1
|
Oon ML, Wu B, Goh JY, Chang KTE, Chong YL, Wong ZW, Oh SY, Tan C, Nga ME, Petersson F. Primary Epithelioid Angiosarcoma of the Submandibular Gland-A Case Report with Histology-Cytology Correlation and Comprehensive Molecular Analysis. Head Neck Pathol 2024; 18:56. [PMID: 38916683 PMCID: PMC11199468 DOI: 10.1007/s12105-024-01667-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/11/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Angiosarcoma is a sarcoma that occurs in a range of tissue types, and only rarely in the salivary glands, showing a predilection for the parotid glands of older patients. Preoperative diagnosis may be challenging, especially on cytology, with significant morphological overlap with high-grade primary salivary gland carcinomas. The molecular alterations of this rare salivary gland neoplasm are also not well-characterized. METHODS AND RESULTS We present a case of right submandibular gland swelling in a 73-year-old male. On fine needle aspiration, including immunohistochemical stains on cell block, the tumor was initially diagnosed as poorly differentiated carcinoma. Resection of the submandibular gland revealed epithelioid angiosarcoma. We performed molecular work-up of the tumor, utilizing targeted next-generation sequencing, DNA methylation profiling and fluorescence in-situ hybridization. Histopathologic assessment revealed an infiltrative tumor comprising solid sheets of epithelioid cells. The tumor cells formed haphazardly anastomosing vascular channels with intracytoplasmic lumina containing red blood cells. On immunohistochemistry, the tumor cells were positive for CD31, CD34 and ERG. Approximately 40% of the tumor cells showed nuclear expression of GATA3. A pathogenic TP53 R267W mutation was detected on next-generation sequencing. DNA methylation analysis did not cluster the tumor with any known sarcoma type. Copy number analysis showed possible MYC amplification and CDKN2A losses, although only the latter was confirmed on fluorescence in-situ hybridization. CONCLUSION Epithelioid angiosarcoma is an important differential diagnosis to high-grade salivary gland carcinoma. In particular, GATA3 expression may be encountered in both angiosarcoma and high-grade salivary gland carcinomas and cause diagnostic confusion. Identification of TP53 mutations and CDKN2A losses suggest shared oncogenic pathways with soft tissue angiosarcomas, and should be further investigated.
Collapse
Affiliation(s)
- Ming Liang Oon
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Bingcheng Wu
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Jian Yuan Goh
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Kenneth Tou En Chang
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Yan Ling Chong
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Zi Wei Wong
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Shoo Yi Oh
- Department of Pathology, National University Hospital, Singapore, Singapore
| | - Charmaine Tan
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore, Singapore
| | - Min En Nga
- Department of Pathology, National University Hospital, Singapore, Singapore
- Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Fredrik Petersson
- Department of Pathology, National University Hospital, Singapore, Singapore.
| |
Collapse
|
2
|
Matsui T, Nojima S, Morii E. Deep Vein Thrombosis as an Initial Symptom of Malignant Tumor: A Case Report of Angiosarcoma in the Iliac Vein. Case Rep Oncol 2021; 14:1542-1547. [PMID: 34899249 PMCID: PMC8613607 DOI: 10.1159/000519598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
Although deep vein thrombosis, as well as subsequent pulmonary embolism, is one of the major and fatal complications in cases of malignant neoplasm, it most often occurs after the diagnosis or treatment of the tumor. On the other hand, malignant tumors that develop with deep vein thrombosis as a specific initial symptom are extremely rare. Here, we report a case of angiosarcoma of the iliac vein, whose initial symptom was dyspnea due to pulmonary embolism. Although angiosarcoma arising directly from major blood vessels is rare, literature reviews, as well as our case, indicate that thromboembolism is an important initial symptom related to angiosarcoma from thick blood vessels and may contribute to immediate diagnosis and therapeutic intervention.
Collapse
Affiliation(s)
- Takahiro Matsui
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Nojima
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
3
|
Cook MR, Lorbach JN, White ME, Zann GJ, Cianciolo RE, Selmic LE, Wavreille V, Kisseberth WC. Case Report: Cutaneous Pleomorphic Lymphangiosarcoma in a Dog Exhibiting Features of Human Composite Hemangioendothelioma. Front Vet Sci 2021; 8:666226. [PMID: 34746271 PMCID: PMC8569467 DOI: 10.3389/fvets.2021.666226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Angiosarcomas are a broad category of vascular origin neoplasms that are poorly characterized in veterinary species. Lymphangiosarcoma (LAS) is an uncommon type of angiosarcoma reported in humans and canines arising from lymphatic endothelium. LAS can be differentiated from other angiosarcomas in dogs based on expression of Prospero-related homeobox gene-1 (PROX-1) or lymphatic vessel endothelial receptor-1 (LYVE-1). Composite hemangioendothelioma (CHE) is a rare angiosarcoma subtype described in people and characterized by a variable biologic behavior and infrequent metastasis. This variant of angiosarcoma histologically combines features of retiform hemangioendothelioma and epithelioid hemangioendothelioma. Information regarding the cytologic and histopathologic appearance and clinical course of dogs with vascular tumors that exhibit features of CHE are unknown. Here, we report a case of pleomorphic LAS with features of CHE arising in a dog and treated with surgery and adjuvant chemotherapy. Case presentation: A 10-year-old intact male Labrador retriever presented with an approximately 6-cm-diameter cutaneous mass caudal to the left elbow that was progressively growing over 1.5 years. On physical examination, palpable extensions were identified coursing proximally over the triceps with concurrent loco-regional peripheral lymphadenopathy. Fine needle aspirates (FNA) and cytologic assessment of the cutaneous mass, left prescapular, and accessory axillary lymph nodes reported that this appeared to be a metastatic epithelial neoplasm, although a mixed carcinoma or collision tumor could not be excluded. An incisional biopsy of the mass was submitted for histopathology and was consistent with a well-differentiated angiosarcoma with features of CHE. The neoplasm expressed vimentin, CD31, von Willebrand factor (vWf), and PROX-1, supporting the diagnosis of LAS. Complete staging was performed, and no additional metastatic lesions were identified. Left forelimb amputation and lymph node removal were performed. Based on the diagnosis of metastatic LAS, doxorubicin chemotherapy was administered. 7 months post-amputation, the tumor recurred at the amputation site without evidence of metastatic disease. Conclusion: This report describes a malignant, locally aggressive lymphatic origin vascular tumor in a dog, with features consistent with descriptions of CHE in humans. Cytologic features in this case were discordant with its true mesenchymal etiology, obfuscating diagnosis. The morphologic features of the mesenchymal neoplastic population and immunohistochemistry (IHC) labeling ultimately supported a diagnosis of pleomorphic LAS with features of CHE.
Collapse
Affiliation(s)
- Matthew R Cook
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Joshua N Lorbach
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Mary E White
- Department of Population Medicine, College of Veterinary Medicine, Midwestern University, Glendale, CA, United States
| | - Geoffrey J Zann
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Rachel E Cianciolo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Vincent Wavreille
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - William C Kisseberth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| |
Collapse
|
4
|
Nodit PG, Snyder DH, Duncan LD, Clark CT. Solitary scalp nodule-A diagnostic dilemma. Diagn Cytopathol 2021; 49:779-781. [PMID: 33881799 DOI: 10.1002/dc.24747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Paul G Nodit
- The Neuroscience department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lisa D Duncan
- Department of Pathology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Christopher T Clark
- Department of Pathology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| |
Collapse
|
5
|
Geller RL, Hookim K, Sullivan HC, Stuart LN, Edgar MA, Reid MD. Cytologic features of angiosarcoma: A review of 26 cases diagnosed on FNA. Cancer Cytopathol 2016; 124:659-68. [DOI: 10.1002/cncy.21726] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 03/28/2016] [Accepted: 03/29/2016] [Indexed: 12/22/2022]
Affiliation(s)
| | - Kim Hookim
- Department of Pathology; Louisiana State University Health Sciences Center-Shreveport; Shreveport Louisiana
| | | | | | - Mark A. Edgar
- Department of Pathology; Emory University; Atlanta Georgia
| | | |
Collapse
|
6
|
Sullivan HC, Edgar MA, Cohen C, Kovach CK, HooKim K, Reid MD. The utility of ERG, CD31 and CD34 in the cytological diagnosis of angiosarcoma: an analysis of 25 cases. J Clin Pathol 2014; 68:44-50. [PMID: 25352641 DOI: 10.1136/jclinpath-2014-202629] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIMS Erythroblast transformation specific related gene (ERG), a proto-oncogene member of the erythroblast transformation specific transcription factor family, is a sensitive marker of endothelial differentiation and is expressed in vascular tumours, including angiosarcomas (AS). Immunohistochemistry is necessary for the diagnosis of AS in fine needle aspirates where low cellularity and lack of preserved tissue architecture impedes diagnosis. The aim of this study was to assess the utility of an ERG-enriched immunohistochemistry panel in the cytological diagnosis of AS. METHODS 25 AS diagnosed on fine needle aspirates were stained for ERG, CD31, CD34, and AE1/AE3. Staining intensity and percentage tumour cell positivity were evaluated. Spearman's correlation was assessed for significant correlations between antibodies. RESULTS Sensitivities for ERG, CD31, CD34 and AE1/AE3 were 100%, 100%, 60% and 21%, respectively. Spearman's analysis revealed that ERG and CD31 staining correlated significantly; there was no significant correlation between CD31 and CD34 staining. CONCLUSIONS With equal sensitivity to, and strong correlation with CD31, ERG staining is highly suitable for the cytological diagnosis of AS. ERG and CD31 are more sensitive vascular markers than CD34. ERG, a nuclear stain, complements the cytoplasmic/membranous staining of CD31. Used in conjunction with CD31, ERG can corroborate the diagnosis of AS.
Collapse
Affiliation(s)
- Harold C Sullivan
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Mark A Edgar
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Cynthia Cohen
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Charles K Kovach
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| | - Kim HooKim
- Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Michelle D Reid
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
7
|
Jung MJ, Kim YO. A case of metastatic angiosarcoma diagnosed by liquid-based preparation: peculiar cytoplasmic changes. KOREAN JOURNAL OF PATHOLOGY 2014; 48:241-7. [PMID: 25013424 PMCID: PMC4087139 DOI: 10.4132/koreanjpathol.2014.48.3.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 04/02/2014] [Accepted: 04/07/2014] [Indexed: 01/06/2023]
Abstract
Angiosarcoma with predominantly epithelioid features is a rare soft tissue neoplasm and the interpretation of its cytopathologic findings may be difficult. We report a case of metastatic angiosarcoma with predominantly epithelioid features diagnosed by liquid-based cytology. The cytopathologic findings in this case differed from those of the conventional preparation and we found a clean background, no hyperchromatic nuclei and several cytoplasmic changes, including intracytoplasmic vacuoles with peculiar shapes, juxtanuclear condensation and perinuclear clearing. Identification of these changes using liquid-based cytology supplemented with immunochemistry may be helpful in reaching a correct cytopathologic diagnosis.
Collapse
Affiliation(s)
- Min Jung Jung
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Young Ok Kim
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
8
|
VandenBussche CJ, Wakely PE, Siddiqui MT, Maleki Z, Ali SZ. Cytopathologic characteristics of epithelioid vascular malignancies. Acta Cytol 2014; 58:356-66. [PMID: 25195738 DOI: 10.1159/000366151] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 07/24/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Epithelioid hemangioendothelioma (EHE) and epithelioid angiosarcoma (EAS) are rare vascular neoplasms that share many morphological characteristics on histology but demonstrate different clinical behavior. Given the many reported clinical and morphological features shared between EAS and EHE, we examined all cases of EAS and EHE diagnosed primarily on fine needle aspiration (FNA) at our three institutions that were confirmed by a tissue diagnosis. STUDY DESIGN A total of 29 cases from 25 patients were identified: 15 EHE from 11 patients and 14 EAS from 14 patients. RESULTS Many cytomorphological features existed on a spectrum that overlapped considerably between EAS and EHE cases. Common features between the two entities include epithelioid morphology and eccentrically placed nucleus. Intracytoplasmic lumens (ICL), a morphological feature that may suggest vascular origin, can be found in both entities but are not always present. CONCLUSIONS Given the general absence of vascular cytomorphological features, such as ICL, the proper classification of these tumors depends on the successful use of immunoperoxidase markers such as factor VIII-related antigen, ERG, or CD31 as well as a high index of suspicion. The distinction between EAS and EHE on FNA alone is treacherous at best.
Collapse
|
9
|
Balaji GG, Arockiaraj JSV, Roy AC, Deepak B. Primary epithelioid angiosarcoma of the calcaneum: a diagnostic dilemma. J Foot Ankle Surg 2013; 53:239-42. [PMID: 24361010 DOI: 10.1053/j.jfas.2013.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Indexed: 02/03/2023]
Abstract
Primary epithelioid angiosarcoma of the bone is very rare. We report a rare case of epithelioid angiosarcoma of the calcaneum and the difficulties we had in diagnosing this condition. A 22-year-old woman presented with complaints of pain and swelling of the left ankle of 8 years' duration. Examination revealed swelling and tenderness over the lateral aspect of calcaneum. Plain radiographs showed an osteolytic lesion of the calcaneum. She underwent curettage and bone grafting, with bone substitutes. Histopathologic examination showed epithelioid angiosarcoma in contrast to the needle biopsy, which had showed an aneurysmal bone cyst. The patient was counseled about the need for amputation. She refused limb ablative surgery, and the likelihood of local recurrence and systemic spread and the need for close follow-up were explained. At the end of 3 years of follow-up, she was pain free and had no evidence of recurrence. We present this case because of the rare site, histopathologic challenges in diagnosing the condition, and unique presentation of the disease.
Collapse
Affiliation(s)
- Gopisankar G Balaji
- Assistant Professor in Orthopaedics, Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
| | - Justin S V Arockiaraj
- Assistant Professor in Orthopaedics, Department of Orthopaedics Unit 1, Christian Medical College, Vellore, Tamil Nadu, India
| | - Alfred Cyril Roy
- Assistant Professor in Orthopaedics, Department of Orthopaedics Unit 1, Christian Medical College, Vellore, Tamil Nadu, India
| | - Burad Deepak
- Assistant Professor in Pathology, Department of Orthopaedics Unit 1, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
10
|
Choi YD, Kim Y, Kim SS, Kim JH, Nam JH, Choi C, Park CS. Intravascular papillary endothelial hyperplasia of the chest wall misdiagnosed as a malignancy on fine needle aspiration. KOREAN JOURNAL OF PATHOLOGY 2013; 47:499-501. [PMID: 24255643 PMCID: PMC3831002 DOI: 10.4132/koreanjpathol.2013.47.5.499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/10/2013] [Accepted: 07/17/2013] [Indexed: 11/17/2022]
Affiliation(s)
- Yoo-Duk Choi
- Department of Pathology, Chonnam National University Medical School, Gwangju, Korea
| | | | | | | | | | | | | |
Collapse
|
11
|
|
12
|
Muzumder S, Das P, Kumar M, Bhasker S, Sarkar C, Medhi K, Iyer VK, Rath GK. Primary epithelioid angiosarcoma of the breast masquerading as carcinoma. ACTA ACUST UNITED AC 2011; 17:64-9. [PMID: 20179806 PMCID: PMC2826780 DOI: 10.3747/co.v17i1.451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Here we report a case of primary epithelioid angiosarcoma (eas) of the breast occurring in a 30-year-old woman. Following fine-needle asspiration cytology (fnac) and tru-cut biopsy, the patient was initially diagnosed with mammary carcinoma and thereafter underwent modified radical mastectomy. Postoperative histopathologic examination and immunohistochemistry revealed a diagnosis of primary epithelioid angiosarcoma of the breast. The patient received postoperative radiotherapy to the chest wall and was started on adjuvant thalidomide. Preoperatively, eas can be mistaken for carcinoma because it is difficult to appreciate the typical morphology on fnac or tru-cut biopsy. Indeed, this is an area of potential diagnostic error because, nowadays, neoadjuvant therapy is often instituted after core biopsy of a breast mass. This case is being reported not only for its diagnostic difficulty, but also because of its rarity in English literature.
Collapse
Affiliation(s)
- S Muzumder
- Department of Radiotherapy, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Singh C, Xie L, Schmechel SC, Manivel JC, Pambuccian SE. Epithelioid angiosarcoma of the kidney: a diagnostic dilemma in fine-needle aspiration cytology. Diagn Cytopathol 2011; 40 Suppl 2:E131-9. [PMID: 21698784 DOI: 10.1002/dc.21762] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 05/21/2011] [Indexed: 02/07/2023]
Abstract
Epithelioid angiosarcomas (EAS) of kidney are rare and aggressive tumors with noncharacteristic imaging features that overlap with those of inflammatory conditions and renal cell carcinoma (RCC). We report the fine-needle aspiration (FNA) cytology findings of a case of EAS that involved the left kidney of an 83-year-old male. The smears and cell block sections showed pleomorphic epithelioid cells with ample cytoplasm, eccentric nuclei, occasional cytoplasmic hyaline globules, and rare intracytoplasmic lumina. Immunohistochemical stains performed on cellblock sections showed that the tumor cells were positive for vimentin, CD31, CD34, Factor VIII, and CD10, but showed no staining for cytokeratins AE1/AE3 and 8/18, HMB45, CD45, smooth muscle actin, and S100. The morphological and immunohistochemical distinction between EAS, primary tumors of the kidney, and other epithelioid and rhabdoid neoplasms is discussed.
Collapse
Affiliation(s)
- Charanjeet Singh
- Department of Laboratory Medicine & Pathology, University of Minnesota Medical School, 420 Delaware SE, Minneapolis, MN 55455, USA
| | | | | | | | | |
Collapse
|
14
|
Dervisis NG, Dominguez PA, Newman RG, Cadile CD, Kitchell BE. Treatment with DAV for advanced-stage hemangiosarcoma in dogs. J Am Anim Hosp Assoc 2011; 47:170-8. [PMID: 21498593 DOI: 10.5326/jaaha-ms-5525] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hemangiosarcoma (HSA) is an aggressive disease that is fairly common in the dog. The authors evaluated a doxorubicin, dacarbazine, and vincristine (DAV) combination protocol in dogs with nonresectable stage II and stage III HSA. Twenty-four dogs were enrolled in this prospective, phase 2 study. Doxorubicin and dacarbazine were administered on day 1 while vincristine was administered on days 8 and 15. The protocol was repeated every 21 days for a maximum of six cycles or until disease progression. Toxicity and efficacy were assessed by clinical and laboratory evaluation and by questionnaires completed by the owners. Of the 24 included dogs, 19 were evaluable for response. The response rate (including five complete responses and four partial responses) was 47.4%. Median time to tumor progression was 101 days and median overall survival was 125 days. Significant toxicities were noted, including 41 high-grade hematologic and 12 high-grade gastrointestinal toxic events. Five dogs discontinued treatment due to chemotherapy-related toxicities, but no treatment-related deaths occurred. Multivariate analysis identified patient age (relative risk [RR], 2.3, P=0.049) to be negatively associated with time to progression whereas dacarbazine dose reductions (RR, 0.06, P=0.031) were positively associated with time to progression. Dacarbazine dose reduction was the sole factor positively associated with overall survival (RR, 0.28, P=0.015). In conclusion, the DAV combination appears to offer clinical responses and may prolong survival in dogs with advanced-stage HSA.
Collapse
Affiliation(s)
- Nikolaos G Dervisis
- Center for Comparative Oncology, Michigan State University, East Lansing, MI, USA.
| | | | | | | | | |
Collapse
|
15
|
Park JW, Serafica-Karen C, Das K. Fine-needle aspiration of metastatic radiation-induced cutaneous epithelioid angiosarcoma of the breast to the liver: A diagnostic dilemma. Diagn Cytopathol 2010; 38:768-71. [PMID: 20187111 DOI: 10.1002/dc.21331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Radiation therapy is a significant risk factor for the development of angiosarcoma. With the increase in breast conservation treatment, the incidence of cutaneous radiation-induced angiosarcoma of the breast is rising. If the angiosarcoma demonstrates epithelioid features, the tumor cells may present a diagnostic dilemma on fine-needle aspiration cytology. We present a case of metastatic radiation-induced cutaneous epithelioid angiosarcoma of the breast to the liver and a review of the literature.
Collapse
Affiliation(s)
- Ji-Weon Park
- Department of Cytopathology, New York University, New York, USA.
| | | | | |
Collapse
|
16
|
Pohar-Marinšek Ž, Lamovec J. Angiosarcoma in FNA smears: diagnostic accuracy, morphology, immunocytochemistry and differential diagnoses. Cytopathology 2010; 21:311-9. [DOI: 10.1111/j.1365-2303.2009.00726.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
17
|
Application of immunocytochemistry to the diagnosis of primary epithelioid angiosarcoma of the lung. Med Mol Morphol 2009; 42:250-3. [DOI: 10.1007/s00795-008-0417-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 09/11/2008] [Indexed: 12/17/2022]
|
18
|
Gill R, O'Donnell RJ, Horvai A. Utility of immunohistochemistry for endothelial markers in distinguishing epithelioid hemangioendothelioma from carcinoma metastatic to bone. Arch Pathol Lab Med 2009; 133:967-72. [PMID: 19492891 DOI: 10.5858/133.6.967] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Epithelioid hemangioendothelioma (EHE) is a rare vascular neoplasm of intermediate malignancy. Epithelioid hemangioendothelioma often presents a difficult diagnostic problem, especially in bone, because the epithelioid morphology and radiographic features raise the possibility of metastatic carcinoma. The current trend of small biopsies obtained with computed tomography-guided techniques exacerbates the problem. The markedly different treatment for EHE and metastatic carcinoma underscores the need for specific markers that can differentiate between these 2 entities. OBJECTIVE To determine the relative utility of endothelial markers in differentiating EHE from metastatic carcinoma, with emphasis on bone biopsies. DESIGN We used immunohistochemistry in formalin-fixed paraffin-embedded tissue to compare the utility of Fli-1, CD34, CD31, podoplanin, and keratin cocktail in 13 EHEs and 13 morphologically similar carcinomas metastatic to bone. Immunohistochemical data were evaluated using Fisher exact test, and specificity and sensitivity were calculated. RESULTS Significant proportions of EHEs were positive for Fli-1 (100%), CD34 (85%), and CD31 (100%) compared with metastatic carcinoma (Fli-1, 15%; CD34, 15%; CD31, 38%) (P < .001, P = .005, and P = .01, respectively). However, these markers were not 100% specific for EHE. Cytokeratin cocktail stained significantly more metastatic carcinomas (100%) than EHEs (38%) (P = .01) but was not 100% specific. No significant difference was observed regarding immunostaining for podoplanin between the tumor types. CONCLUSIONS Fli-1 is most helpful in distinguishing EHE from metastatic carcinoma. However, the absence of complete specificity of any of the endothelial markers for EHE, or of keratin cocktail for carcinoma, suggests that these markers are best used in combination.
Collapse
Affiliation(s)
- Ryan Gill
- Department of Laboratory Medicine, University of California, San Francisco, USA
| | | | | |
Collapse
|
19
|
Driemel O, Müller-Richter UDA, Hakim SG, Bauer R, Berndt A, Kleinheinz J, Reichert TE, Kosmehl H. Oral acantholytic squamous cell carcinoma shares clinical and histological features with angiosarcoma. Head Face Med 2008; 4:17. [PMID: 18671846 PMCID: PMC2515303 DOI: 10.1186/1746-160x-4-17] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Accepted: 07/31/2008] [Indexed: 01/21/2023] Open
Abstract
Background acantholytic squamous cell carcinomas (ASCC) and intraoral angiosarcoma share similar histopathological features. Aim of this study was to find marker for a clear distinction. Methods Four oral acantholytic squamous cell carcinomas and one intraoral angiosarcoma are used to compare the eruptive intraoral growth-pattern, age-peak, unfavourable prognosis and slit-like intratumorous spaces in common histological staining as identical clinical and histopathological features. Immunohistochemical staining for pancytokeratin, cytokeratin, collagen type IV, γ2-chain of laminin-5, endothelial differentiation marker CD31 and CD34, F VIII-associated antigen, Ki 67-antigen, β-catenin, E-cadherin, α-smooth-muscle-actin and Fli-1 were done. Results Cytokeratin-immunoreactive cells can be identified in both lesions. The large vascularization of ASCC complicates the interpretation of vascular differential markers being characteristic for angiosarcoma. Loss of cell-cell-adhesion, monitored by loss of E-cadherin and β-catenin membrane-staining, are indetified as reasons for massive expression of invasion-factor ln-5 in ASCC and considered responsible for unfavourable prognosis of ASCC. Expression of Fli-1 in angiosarcoma and cellular immunoreaction for ln-5 in ASCC are worked out as distinguishing features of both entities. Conclusion Fli-1 in angiosarcoma and ln-5 in ASCC are distinguishing features.
Collapse
Affiliation(s)
- Oliver Driemel
- Department of Oral and Maxillofacial Plastic Surgery, University of Würzburg, Würzburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Sattout AH, Deolekar MV, Tait WF, Williams GT. Femoral artery angiosarcoma presenting with distal embolization: Report of a case. Surg Today 2008; 38:541-4. [DOI: 10.1007/s00595-007-3643-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 06/21/2007] [Indexed: 10/22/2022]
|
21
|
Tse LF, Ek ET, Slavin JL, Schlicht SM, Choong PF. Intraosseous angiosarcoma with secondary aneurysmal bone cysts presenting as an elusive diagnostic challenge. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2008; 5:10. [PMID: 18492283 PMCID: PMC2413251 DOI: 10.1186/1477-7800-5-10] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 05/20/2008] [Indexed: 01/21/2023]
Abstract
Angiosarcoma of bone is an exceedingly rare primary bone malignancy that can present as an aggressive osteolytic lesion. Histological diagnosis can be extremely challenging, as the pathological features often resemble that of aneurysmal bone cysts. We report an interesting and peculiar case of an intraosseous angiosarcoma that presented as a diagnostic dilemma and discuss the relevant radiological and pathologic findings.
Collapse
Affiliation(s)
- Lung Fung Tse
- Department of Orthopaedics, St, Vincent's Hospital, Melbourne, Australia.
| | | | | | | | | |
Collapse
|