Thorax 1982;37:222-223 Short reports Haemangiosarcoma of the chest wall

Haemangiosarcoma is a rare tumour of the chest wall and pleura, and few cases have been reported in the literature with any successful outcome. This paper reports a case with a successful outcome after operation. Clinical findings A 15-year-old boy developed a sudden onset of pain in the right chest while playing rugby. There was no history of direct injury or fall, or of previous chest disease. He had never worked with PVC or vinyl chloride.1 The chest wall appeared and felt normal. Percussion revealed dullness over the right chest in the mid-axillary line from the fifth to eighth ribs. Breath sounds were normal. There was no lymphadenopathy. Chest radiographs (fig 1) showed a peripheral lobulated shadow in the right mid-zone, related to the apical segment of the right lower lobe. Exploratory thoracotomy was carried out through a posterolateral incision revealing a tumour covering the third, fourth, and fifth ribs. The tumour was vascular in nature and contained clot-like material. Three specimens were sent for frozen section which were reported as fibrous tissue with chronic inflammatory cells but no neoplasia. The whole mass however appeared neoplastic and was therefore excised together with the third, fourth, and fifth ribs and their intercostal muscles over a wide area. Pathology The specimen consisted of 10 cm lengths of three ribs with attached connective tissue, muscle and pleura. There was a circumscribed mass on one surface covered by a smooth membrane and extending to the periosteal surface of the ribs but not invading the bone. The mass which measured 6 x 4 x 3 cm was composed of firm white tissue in which there were a number of spaces containing blood clot, some of which appeared to be organised. Sections of the mass showed sheets and clumps of small round and elongated cells with hyperchromatic nuclei and scanty cytoplasm traversed by large dilated blood channels (fig 2). In parts there were numerous small thin-walled vascular spaces lined by tumour cells (fig 3), some of which projected into the lumen of th