- Email: [email protected]
Solitary Fibrous Tumor Causing Cardiac Tamponade
Ann Thorac Surg 2013;96:319 –21
CASE REPORT TAMENISHI ET AL FIBROUS TUMOR CAUSING CARDIAC TAMPONADE
319
Fig 3. Cineangiographic images taken during percutaneous atrial septal defect creation and after surgical Potts graft anastomosis showing the inflated 12 ⫻ 30 mm balloon with (A) a waist induced by the interatrial septum and (B) the right-to-left shunt through the Pottslike polytetrafluoroethylene tube (asterisk). (DAO ⫽ descending aorta; LPA ⫽ left pulmonary artery.)
Comment Based on the poor prognosis of children with pulmonary hypertension [1, 8], different rescue treatments have been proposed in patients with severe PAH and right ventricular failure. Atrial septostomy is currently recommended for bridging these patients to lung transplantation [8]. Recently, surgical anastomosis between the left pulmonary artery and the descending aorta has been described in patients with end-stage IPAH with suprasystemic pulmonary artery pressures who are refractory to medical treatment [4, 5]. This pulmonary-to-systemic connection changes cardiac pathophysiologic features to those of Eisenmenger’s physiology. To our knowledge, we report the first patient with end-stage biventricular failure with out-of-proportion postcapillary PAH caused by Shone’s complex with associated borderline left ventricular morphologic features, in whom an interventional/surgical hybrid approach consisting of balloon atrial septostomy combined with a Potts shunt was successfully performed. Suprasystemic pulmonary arterial pressure decreased to the systemic level combined with an increase of the systemic blood flow. Left ventricular preload decreased because of the atrial left-to-right shunt and the reduced transpulmonary blood flow through the Potts shunt. The change of the cardiac pathophysiologic characteristics into those of Eisenmenger’s physiology preserved highly oxygenated coronary and cerebral blood flow and avoided extreme oxygen desaturation of the lower body parts by the atrial left-to-right shunt. However a prerequisite for the hybrid operation presented, which includes both atrial and pulmonary arterial level shunts as opposed to a pulmonary arterial shunt alone as reported by Blanc and colleagues [4], is that postoperative left ventricular end-diastolic pressure has to be higher than right ventricular pressure such that the atrial level shunt is left to right, avoiding complete systemic desaturation (eg, upper and lower body), which may not be tolerated. As such, it may not be advised in other conditions associated with severe pulmonary hypertension in which this criterion is not met. © 2013 by The Society of Thoracic Surgeons Published by Elsevier Inc
References 1. Benza RL, Miller DP, Barst RJ, et al. An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL Registry. Chest 2012;142:448 –56. 2. Raymond RJ, Hinderliter AL, Willis PW, et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 2002;39:1214 –9. 3. Gan CT, Lankhaar JW, Marcus JT, et al. Impaired left ventricular filling due to right-to-left ventricular interaction in patients with pulmonary arterial hypertension. Am J Physiol Heart Circ Physiol 2006;290:H1528 –33. 4. Blanc J, Vouhe P, Bonnet D. Potts shunt in patients with pulmonary hypertension. N Engl J Med 2004;350:623. 5. Baruteau AE, Serraf A, Lévy M, et al. Potts shunt in children with idiopathic pulmonary arterial hypertension: long-term results. Ann Thorac Surg 2012;94:817–24. 6. Michel-Behnke I, Akintuerk H, Marquardt I, et al. Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions. Heart 2003;89:645–50. 7. Akintuerk H, Michel-Behnke I, Valeske K, et al. Hybrid transcatheter-surgical palliation: basis for univentricular or biventricular repair: the Giessen experience. Pediatr Cardiol 2007;28:79 – 87. 8. Micheletti A, Hislop AA, Lammers A, et al. Role of atrial septostomy in the treatment of children with pulmonary arterial hypertension. Heart 2006;92:969 –72.
Solitary Fibrous Tumor Causing Cardiac Tamponade Akinori Tamenishi, MD, Yasumoto Matsumura, MD, and Hiroshi Okamoto, MD Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
Solitary fibrous tumor of the pleura is a rare primary tumor arising from mesenchymal cells in the areolar tissue subjacent to the mesothelial-lined pleura. Most solitary fibrous tumor of the pleura arises from the visceral or the parietal pleura, and asymptomatically occupies the hemithoracic cavity. We report a rare case of solitary fibrous tumor of the pleura causing cardiac Accepted for publication Nov 19, 2012. Address correspondence to Dr Tamenishi, Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, 2-37 Shibata 2-chome, Yokkaichi 510-8567, Japan; e-mail: [email protected].
0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2012.11.062
FEATURE ARTICLES
tional class II, whereas the distance for a 6-minute walk improved from 75 meters to 375 meters.
320
CASE REPORT TAMENISHI ET AL FIBROUS TUMOR CAUSING CARDIAC TAMPONADE
tamponade. A 30-year-old woman presented with pericardial tumor. The surgical resection of the tumor was complete. We describe the details of this case and a brief review of the literature about solitary fibrous tumor. (Ann Thorac Surg 2013;96:319 –21) © 2013 by The Society of Thoracic Surgeons
S
olitary fibrous tumor of the pleura (SFTP) is a rare tumor originating from mesenchymal tissue underlying the mesothelial layer of the pleura. Most patients are asymptomatic, and the lesion is often discovered on routine chest radiographs. As the tumor tends to grow large, it causes clinical symptoms of compression. We describe a rare case of SFTP causing cardiac tamponade.
FEATURE ARTICLES
A 30-year-old woman was admitted to an affiliate hospital with syncope. Her hemodynamic condition was that of a pre-shock state, with blood pressure of 72/48 mm Hg, facial edema, and severe cyanosis. The chest X-ray film showed cardiomegaly. Transthoracic echocardiography revealed pericardial effusion, biventricular collapse, and a tumor occupying the pericardial space. She was diagnosed as having cardiac tamponade, and immediately underwent pericardicentesis and drainage. The discharge was bloody, and the amount of that was 850 mL. The cytology of the discharge proved to be negative. Pericardial tumor was suspected, and she was introduced to our clinic. The patient’s hemodynamic state was stable when she was admitted to our hospital. Her pulse rate was 70 regular beats per minute, and blood pressure was 118/70 mm Hg. On cardiac auscultation, no murmur was heard. Superficial lymph nodes were not palpable, and no tumorous lesions were detected. On laboratory examination, the hemoglobin was 10.5 mg/dL. The chest radiography revealed a large tumor mass in the left superior side next to the heart (Fig 1A). Computed tomography showed a tumor mass measuring 90 ⫻ 74 ⫻ 51 mm in the pericardial sac. Computed tomography density of the tumor was homogeneous. Enhanced computed tomography revealed hypervascularity of the tumor (Fig 1B). Surgery was carried out through a median sternotomy. The heart displayed adhesions at the pericardium due to cardiac tamponade. The tumor was detected in the Fig 1. (A) Chest radiography revealing a large tumor mass in the left superior side next to the heart. (B) Enhanced computed tomography demonstrating hypervascularity of the tumor (arrow).
Ann Thorac Surg 2013;96:319 –21
left side of the heart. It was attached to the left pulmonary artery and extended toward the left hilum of lung. Dissection of the tumor was easily performed from heart, pericardium, and left pulmonary artery, but the tumor displayed strong adhesions at the left hilum of lung. The tumor was excised, including the pericardium and parietal pleura around left hilum of lung. The patient recovered uneventfully and was discharged 2 weeks postoperatively. The excised tumor was 7 ⫻ 7 ⫻ 5 cm in size. It appeared as a well-encapsulated nodular mass. Cut sections had a whorled, fibrous, fascicular appearance (Fig 2A). Histopathology examination showed uniform collagen-forming spindle cells, which were arranged in interlacing fascicles and showed no mitotic activity (Fig 2B). On immunohistochemical staining, the tumor cells were negative for actins, desmins, S-100, neuron-specific enolase, and neurofilament, whereas their cytoplasm was positive for CD34. These histopathologic findings proved this tumor to be benign SFTP. There has been no recurrence for 6 years after surgery.
Comment Solitary fibrous tumor of the pleura is an uncommon neoplasm, which accounts for less than 5% of all pleural neoplasms, with just more than 900 cases reported in the literature [1, 2]. More than 80% of SFTP, fortunately, have a benign course, but local recurrence postoperatively and malignant transformation has been reported. They are readily curable with careful, complete resections. Overall, 43% to 67% of patients with benign SFTP are asymptomatic, whereas more than 75% of malignant tumors cause symptoms due to occupation of space. Larger tumors may prompt some symptoms, commonly cough, chest pain, and dyspnea. Extrathoracic symptoms are hypertrophic pulmonary osteoarthropathy, clubbing, and hypoglycemia [3], but syncope caused by cardiac tamponade, as in our case, has been never reported. Bleeding incidentally derived from this hypervascularity tumor might cause cardiac tamponade. The SFTP commonly occupies the thoracic cavity. Most operations are performed through standard thoracotomy or by video-assisted thoracic surgery [4, 5].
Ann Thorac Surg 2013;96:321–3
CASE REPORT REGUEIRO ET AL ASPERGILLUS ENDOCARDITIS IN LUNG TRANSPLANTS
321
Magdeleinat and colleagues [6] reviewed 60 cases of SFTP in a 20-year period. They reported that only one operation was performed through median sternotomy for the tumor originating from mediastinal pleura. Although our case was performed through median sternotomy, the tumor might have originated from parietal pleura of hilum of the lung. The tumor grew not in the thoracic cavity but into the pericardial sac through hilum of the lung. Perrot and colleagues [7] stated that tumors arising from the parietal pleura were more difficult to resect than those from the visceral pleura because they were large, affixed to the chest wall, and required extrapleural resection. Our case did not present with a broad base of attachment, so that we could accomplish complete extirpation of the tumor including pericardium. There has been no recurrence for 6 years after surgery in our case. The reason for recurrence is possibly insufficient resection [8]; thus, complete excision is the best treatment for SFTP.
5. Rena O, Filosso PL, Papalia E, et al. Solitary fibrous tumor of the pleura: surgical treatment. Eur J Cardiothorac Surg 2001; 19:185–9. 6. Magdeleinat P, Alifano M, Petino A, et al. Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome. Eur J Cardiothorac Surg 2002;21:1087–93. 7. Perrot MD, Kurt AM, Robert JH, Borisch B, Spiliopoulos A. Clinical behavior of solitary fibrous tumors of the pleura. Ann Thorac Surg 1999;67:1456 –9. 8. Regal MA, Rubaish AMA, Ghoneimy YFA, Hammad RI. Solitary benign fibrous tumors of the pleura. Asian Cardiovasc Thorac Ann 2008;16:139 – 42.
References
Departments of Cardiovascular Surgery, Thoracic Surgery, and Anesthesiology, Hospital Universitario “Marqués de Valdecilla,” Santander, Spain
1. Karen M, Phipps H, Francis C, et al. Solitary fibrous tumors of the pleura: results of surgical treatment and long-term prognosis. J Thoracic Cardiovasc Surg 2009;138:19 –25. 2. Triviño A, Cozar F, Congregado M, Loscertales J. Giant solitary fibrous tumor of the pleura. Interact Cardiovasc Thorac Surg 2011;12:1063–5. 3. Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control 2006;13:264 –9. 4. Cardillo G, Fracciolo F, Cavazzana AO, Capece G, Gasparri R, Martelli M. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients. Ann Thorac Surg 2000;70:1808 –12. © 2013 by The Society of Thoracic Surgeons Published by Elsevier Inc
Aspergillus Endocarditis in Lung Transplant Recipient: Successful Surgical Treatment Francisco Regueiro, MD, Francisco Gutiérrez, MD, Roberto Mons, MD, Gabriel Riancho, MD, and José Manuel Revuelta, MD, PhD
Solid organ transplantation can be followed by Aspergillus infection, implying high mortality rates. The highest Accepted for publication Nov 12, 2012. Address correspondence to Dr Regueiro, Department of Cardiovascular Surgery, Hospital Universitario “Marqués de Valdecilla,” Santander, Spain; e-mail: [email protected].
0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2012.11.031
FEATURE ARTICLES
Fig 2. (A) Photograph of an excised tumor specimen. (B) Microscopic findings of the tumor tissue: uniform collagen-forming spindle cells, which were arranged in interlacing fascicles and showed no mitotic activity (hematoxylin-eosin stain, original magnification ⫻40).
CASE REPORT TAMENISHI ET AL FIBROUS TUMOR CAUSING CARDIAC TAMPONADE
319
Fig 3. Cineangiographic images taken during percutaneous atrial septal defect creation and after surgical Potts graft anastomosis showing the inflated 12 ⫻ 30 mm balloon with (A) a waist induced by the interatrial septum and (B) the right-to-left shunt through the Pottslike polytetrafluoroethylene tube (asterisk). (DAO ⫽ descending aorta; LPA ⫽ left pulmonary artery.)
Comment Based on the poor prognosis of children with pulmonary hypertension [1, 8], different rescue treatments have been proposed in patients with severe PAH and right ventricular failure. Atrial septostomy is currently recommended for bridging these patients to lung transplantation [8]. Recently, surgical anastomosis between the left pulmonary artery and the descending aorta has been described in patients with end-stage IPAH with suprasystemic pulmonary artery pressures who are refractory to medical treatment [4, 5]. This pulmonary-to-systemic connection changes cardiac pathophysiologic features to those of Eisenmenger’s physiology. To our knowledge, we report the first patient with end-stage biventricular failure with out-of-proportion postcapillary PAH caused by Shone’s complex with associated borderline left ventricular morphologic features, in whom an interventional/surgical hybrid approach consisting of balloon atrial septostomy combined with a Potts shunt was successfully performed. Suprasystemic pulmonary arterial pressure decreased to the systemic level combined with an increase of the systemic blood flow. Left ventricular preload decreased because of the atrial left-to-right shunt and the reduced transpulmonary blood flow through the Potts shunt. The change of the cardiac pathophysiologic characteristics into those of Eisenmenger’s physiology preserved highly oxygenated coronary and cerebral blood flow and avoided extreme oxygen desaturation of the lower body parts by the atrial left-to-right shunt. However a prerequisite for the hybrid operation presented, which includes both atrial and pulmonary arterial level shunts as opposed to a pulmonary arterial shunt alone as reported by Blanc and colleagues [4], is that postoperative left ventricular end-diastolic pressure has to be higher than right ventricular pressure such that the atrial level shunt is left to right, avoiding complete systemic desaturation (eg, upper and lower body), which may not be tolerated. As such, it may not be advised in other conditions associated with severe pulmonary hypertension in which this criterion is not met. © 2013 by The Society of Thoracic Surgeons Published by Elsevier Inc
References 1. Benza RL, Miller DP, Barst RJ, et al. An evaluation of long-term survival from time of diagnosis in pulmonary arterial hypertension from the REVEAL Registry. Chest 2012;142:448 –56. 2. Raymond RJ, Hinderliter AL, Willis PW, et al. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol 2002;39:1214 –9. 3. Gan CT, Lankhaar JW, Marcus JT, et al. Impaired left ventricular filling due to right-to-left ventricular interaction in patients with pulmonary arterial hypertension. Am J Physiol Heart Circ Physiol 2006;290:H1528 –33. 4. Blanc J, Vouhe P, Bonnet D. Potts shunt in patients with pulmonary hypertension. N Engl J Med 2004;350:623. 5. Baruteau AE, Serraf A, Lévy M, et al. Potts shunt in children with idiopathic pulmonary arterial hypertension: long-term results. Ann Thorac Surg 2012;94:817–24. 6. Michel-Behnke I, Akintuerk H, Marquardt I, et al. Stenting of the ductus arteriosus and banding of the pulmonary arteries: basis for various surgical strategies in newborns with multiple left heart obstructive lesions. Heart 2003;89:645–50. 7. Akintuerk H, Michel-Behnke I, Valeske K, et al. Hybrid transcatheter-surgical palliation: basis for univentricular or biventricular repair: the Giessen experience. Pediatr Cardiol 2007;28:79 – 87. 8. Micheletti A, Hislop AA, Lammers A, et al. Role of atrial septostomy in the treatment of children with pulmonary arterial hypertension. Heart 2006;92:969 –72.
Solitary Fibrous Tumor Causing Cardiac Tamponade Akinori Tamenishi, MD, Yasumoto Matsumura, MD, and Hiroshi Okamoto, MD Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
Solitary fibrous tumor of the pleura is a rare primary tumor arising from mesenchymal cells in the areolar tissue subjacent to the mesothelial-lined pleura. Most solitary fibrous tumor of the pleura arises from the visceral or the parietal pleura, and asymptomatically occupies the hemithoracic cavity. We report a rare case of solitary fibrous tumor of the pleura causing cardiac Accepted for publication Nov 19, 2012. Address correspondence to Dr Tamenishi, Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, 2-37 Shibata 2-chome, Yokkaichi 510-8567, Japan; e-mail: [email protected].
0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2012.11.062
FEATURE ARTICLES
tional class II, whereas the distance for a 6-minute walk improved from 75 meters to 375 meters.
320
CASE REPORT TAMENISHI ET AL FIBROUS TUMOR CAUSING CARDIAC TAMPONADE
tamponade. A 30-year-old woman presented with pericardial tumor. The surgical resection of the tumor was complete. We describe the details of this case and a brief review of the literature about solitary fibrous tumor. (Ann Thorac Surg 2013;96:319 –21) © 2013 by The Society of Thoracic Surgeons
S
olitary fibrous tumor of the pleura (SFTP) is a rare tumor originating from mesenchymal tissue underlying the mesothelial layer of the pleura. Most patients are asymptomatic, and the lesion is often discovered on routine chest radiographs. As the tumor tends to grow large, it causes clinical symptoms of compression. We describe a rare case of SFTP causing cardiac tamponade.
FEATURE ARTICLES
A 30-year-old woman was admitted to an affiliate hospital with syncope. Her hemodynamic condition was that of a pre-shock state, with blood pressure of 72/48 mm Hg, facial edema, and severe cyanosis. The chest X-ray film showed cardiomegaly. Transthoracic echocardiography revealed pericardial effusion, biventricular collapse, and a tumor occupying the pericardial space. She was diagnosed as having cardiac tamponade, and immediately underwent pericardicentesis and drainage. The discharge was bloody, and the amount of that was 850 mL. The cytology of the discharge proved to be negative. Pericardial tumor was suspected, and she was introduced to our clinic. The patient’s hemodynamic state was stable when she was admitted to our hospital. Her pulse rate was 70 regular beats per minute, and blood pressure was 118/70 mm Hg. On cardiac auscultation, no murmur was heard. Superficial lymph nodes were not palpable, and no tumorous lesions were detected. On laboratory examination, the hemoglobin was 10.5 mg/dL. The chest radiography revealed a large tumor mass in the left superior side next to the heart (Fig 1A). Computed tomography showed a tumor mass measuring 90 ⫻ 74 ⫻ 51 mm in the pericardial sac. Computed tomography density of the tumor was homogeneous. Enhanced computed tomography revealed hypervascularity of the tumor (Fig 1B). Surgery was carried out through a median sternotomy. The heart displayed adhesions at the pericardium due to cardiac tamponade. The tumor was detected in the Fig 1. (A) Chest radiography revealing a large tumor mass in the left superior side next to the heart. (B) Enhanced computed tomography demonstrating hypervascularity of the tumor (arrow).
Ann Thorac Surg 2013;96:319 –21
left side of the heart. It was attached to the left pulmonary artery and extended toward the left hilum of lung. Dissection of the tumor was easily performed from heart, pericardium, and left pulmonary artery, but the tumor displayed strong adhesions at the left hilum of lung. The tumor was excised, including the pericardium and parietal pleura around left hilum of lung. The patient recovered uneventfully and was discharged 2 weeks postoperatively. The excised tumor was 7 ⫻ 7 ⫻ 5 cm in size. It appeared as a well-encapsulated nodular mass. Cut sections had a whorled, fibrous, fascicular appearance (Fig 2A). Histopathology examination showed uniform collagen-forming spindle cells, which were arranged in interlacing fascicles and showed no mitotic activity (Fig 2B). On immunohistochemical staining, the tumor cells were negative for actins, desmins, S-100, neuron-specific enolase, and neurofilament, whereas their cytoplasm was positive for CD34. These histopathologic findings proved this tumor to be benign SFTP. There has been no recurrence for 6 years after surgery.
Comment Solitary fibrous tumor of the pleura is an uncommon neoplasm, which accounts for less than 5% of all pleural neoplasms, with just more than 900 cases reported in the literature [1, 2]. More than 80% of SFTP, fortunately, have a benign course, but local recurrence postoperatively and malignant transformation has been reported. They are readily curable with careful, complete resections. Overall, 43% to 67% of patients with benign SFTP are asymptomatic, whereas more than 75% of malignant tumors cause symptoms due to occupation of space. Larger tumors may prompt some symptoms, commonly cough, chest pain, and dyspnea. Extrathoracic symptoms are hypertrophic pulmonary osteoarthropathy, clubbing, and hypoglycemia [3], but syncope caused by cardiac tamponade, as in our case, has been never reported. Bleeding incidentally derived from this hypervascularity tumor might cause cardiac tamponade. The SFTP commonly occupies the thoracic cavity. Most operations are performed through standard thoracotomy or by video-assisted thoracic surgery [4, 5].
Ann Thorac Surg 2013;96:321–3
CASE REPORT REGUEIRO ET AL ASPERGILLUS ENDOCARDITIS IN LUNG TRANSPLANTS
321
Magdeleinat and colleagues [6] reviewed 60 cases of SFTP in a 20-year period. They reported that only one operation was performed through median sternotomy for the tumor originating from mediastinal pleura. Although our case was performed through median sternotomy, the tumor might have originated from parietal pleura of hilum of the lung. The tumor grew not in the thoracic cavity but into the pericardial sac through hilum of the lung. Perrot and colleagues [7] stated that tumors arising from the parietal pleura were more difficult to resect than those from the visceral pleura because they were large, affixed to the chest wall, and required extrapleural resection. Our case did not present with a broad base of attachment, so that we could accomplish complete extirpation of the tumor including pericardium. There has been no recurrence for 6 years after surgery in our case. The reason for recurrence is possibly insufficient resection [8]; thus, complete excision is the best treatment for SFTP.
5. Rena O, Filosso PL, Papalia E, et al. Solitary fibrous tumor of the pleura: surgical treatment. Eur J Cardiothorac Surg 2001; 19:185–9. 6. Magdeleinat P, Alifano M, Petino A, et al. Solitary fibrous tumors of the pleura: clinical characteristics, surgical treatment and outcome. Eur J Cardiothorac Surg 2002;21:1087–93. 7. Perrot MD, Kurt AM, Robert JH, Borisch B, Spiliopoulos A. Clinical behavior of solitary fibrous tumors of the pleura. Ann Thorac Surg 1999;67:1456 –9. 8. Regal MA, Rubaish AMA, Ghoneimy YFA, Hammad RI. Solitary benign fibrous tumors of the pleura. Asian Cardiovasc Thorac Ann 2008;16:139 – 42.
References
Departments of Cardiovascular Surgery, Thoracic Surgery, and Anesthesiology, Hospital Universitario “Marqués de Valdecilla,” Santander, Spain
1. Karen M, Phipps H, Francis C, et al. Solitary fibrous tumors of the pleura: results of surgical treatment and long-term prognosis. J Thoracic Cardiovasc Surg 2009;138:19 –25. 2. Triviño A, Cozar F, Congregado M, Loscertales J. Giant solitary fibrous tumor of the pleura. Interact Cardiovasc Thorac Surg 2011;12:1063–5. 3. Robinson LA. Solitary fibrous tumor of the pleura. Cancer Control 2006;13:264 –9. 4. Cardillo G, Fracciolo F, Cavazzana AO, Capece G, Gasparri R, Martelli M. Localized (solitary) fibrous tumors of the pleura: an analysis of 55 patients. Ann Thorac Surg 2000;70:1808 –12. © 2013 by The Society of Thoracic Surgeons Published by Elsevier Inc
Aspergillus Endocarditis in Lung Transplant Recipient: Successful Surgical Treatment Francisco Regueiro, MD, Francisco Gutiérrez, MD, Roberto Mons, MD, Gabriel Riancho, MD, and José Manuel Revuelta, MD, PhD
Solid organ transplantation can be followed by Aspergillus infection, implying high mortality rates. The highest Accepted for publication Nov 12, 2012. Address correspondence to Dr Regueiro, Department of Cardiovascular Surgery, Hospital Universitario “Marqués de Valdecilla,” Santander, Spain; e-mail: [email protected].
0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2012.11.031
FEATURE ARTICLES
Fig 2. (A) Photograph of an excised tumor specimen. (B) Microscopic findings of the tumor tissue: uniform collagen-forming spindle cells, which were arranged in interlacing fascicles and showed no mitotic activity (hematoxylin-eosin stain, original magnification ⫻40).