealedacranialmediastinalmasseffectadjacenttotheheart Onsurgicalexploration apedunculatedmassattachedtotheesophagus trachea brachiocephalictrunk leftsubclavianarteryandcranialvenacavawithoutattachmenttotherightatriumandauricularappendagewasremovedanddebridedbyuseofbluntdissectionanddrygauzes respectively abstract Primarycranialmediastinalhemangiosarcomas颅脑原发性纵隔血管肉瘤cachexia瘦弱 萎靡不振respiratorydistress呼吸窘迫Lateralradiographicprojection横向射线投影thorax胸部pleuraleffusion胸腔积液Computedtomography计算机断层扫描cranialmediastinalmass前纵隔肿块pedunculatedmass带蒂肿块esophagus食管trachea气管brachiocephalictrunk头臂干leftsubclavianartery左锁骨下动脉cranialvenacava颅腔静脉rightatrium右心房auricularappendage心耳debrided清除bluntdissection钝性剥离drygauzes干纱布 AbstractHistopathologyresultsdescribedthecranialmediastinalmassashemangiosarcoma At8monthsand5dayspost operatively thepatientdied Primarycranialmediastinalhemangiosarcomas althoughaseeminglyrarecauseofthoracicpathologyinyoungdogs shouldbeconsideredinthedifferentialdiagnosisforpleuraleffusionandsofttissuemasseffectinthecranialmediastinum Thisisthefirstcasereportinadogtodescribeprimarycranialmediastinalhemangiosarcoma 组织病理学说 Casepresentation A30 kg 2 year old intactfemaleGermanshepherdwaspresentedforevaluationofcachexiaandrespiratorydistressofafewdays duration Onphysicalexamination thedogshowedlaboredbreathingwitharespiratoryrateofapproximately90 minute Alowhematocrit 28 9 wasidentifiedoncompletebloodcountprofiling At189 103 L plateletswereinthelow normalrange referencerange 180to500 103 L Aurinalysisandserumbiochemistryandcoagulationprofileswereunremarkable Lateralandventrodorsalradiographicprojectionsofthethoraxrevealedsignificantaccumulationofpleuraleffusionandwideningofthecranialmediastinumwithincreasedsoft tissuedensity Figure1AandB Sanguineousfluid 700ml wasremovedunderultrasound guidedthoracocentesis Figure1Preoperativeradiographicview A Lateralprojectionofthethoraxrevealssignificantaccumulationofpleuraleffusion B Ventrodorsalprojectionofthethoraxrevealsawidenedcranialmediastinumwithincreasedsoft tissuedensity Pleuraleffusionandultrasound guidedfineneedleaspirationcytologyofthemasspredominantlyrevealederythrocytesandnotumorcells Onauscultation therewasnoevidenceofmuffledheartsound AthoracicultrasoundandCTscanrevealedamasseffectinthecranialmediastinumadjacenttotheheart Figure2 Themasswasapproximately9cminheight 8cminwidthand12cminlength Therewasnoevidenceofinvasionintothecranialvenacava brachiocephalictrunkorleftsubclavianartery AnabdominalCTscanwasperformedtoruleoutotherdifferentialsanddemonstratednoevidenceofmassesonthespleen liverandothersites TheCTscandiagnosiswascranialmediastinalsofttissueneoplasm 肿瘤 Figure2Preoperativesagittalcomputedtomographypost contrastimage Amasseffectispresentinthecranialmediastinum adjacenttotheheart Themassisapproximately9cminheight 8cminwidthand12cminlength 矢状的 Surgicalexplorationofthethoraxwasperformedthroughmediansternotomy Theupperhalfofthemanubriumandthexiphoidprocesswereleftintact Apedunculatedmasslocatedinthecranialmediastinumwasattachedtothesurroundingorgansincludingtheesophagus trachea brachiocephalictrunk leftsubclavianarteryandcranialvenacavawithoutattachmenttotherightatrium rightauricularappendage pericardiumandheartbase Figure3 Figure3Intraoperativephotograph Apedunculatedmasslocatedinthecranialmediastinumisattachedtothesurroundingorgansincludingtheesophagus trachea brachiocephalictrunk leftsubclavianarteryandcranialvenacava 术中 Themasswasremovedbybluntdissectionfromtheorganstowhichitwasattached includingtheesophagus trachea brachiocephalictrunk leftsubclavianarteryandcranialvenacava Theinternalthoracicarteryandveinweresacrificedforaggressivesurgicalremovalofthemass Segmentsoftheresidualmassattachedtotheorgansweredebridedwithdrygauze Theremovedmasswassubmittedformicroscopicevaluation Thethoraciccavitywasthenlavagedwithwarmedsterilesaline Aleft sidedthoracostomytubewasplacedfordrainageofanticipatedpost operativepleuraleffusion Sternotomyclosurewasaccomplishedwithacruciatesuturepatternusing1polydioxanone withhematoxylineandeosin Thesamplewasblindlysubmittedtotwodifferentpathologists Pathologist1reportedthatthesampleconsistedofresidualfatwithsomefibrousstroma Thereweremultifocal extensiveareasofhemorrhage Thesewereassociatedwithcoagulationnecrosis Surroundingareasofhemorrhagewerecomposedofnestsofneoplasticendothelialcells Thecellsweretightlypackedwithminimalamphophiliccytoplasmandhyperchroma ticplumpoblongnucleiwithcoarselystippledchromatinandasinglenucleolus Figure4AandB Pathologist2reportedthatthesampleconsistedofcollagenousconnectivetissueinwhichtherewasapoorlydemarcated unencapsulatedneoplasmcomposedofvascularchannesseparatedbyabundanthemorrhageandfibrin Theneoplasticcellswerespindletoplumpinshapewithabundantamphophiliccytoplasmandindistinctcellborders Thenucleiwereovalwithreticularchromatinandoccasionallycontainedasingleprominentnucleolus Thereweremultifocalareasofnecrosis HistopathologyresultsdescribedthecranialmediastinalmassasHSA Forimmunohistochemistry CD31andfactorVIIIwereusedasHSAmarkers AtypicalspindlecellswerepositiveforCD31andfactorVIII whichsupportedHSA asdescribedabove Figure4CandD Figure4Cranialmediastinalhemangiosarcoma A Thesampleconsistsofresidualfatwithsomefibrousstromaandtherearemultifocal extensiveareasofhemorrhage Surroundingareasofhemorrhagearecomposedofnestsofneoplasticendothelialcells 50XH Estainobjective B Thecellsaretightlypackedwithminimalamphophiliccytoplasmandhyperchromaticplumpoblongnucleiwithcoarselystippledchromatinandasinglenucleolus 200XH Estainobjective C CD31immunohistochemistryshowsimmunoreactivityofcellsliningvascularchannels AtypicalspindlecellsarepositiveforCD31 20XCD31stainobjective D FactorVIIIimmunohistochemistryshowsimmunoreactivityofcellsliningvascularchannels AtypicalspindlecellsarepositiveforfactorVIII 20XfactorVIIIstainobjective Thethoracostomytubewasremoved8dayspostoperativelywhentheamountofserosanguineousfluidproductionwas1 7ml kg day Thepatient shematocritlevelwas34 3 oncompletebloodcountprofiling 7dayspost operatively Theownerdidnotconsenttochemotherapy Recheckexaminationswerescheduledmonthly At6months lateraland