Anterior mediastinal epithelioid hemangioendothelioma associated with myelolipoma and extramedullary hematopoiesis mimicking a mature teratoma: A radiologic-pathologic correlation.
- 1Department of Radiology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
- 2Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA.
- 3Department of Pediatrics, University of Connecticut, Hartford, CT, USA.
Abstract
Epithelioid hemangioendothelioma (EHE) is an ultra-rare vascular neoplasm with variable biologic behavior. Mediastinal EHE is particularly uncommon and may mimic more prevalent prevascular mediastinal tumors. We report a 52-year-old man with a 10.5 × 8.9 × 9.6 cm mixed-density left upper anterior mediastinal mass containing macroscopic fat, soft-tissue components, and coarse calcification. FDG PET/CT demonstrated mild-to-moderate uptake (SUVmax 4.8) without nodal or distant metastatic disease, and the imaging appearance favored mature teratoma. Resection demonstrated a 9.5 cm conventional EHE intimately associated with a myelolipomatous component containing extensive extramedullary hematopoiesis and metaplastic ossification. The neoplastic cells expressed endothelial markers, and RNA fusion analysis detected WWTR1::CAMTA1. Surgical margins were negative, early postoperative and abdominopelvic imaging showed no residual or metastatic disease, and multidisciplinary review recommended surveillance without adjuvant therapy. Although similar EHE-myelolipoma/extramedullary hematopoiesis associations have been reported, this case emphasizes the multimodality imaging mimic of mature teratoma and provides direct radiologic-pathologic correlation of the fat-containing, solid, and ossified components.
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BibTeX
@article{dhakal2026anterior,
title = {{Anterior mediastinal epithelioid hemangioendothelioma associated with myelolipoma and extramedullary hematopoiesis mimicking a mature teratoma: A radiologic-pathologic correlation.}},
author = {Saubhagya Dhakal and Paulo Savoia and Subhashis Mitra and Manisha Sharma},
journal = {Radiology case reports},
year = {2026},
month = oct,
doi = {10.1016/j.radcr.2026.09.030},
url = {https://europepmc.org/article/MED/42904195},
note = {CC BY},
}
RIS
TY - JOUR
TI - Anterior mediastinal epithelioid hemangioendothelioma associated with myelolipoma and extramedullary hematopoiesis mimicking a mature teratoma: A radiologic-pathologic correlation.
AU - Saubhagya Dhakal
AU - Paulo Savoia
AU - Subhashis Mitra
AU - Manisha Sharma
PY - 2026
DA - 2026/10/12
JO - Radiology case reports
DO - 10.1016/j.radcr.2026.09.030
UR - https://europepmc.org/article/MED/42904195
AB - Epithelioid hemangioendothelioma (EHE) is an ultra-rare vascular neoplasm with variable biologic behavior. Mediastinal EHE is particularly uncommon and may mimic more prevalent prevascular mediastinal tumors. We report a 52-year-old man with a 10.5 × 8.9 × 9.6 cm mixed-density left upper anterior mediastinal mass containing macroscopic fat, soft-tissue components, and coarse calcification. FDG PET/CT demonstrated mild-to-moderate uptake (SUVmax 4.8) without nodal or distant metastatic disease, and the imaging appearance favored mature teratoma. Resection demonstrated a 9.5 cm conventional EHE intimately associated with a myelolipomatous component containing extensive extramedullary hematopoiesis and metaplastic ossification. The neoplastic cells expressed endothelial markers, and RNA fusion analysis detected WWTR1::CAMTA1. Surgical margins were negative, early postoperative and abdominopelvic imaging showed no residual or metastatic disease, and multidisciplinary review recommended surveillance without adjuvant therapy. Although similar EHE-myelolipoma/extramedullary hematopoiesis associations have been reported, this case emphasizes the multimodality imaging mimic of mature teratoma and provides direct radiologic-pathologic correlation of the fat-containing, solid, and ossified components.
SN - 1930-0433
ER -