Mediastinal Glomus Tumor Resected by Thoracoscopy

Abstract

SESSION TITLE: Student/Resident Case Report Poster - Disorders of the Mediastinum SESSION TYPE: Student/Resident Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM INTRODUCTION: Glomus tumors or glomangiomas are rare tumors that develop from glomus bodies, they constitute less than 2% of soft tissue tumors, usually with cutaneous manifestations such as subungueal and subdermal unique, small size lesions in palms and foot soles. Atypical localizations (extracutaneous) are described in gastrointestinal tract and tympanic membrane, pulmonary and mediastinal glomus tumors are extremely rare. CASE PRESENTATION: A 50-year-old woman with 22 years history of rheumatoid arthritis in current treatment with hydroxychloroquine and methotrexate, moderate aortic and tricuspid insufficiency with conservative management, systemic hypertension treated with verapamil and uncontrolled Myasthenia Gravis (MG) of one year of evolution characterized by ptosis and diplopia, with anti-acetylcholine antibodies value of ≤0.2 nmol / L, negative antiMuSK antibodies, a Jolly test with normal result and a single fiber electromyography test with a pattern that supports the diagnosis of MG, seronegative myasthenia gravis diagnosis was established, due to this reason high dose pyridostigmine and prednisone treatment was applied, observing the partial improvement. A chest CT Scan was performed and showed a hypodense lesion of 8 x 7 mm adjacent to the aortic arch not compatible with thymoma. The patient underwent to VATS in which a pedunculated round tumor of approximately 1 cm was found adjacent to the aortic arch. Complete resection of the 8 x 6 x 4 mm tumor with greyish color and soft texture was performed and because of the medical history of MG a thymectomy was performed in the same procedure. The patient was discharged once completed antibiotic treatment. In the next days immunohistochemistry reported Vimentin +, CK - and EMA -, compatible with Glomangioma. A follow up chest CT Scan was performed six months after the surgery, which showed no evidence of mediastinal lesions. DISCUSSION: Clinical presentation glomangiomas is often variable, however the pain and mass effect symptoms are the most common presentation. The thoracoscopic approach for resection of the glomangiomas is considered the gold standar because of its association with a lower morbidity and mortality. This approach also is associated with a more favorable evolution and less pain in the postoperative period. CONCLUSIONS: Although mediastinal glomus tumors are a rare entity, they must be considered as one of the differential diagnoses of mediastinal masses that are not well characterized by imaging studies. Reference #1: Rychlik I, O’Donnell M, Davey P, et al. Glomus tumor of the mediastinum. Asian Cardiovascular and Thoracic Annals, 2013; 22:95-97. Reference #2: Gombos Z, Zhang PJ. Glomus tumor. Arch Pathol Lab Med, 2008; 132:1448-4852. Reference #3: Gebauer F, Quass A, Izbicki J, et al. Glomagioma of the lung: a case report and review of the literature. Journal of Medical Case Reports 2014, 8:5. DISCLOSURE: The following authors have nothing to disclose: Julio Herrera-Zamora, Guillermo Ponce de León-Ballesteros, Francina Valezka Bolanos Morales, Rafael Perez-Soto, Yadira Mata-Mendoza, Nszeer Ahmad, Patricio Santillan-Doherty No Product/Research Disclosure Information