犬血管肉瘤.ppt

1 Primarycranialmediastinalhemangiosarcomainayoungdog 2 Primarycranialmediastinalhemangiosarcomasareuncommontumors A30 kg 2 year old intactfemaleGermanshepherdwaspresentedforevaluationofcachexiaandrespiratorydistressofafewdays duration Lateralradiographicprojectionofthethoraxrevealedsignificantpleuraleffusion Computedtomographyrevealedacranialmediastinalmasseffectadjacenttotheheart Onsurgicalexploration apedunculatedmassattachedtotheesophagus trachea brachiocephalictrunk leftsubclavianarteryandcranialvenacavawithoutattachmenttotherightatriumandauricularappendagewasremovedanddebridedbyuseofbluntdissectionanddrygauzes respectively abstract 3 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 4 AbstractHistopathologyresultsdescribedthecranialmediastinalmassashemangiosarcoma At8monthsand5dayspost operatively thepatientdied Primarycranialmediastinalhemangiosarcomas althoughaseeminglyrarecauseofthoracicpathologyinyoungdogs shouldbeconsideredinthedifferentialdiagnosisforpleuraleffusionandsofttissuemasseffectinthecranialmediastinum Thisisthefirstcasereportinadogtodescribeprimarycranialmediastinalhemangiosarcoma 组织病理学说 5 Casepresentation A30 kg 2 year old intactfemaleGermanshepherdwaspresentedforevaluationofcachexiaandrespiratorydistressofafewdays duration Onphysicalexamination thedogshowedlaboredbreathingwitharespiratoryrateofapproximately90 minute Alowhematocrit 28 9 wasidentifiedoncompletebloodcountprofiling 6 At189 103 L plateletswereinthelow normalrange referencerange 180to500 103 L Aurinalysisandserumbiochemistryandcoagulationprofileswereunremarkable Lateralandventrodorsalradiographicprojectionsofthethoraxrevealedsignificantaccumulationofpleuraleffusionandwideningofthecranialmediastinumwithincreasedsoft tissuedensity Figure1AandB Sanguineousfluid 700ml wasremovedunderultrasound guidedthoracocentesis 7 Figure1Preoperativeradiographicview A Lateralprojectionofthethoraxrevealssignificantaccumulationofpleuraleffusion B Ventrodorsalprojectionofthethoraxrevealsawidenedcranialmediastinumwithincreasedsoft tissuedensity 8 Pleuraleffusionandultrasound guidedfineneedleaspirationcytologyofthemasspredominantlyrevealederythrocytesandnotumorcells Onauscultation therewasnoevidenceofmuffledheartsound AthoracicultrasoundandCTscanrevealedamasseffectinthecranialmediastinumadjacenttotheheart Figure2 9 Themasswasapproximately9cminheight 8cminwidthand12cminlength Therewasnoevidenceofinvasionintothecranialvenacava brachiocephalictrunkorleftsubclavianartery AnabdominalCTscanwasperformedtoruleoutotherdifferentialsanddemonstratednoevidenceofmassesonthespleen liverandothersites TheCTscandiagnosiswascranialmediastinalsofttissueneoplasm 肿瘤 10 Figure2Preoperativesagittalcomputedtomographypost contrastimage Amasseffectispresentinthecranialmediastinum adjacenttotheheart Themassisapproximately9cminheight 8cminwidthand12cminlength 矢状的 11 Surgicalexplorationofthethoraxwasperformedthroughmediansternotomy Theupperhalfofthemanubriumandthexiphoidprocesswereleftintact Apedunculatedmasslocatedinthecranialmediastinumwasattachedtothesurroundingorgansincludingtheesophagus trachea brachiocephalictrunk leftsubclavianarteryandcranialvenacavawithoutattachmenttotherightatrium rightauricularappendage pericardiumandheartbase Figure3 12 Figure3Intraoperativephotograph Apedunculatedmasslocatedinthecranialmediastinumisattachedtothesurroundingorgansincludingtheesophagus trachea brachiocephalictrunk leftsubclavianarteryandcranialvenacava 术中 13 Themasswasremovedbybluntdissectionfromtheorganstowhichitwasattached includingtheesophagus trachea brachiocephalictrunk leftsubclavianarteryandcranialvenacava Theinternalthoracicarteryandveinweresacrificedforaggressivesurgicalremovalofthemass Segmentsoftheresidualmassattachedtotheorgansweredebridedwithdrygauze Theremovedmasswassubmittedformicroscopicevaluation Thethoraciccavitywasthenlavagedwithwarmedsterilesaline Aleft sidedthoracostomytubewasplacedfordrainageofanticipatedpost operativepleuraleffusion 14 Sternotomyclosurewasaccomplishedwithacruciatesuturepatternusing1polydioxanone withhematoxylineandeosin Thesamplewasblindlysubmittedtotwodifferentpathologists Pathologist1reportedthatthesampleconsistedofresidualfatwithsomefibrousstroma Thereweremultifocal extensiveareasofhemorrhage Thesewereassociatedwithcoagulationnecrosis Surroundingareasofhemorrhagewerecomposedofnestsofneoplasticendothelialcells Thecellsweretightlypackedwithminimalamphophiliccytoplasmandhyperchroma ticplumpoblongnucleiwithcoarselystippledchromatinandasinglenucleolus Figure4AandB 15 Pathologist2reportedthatthesampleconsistedofcollagenousconnectivetissueinwhichtherewasapoorlydemarcated unencapsulatedneoplasmcomposedofvascularchannesseparatedbyabundanthemorrhageandfibrin Theneoplasticcellswerespindletoplumpinshapewithabundantamphophiliccytoplasmandindistinctcellborders 16 Thenucleiwereovalwithreticularchromatinandoccasionallycontainedasingleprominentnucleolus Thereweremultifocalareasofnecrosis HistopathologyresultsdescribedthecranialmediastinalmassasHSA Forimmunohistochemistry CD31andfactorVIIIwereusedasHSAmarkers AtypicalspindlecellswerepositiveforCD31andfactorVIII whichsupportedHSA asdescribedabove Figure4CandD 17 Figure4Cranialmediastinalhemangiosarcoma A Thesampleconsistsofresidualfatwithsomefibrousstromaandtherearemultifocal extensiveareasofhemorrhage Surroundingareasofhemorrhagearecomposedofnestsofneoplasticendothelialcells 50XH Estainobjective B Thecellsaretightlypackedwithminimalamphophiliccytoplasmandhyperchromaticplumpoblongnucleiwithcoarselystippledchromatinandasinglenucleolus 200XH Estainobjective C CD31immunohistochemistryshowsimmunoreactivityofcellsliningvascularchannels AtypicalspindlecellsarepositiveforCD31 20XCD31stainobjective D FactorVIIIimmunohistochemistryshowsimmunoreactivityofcellsliningvascularchannels AtypicalspindlecellsarepositiveforfactorVIII 20XfactorVIIIstainobjective 18 Thethoracostomytubewasremoved8dayspostoperativelywhentheamountofserosanguineousfluidproductionwas1 7ml kg day Thepatient shematocritlevelwas34 3 oncompletebloodcountprofiling 7dayspost operatively Theownerdidnotconsenttochemotherapy Recheckexaminationswerescheduledmonthly At6months lateralandventrodorsalradiographi