犬血管肉瘤.ppt

,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,Primary cranial mediastinal hemangiosarcoma ina young dog,Hun-Young Yoon,1,*,Hye-Mi Kang,2,and Mi-Young Lee,3,1Department of Veterinary Surgery,College of Veterinary Medicine,Konkuk,University,Seoul 143-701,South Korea,Full list of author information is available at the end of the article,Primary cranial mediastinal hemangiosarcomas,are uncommon tumors.A 30-kg,2-year-old,intact female German,shepherd was presented for evaluation of,cachexia,and,respiratory distress,of a few days duration.,Lateral radiographic,projection,of the,thorax,revealed significant,pleural effusion,.,Computed tomography,revealed a,cranial mediastinal,mass,effect adjacent to the heart.On surgical exploration,a,pedunculated mass,attached to the,esophagus,trachea,brachiocephalic trunk,left subclavian artery,and,cranial vena cava,without attachment to the,right atrium,and,auricular,appendage,was removed and,debrided,by use of,blunt dissection,and,dry gauzes,respectively.,abstract,Primary cranial mediastinal hemangiosarcomas,颅脑原发性纵隔血管肉瘤,c,achexia,瘦弱，萎靡不振,respiratory distress,呼吸窘迫,Lateral radiographic,projection,横向射线投影,thorax,胸部,pleural effusion,胸腔积液,Computed tomography,计算机断层扫描,cranial mediastinal,mass,前纵隔肿块,pedunculated mass,带蒂肿块,esophagus,食管,trachea,气管,brachiocephalic trunk,头臂干,left subclavian artery,左锁骨下动脉,cranial vena cava,颅腔静脉,right atrium,右心房,auricular,appendage,心耳,debrided,清除,blunt dissection,钝性剥离,dry gauzes,干纱布,New words,Abstract,Histopathology,results,described the cranial mediastinal mass as hemangiosarcoma.At 8 months and 5 days post-operatively,the patient died.,Primary cranial mediastinal hemangiosarcomas,although a seemingly rare cause of thoracic pathology in young,dogs,should be considered in the differential diagnosis for pleural effusion and soft tissue mass effect in the cranial,mediastinum.This is the first case report in a dog to describe primary cranial mediastinal hemangiosarcoma.,组织病理学说,Case presentation,A 30-kg,2-year-old,intact female German shepherd,was presented for evaluation of cachexia and respiratory,distress of a few days duration.On physical examination,the dog showed,labored breathing,with a,respiratory rate,of approximately 90/minute.A low,hematocrit,(28.9%),was identified on complete,blood count profiling,.,呼吸困难,呼吸频率,血细胞计数分析,红细胞比容,At,189 103/L,platelets,were in the low-normal range,(reference range:180 to 500 103/L).A,urinalysis,and,serum biochemistry and,coagulation profiles,were unremarkable.,Lateral and,ventrodorsal,radiographic projections,of the thorax revealed significant accumulation of pleural,effusion and widening of the cranial mediastinum with,increased soft-tissue density(Figure 1A and B),.,Sanguineous,fluid(700 ml)was removed under ultrasound-guided,thoracocentesis,.,血小板,尿检,凝结谱,腹背的,血腥的,穿刺,Figure 1 Preoperative radiographic view.(A)Lateral projection of the thorax reveals significant accumulation of pleural effusion.(B)Ventrodorsal projection of the thorax reveals a widened cranial mediastinum with increased soft-tissue density.,Pleural effusion and ultrasound-guided,fine needle aspiration cytology,of the mass predominantly,revealed,erythrocytes,and no tumor cells.On,auscultation,there was no evidence of,muffled heart sound,.A thoracic,ultrasound and CT scan revealed a mass effect in the,cranial mediastinum adjacent to the heart(Figure 2).,细针穿刺细胞学检查,红细胞,听诊,低沉的心音,The mass was approximately 9 cm in height,8 cm in,width and 12 cm in length.There was no evidence of,invasion into the cranial vena cava,brachiocephalic,trunk or left subclavian artery.An abdominal CT,scan was performed to rule out other differentials and,demonstrated no evidence of masses on the spleen,liver and other sites.The CT scan diagnosis was cranial,mediastinal soft tissue,neoplasm,.,肿瘤,Figure 2 Preoperative,sagittal,computed tomography post-contrast image.A mass effect is present in the cranial mediastinum,adjacent to the heart.The mass is approximately 9 cm in height,8 cm in width and 12 cm in length.,矢状的,Surgical exploration of the thorax was performed through,median sternotomy,.The upper half of the,manubrium,and the,xiphoid process,were left intact.A pedunculated mass located in the cranial mediastinum was attached to the surrounding organs including the esophagus,trachea,brachiocephalic trunk,left subclavian artery and cranial vena cava without attachment to the right atrium,right auricular appendage,pericardium and heart base(Figure 3).,正中胸骨切开术,柄状部,剑突,Figure 3,Intraoperative,photograph.A pedunculated mass located in the cranial mediastinum is attached to the surrounding organs including the esophagus,trachea,brachiocephalic trunk,left subclavian artery and cranial vena cava.,术中,The mass was removed by blunt dissection from the organs to which it was attached,including the esophagus,trachea,brachiocephalic trunk,left subclavian artery and cranial vena cava.The,internal thoracic artery,and vein were sacrificed for aggressive surgical removal of the mass.,Segments,of the resi,dual m,ass attached to the organs were debrided with dry gauze.The removed mass was submitted for microscopic evaluation.The thoracic cavity was then,lavaged,with warmed,sterile saline,.A,left-sided thoracostomy tube,was placed for,drainage,of anticipated post-operative pleural effusion.,胸廓内动脉,部分,冲洗,生理盐水,左侧胸腔引流管,排水,Sternotomy closure was accomplished with a,cruciate suture,pattern using 1,polydioxanone,.,with,hematoxyline,and,eosin,.The sample was blindly submitted to two different pathologists.Pathologist 1 reported that the sample consisted of residual fat withsome,fibrous stroma,.There were,multifocal,extensive areas of hemorrhage.These were associated with coagulation necrosis.Surrounding areas of hemorrhage were composed of,nests of neoplastic endothelial cells,.The cells were tightly packed with minimal,amphophilic cytoplasm,and,hyperchroma-tic plump oblong nuclei,with,coarsely stippled chromatin,and a single nucleolus(Figure 4A and B).,十字缝合,聚对二氧环己酮,染色剂,苏木精,纤维基质,多病灶,凝固性坏死,肿瘤血管内皮细胞巢,双亲细胞质,粗点状染色质,丰满的椭圆形核深染,Pathologist 2 reported that the sample consisted of,collagenous connective tissue,in which there was a poorly demarcated,unencapsulated neoplasm,composed of vascular channes separated by abundant hemorrhage and,fibrin.,The neoplastic cells were,spindle,to,plump,in shape with abundant amphophilic cytoplasm and indistinct cell borders.,胶原结缔组织,非封闭性肿瘤,血管沟,纤维蛋白,纺锤型,圆形,The nuclei were,oval,with,reticular,chromatin and occasionally contained a single prominent,nucleolus,.There were multifocal areas of necrosis.Histopathology results described the cranial mediastinal mass as HSA.For immunohistochemistry,CD31 and factor VIII were used as HSA markers.Atypical spindle cells were positive for CD31 and factor VIII,which supported HSA,as described above(Figure 4C and D).,椭圆形的,网状的,核仁,Figure 4 Cranial mediastinal hemangiosarcoma.(A)The sample consists of residual fat with some fibrous stroma and there are multifocal,extensive areas of hemorrhage.Surrounding areas of hemorrhage are composed of nests of neoplastic endothelial cells,50X H&E stain objective.(B)The cells are tightly packed with minimal amphophilic cytoplasm and hyperchromatic plump oblong nuclei with coarsely stippled chromatin and a single nucleolus,200X H&E stain objective.(C)CD31 immunohistochemistry shows immunoreactivity of cells lining vascular channels.Atypical spindle cells are positive for CD31,20X CD31 stain objective.(D)Factor VIII immunohistochemistry shows immunoreactivity of cells lining vascular channels.Atypical spindle cells are positive for factor VIII,20X factor VIII stain objective,.,The thoracostomy tube was removed 8 days postoperatively,when the amount of,serosanguineous,fluid,production was 1.7 ml/kg/day.The patients hematocrit,level was 34.3%on complete blood count profiling,7 days post-operatively.The owner did not consent to,chemotherapy,.Recheck examinations were scheduledmonthly.At 6 months,lateral and ventrodorsal radiographic,projections of the thorax revealed no pleural,effusion and no evidence of increased soft-tissue density,associated with widening of the cranial mediastinum,(Figure 5A and B).,血清,化疗,However,it was not possible to,determine whether there was macroscopic metastasis.,The owner did not consent to further CT scan to identify,macroscopic metastasis.There was no evidence of cachexia,and respiratory distress,6 months post-operatively.At,8 months and 5 days post-operatively,the patient died,with respiratory distress of a weeks duration.The owner,declined a,postmortem examination,.,尸检,Figure 5 Postoperative radiographic view at 6 months.Lateral(A)and ventrodorsal(B)projections of the thorax reveal no pleural effusion and no evidence of increased soft-tissue density associated with widening of the cranial mediastinum.,End,Thank,you,