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Komatsu Y, Miyamoto I, Ohashi Y, Katagiri K, Saito D, Obara M, Takeda Y, Shiga K, Yamada H. Primary epithelioid angiosarcoma originating from the mandibular gingiva: a case report of an extremely rare oral lesion. World J Surg Oncol 2020; 18:260. [PMID: 33010804 PMCID: PMC7533036 DOI: 10.1186/s12957-020-01999-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background Angiosarcoma occurs very rarely in the oral cavity, and the epithelioid type is even rarer. Here, we report a rare case involving an elderly man with a primary epithelioid angiosarcoma that originated from the mandibular gingiva and resembled a dentigerous cyst on radiographs. Case presentation A 66-year-old Japanese man visited our hospital with a chief complaint of gingival swelling in right mandibular third molar region. A panoramic radiograph showed bone resorption around the crown of right mandibular third molar, which was impacted. Incisional biopsy confirmed a diagnosis of epithelioid angiosarcoma. The lesion exhibited aggressive proliferation after biopsy resulting in uncontrolled bleeding and difficulty in closing the mouth. Mandibular segmental resection including the tumor was performed without reconstruction. Because of the aggressive preoperative course of the tumor, the patient received adjuvant chemotherapy. There were no signs of recurrence during a 2-year follow-up period. Conclusions A review of the literature yielded only four reported cases of epithelioid angiosarcoma in the jaw region, with the lesions occurring in the maxilla in three cases. To our knowledge, this is the second case of primary epithelioid angiosarcoma in the mandible.
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Affiliation(s)
- Yuko Komatsu
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Ikuya Miyamoto
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan. .,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.
| | - Yu Ohashi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Katsunori Katagiri
- Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.,Department of Head and Neck Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Daisuke Saito
- Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.,Department of Head and Neck Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Mizuki Obara
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Yasunori Takeda
- Division of Clinical Pathology, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Kiyoto Shiga
- Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan.,Department of Head and Neck Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Hiroyuki Yamada
- Division of Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Reconstructive Surgery, School of Dentistry, Iwate Medical University, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.,Head and Neck Cancer Center, Iwate Medical University, 2-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
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Di Battista M, Darling MR, Scrivener E, Stapleford R, Wehrli B, McCord C. Histologic and Immunopathologic Variability in Primary Intraoral Angiosarcoma: A Case Report and Review of the Literature. Head Neck Pathol 2020; 14:1139-1148. [PMID: 32026293 PMCID: PMC7669916 DOI: 10.1007/s12105-020-01134-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/22/2020] [Indexed: 01/01/2023]
Abstract
Primary intraoral angiosarcoma is an exceptionally rare malignancy of vascular origin which can be challenging to diagnose due to microscopic and immunohistochemical variability. A histopathologically challenging case of primary intraoral angiosarcoma, occurring in a pediatric patient is presented. A comprehensive review of the literature reveals that primary intraoral angiosarcomas occur with nearly equal frequency in males and females, affect the gingiva and the tongue most commonly and are treated primarily with surgery. As with angiosarcoma in other sites, primary intraoral angiosarcoma behaves aggressively with the majority of patients succumbing to their disease.
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Affiliation(s)
| | - Mark R. Darling
- Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON Canada ,Division of Oral Pathology, Department of Pathology and Laboratory Medicine, Western University, 1151 Richmond Street, London, ON N6A 4C1 Canada ,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON Canada
| | | | - Richard Stapleford
- Great Lakes Oral and Maxillofacial Surgery Centre, Windsor, ON Canada ,Department of Oral and Maxillofacial Surgery and Dentistry, Windsor Regional Hospital, Windsor, ON Canada
| | - Bret Wehrli
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON Canada
| | - Christina McCord
- Department of Dentistry, London Health Sciences Centre, London, ON Canada ,Department of Dentistry, Schulich School of Medicine and Dentistry, Western University, London, ON Canada ,Division of Oral Pathology, Department of Pathology and Laboratory Medicine, Western University, 1151 Richmond Street, London, ON N6A 4C1 Canada ,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, ON Canada
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Prognostic Value of Quantitative Parameters of 18F-FDG PET/CT for Patients With Angiosarcoma. AJR Am J Roentgenol 2020; 214:649-657. [PMID: 31939696 DOI: 10.2214/ajr.19.21635] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE. The purpose of this study was to evaluate quantitative parameters in 18F-FDG PET/CT in terms of correlation with histologic grade and overall survival in patients with angiosarcoma. MATERIALS AND METHODS. The cases of 16 patients with histologically confirmed angiosarcoma who had undergone pretreatment FDG PET/CT were retrospectively analyzed. Maximum standardized uptake value for the primary tumor (pSUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) for the whole body, tumor-to-blood ratio (TBR) for the primary tumor, and summed ratios of tumor-to-blood glycolytic activity for all lesions (whole-body TLG ratio) were calculated. Tumors were divided into high grade and low grade, according to the pathologic results. Correlations between these metabolic parameters and tumor grade were investigated. The prognostic value of these parameters and various clinicopathologic factors with respect to overall survival was assessed with the Cox proportional hazards regression model. RESULTS. Histopathologic examination revealed 10 high-grade and six low-grade tumors. Among the quantitative parameters, pSUVmax (p < 0.0001) and primary TBR (p = 0.0003) were significantly higher for high-grade tumors than for low-grade tumors. Ten patients died during follow-up (median survival time, 19.6 months). Higher pSUVmax (p = 0.040), MTV (p = 0.016), whole-body TLG (p = 0.010), primary TBR (p = 0.019), and whole-body TLG ratio (p = 0.007) correlated significantly with poorer overall survival. Single lesion at initial diagnosis (p = 0.0008) and performance of curative surgery (p = 0.0008) were strong favorable prognostic factors for overall survival, but histologic grade was not identified as a significant predictor. CONCLUSION. In angiosarcoma, high-grade tumors had significantly higher pSUVmax and primary TBR at FDG PET/CT. All quantitative parameters evaluated in this study were found to be significant prognostic factors for overall survival.
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Nagata M, Yoshitake Y, Nakayama H, Yoshida R, Kawahara K, Nakagawa Y, Shinohara M. Angiosarcoma of the oral cavity: a clinicopathological study and a review of the literature. Int J Oral Maxillofac Surg 2014; 43:917-23. [PMID: 24656496 DOI: 10.1016/j.ijom.2014.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 02/06/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Abstract
Soft tissue sarcomas are uncommon in the head and neck. Primary angiosarcomas of the oral cavity area are extremely rare, and have mostly been presented as case reports. This paper presents the clinical and histological features of three such cases. All patients were diagnosed based on the presence of rapidly extending masses involving the tongue, maxillary gingiva, or mandibular gingiva; bone destruction was present in two cases. The resected specimens revealed clustered large, pleomorphic, and spindle-shaped cells with a markedly haemorrhagic background. Tumour cells showed expression of vascular endothelial markers, such a CD31, CD34, and factor VIII-related antigen. Despite undergoing radical surgery, distant metastases developed in all three cases. We also studied the clinicopathological features of a series of oral angiosarcomas. This article therefore reports the clinicopathological features of the three new cases and provides a review of the cases of primary oral angiosarcoma reported during the past 20 years.
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Affiliation(s)
- M Nagata
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
| | - Y Yoshitake
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Nakayama
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - R Yoshida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - K Kawahara
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Y Nakagawa
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - M Shinohara
- Department of Oral and Maxillofacial Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Karube R, Sasaki H, Shinozuka K, Fujisawa Y, Yanagawa T, Yamagata K, Onizawa K, Otsuka F, Bukawa H. Angiosarcoma of the scalp diagnosed by the presence of neck inflammation: a case report. Int J Oral Sci 2012; 4:166-9. [PMID: 22699262 PMCID: PMC3465010 DOI: 10.1038/ijos.2012.36] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Angiosarcoma is an uncommon malignancy, which spread out from the endothelial cells of vessels. Scalp angiosarcoma with cervical lymph node metastasis is particularly rare. This article describes a rare case of angiosarcoma of the scalp, presenting as neck inflammation. Imaging procedures such as computed tomography (CT), magnetic resonance image (MRI) and ultrasonography (US) were not sufficient to diagnose this case. A needle biopsy provided an effective and accurate diagnosis of cervical lymph node metastasis. Additional observation and physical examination was required to diagnose the origin of the primary cancerous lesion. Once the angiosarcoma diagnosis was confirmed histologically, sequential weekly and monthly docetaxel (DTX) treatment was effective in preventing reoccurrence. Nonetheless, the optimization of angiosarcoma treatment remains a future goal. Although patients generally describe pain and swelling at the primary lesion site, this patient complained only of painful neck inflammation, without any indication of pain or swelling of the scalp. A revised diagnostic protocol should note that cervical lymph node metastasis of unknown primary origin may result from angiosarcoma of the scalp.
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Affiliation(s)
- Rei Karube
- Department of Oral and Maxillofacial Surgery, University of Tsukuba, Tsukuba City, Japan
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Suzuki G, Ogo E, Tanoue R, Tanaka N, Watanabe Y, Abe T, Iwamoto O, Kusukawa J, Hayabuchi N. Primary gingival angiosarcoma successfully treated by radiotherapy with concurrent intra-arterial chemotherapy. Int J Clin Oncol 2010; 16:439-43. [PMID: 21107878 DOI: 10.1007/s10147-010-0145-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2010] [Accepted: 10/20/2010] [Indexed: 11/30/2022]
Abstract
The occurrence of angiosarcoma in the oral cavity is extremely rare, and optimal management of this tumor is undefined. These tumors are aggressive, with a high propensity for local recurrence. We present here a case of primary gingival angiosarcoma successfully treated by intra-arterial chemotherapy concurrent with radiation therapy. A 69-year-old female with a primary angiosarcoma in the right maxillary gingiva was admitted to our hospital. The diagnosis of angiosarcoma was established by immunohistochemistry. The patient refused surgical treatment, and so intra-arterial cisplatin and concurrent radiation were given. The gingival tumor disappeared after completion of the therapeutic regimen. However, the patient died 8 months after initial treatment because of multiple lung metastases. Locoregional control was achieved up to her death. To our knowledge, this is the first report of this treatment for angiosarcoma of the oral cavity.
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Affiliation(s)
- Gen Suzuki
- Department of Radiology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
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Pace V, Wieczorek G, Pace M, Weber K, Perentes E. Spontaneous metastatic angiosarcoma of the tongue in a Wistar rat: morphological and immunohistochemical characterization. Toxicol Pathol 2010; 38:472-5. [PMID: 20215585 DOI: 10.1177/0192623310362247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A primary angiosarcoma was found in the tongue of a six-week-old female Wistar rat, sacrificed for humane reasons during the course of a four-week toxicology study. At necropsy, a nodule protruding from the dorsal part of the tongue was found. The nodule displayed microscopically, irregularly shaped vascular spaces separated by collagenous stroma. The spindle-shaped endothelial cells showed pleomorphism, hyperchromatism, and low mitotic activity; large nuclei with one or more nucleoli were present. Multiple metastases were found in the lungs, and the morphology of the cells resembled that of the primary tumor. Immunohistochemically, the primary tumor and the lung metastases were positive for von Willebrand factor and vimentin. The diagnosis of tongue angiosarcoma metastasizing to the lungs was made on the basis of microscopic and immunohistochemical findings.
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Affiliation(s)
- V Pace
- AnaPath GmbH, Oberbuchsiten 4625, Switzerland.
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