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Damouny M, Mansour S, Khuri S. Primary Angiosarcoma of the Spleen: An Aggressive Neoplasm. World J Oncol 2022; 13:337-342. [PMID: 36660212 PMCID: PMC9822683 DOI: 10.14740/wjon1542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 12/25/2022] Open
Abstract
Primary tumors of the spleen are rare, with an incidence rate of about 0.1%. These tumors could be benign, usually asymptomatic, or malignant which are usually symptomatic with abdominal pain being the most common symptom. Lymphoid neoplasms are the most common primary splenic tumors. Primary angiosarcoma is one of the extremely rare malignant vascular neoplasms of the spleen, which carries a dismal prognosis. It constitutes almost 7.4% of all primary malignant splenic neoplasms and is well known as an aggressive tumor with high local recurrence and distant metastasis rates. Overall survival is up to 12 months following diagnosis, regardless of management strategy. Due to the broad differential diagnosis of splenic tumors, this tumor is often forgotten, and is very challenging to diagnose early. Less than 300 cases of primary splenic angiosarcoma have been reported in the English literature. The main issue of this article is to review the current English literature to figure out the characteristic demographic features, clinical presentation, imaging findings and management of such tumors, in order to increase awareness of the treating physicians to improve diagnosis, management, as well as overall survival.
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Affiliation(s)
- Mira Damouny
- General Surgery Department, Rambam Medical Center, Haifa, Israel
| | - Subhi Mansour
- General Surgery Department, Rambam Medical Center, Haifa, Israel
| | - Safi Khuri
- General Surgery Department, Rambam Medical Center, Haifa, Israel,HPB and Surgical Oncology Unit, Rambam Medical Center, Haifa, Israel,Corresponding Author: Safi Khuri, HepatoPancreatoBiliary Surgical Unit, General Surgery Department, Rambam Medical Care Center, Haa’leya Hashniya, Haifa 31096, Israel.
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Venegas LF, Pohlmann PR, Balbinot AL, Schuck E, Oliveira CTMD, Frank KJ, Dillemburg CF, Costa MSBD, Rivero LFR, Pütten ACK. Primary splenic angiosarcoma: case report and literature review. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.1998v44n1.2800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This paper describes a case of an aggressive primary splenic angiosarcoma in a 29-year-old man and makes a review of its clinicai findings, pathologic reports, treatment and prognosis. Angiosarcomas comprise less than 1% of soft tissue sarcomas, and only a small percentage of these tumors arise in the spleen. These tumors usually represent a diagnostic challenge for the pathologist in view of its variegated histology, and the development of new immu-nohistochemical markers for vascular tumors like CD31 (platelet-endothelial cell adhesion molecule) helps to rule out other diagnoses. There is no standard chemotherapy treatment for angiosarcomas, and the prognosis of splenic angiosarcoma is particularly poor.
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Abstract
Introduction: Spleen angiosarcoma (SA) is a rare malignant neoplasm that arises from the splenic vascular endothelium, with only around 300 cases reported to date. Due to a limited number of reported cases, there is a paucity of data and a lack of understanding of its presentation, diagnosis, and management. In this study, we aim to provide a comprehensive review of SA.Areas covered: On 27 February 2021, a literature search was done in PubMed and Embase database. The search yielded 122 articles involving 205 patients. The focus was on patient demographics, risk factors, clinical presentations, investigation results, preliminary diagnoses, therapies provided, and patient outcomes. These factors were analyzed to identify possible risk factors, diagnostic modalities, and therapeutic principles that were not mentioned before.Expert opinion: The clinical presentation or investigation results of patients with SA are often nonspecific. Hence, they may not be sufficient to clinch the diagnosis of SA if used alone. The authors recommend a triple assessment of clinical examination, imaging findings, and pathology to diagnose SA with high accuracy. Splenectomy should be the mainstay of management, with chemotherapy and radiotherapy considered as adjuncts, especially in the presence of metastases.
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Duan YF, Jiang Y, Wu CX, Zhu F. Spontaneous rupture of primary splenic angiosarcoma: a case report and literature review. World J Surg Oncol 2013; 11:53. [PMID: 23497454 PMCID: PMC3599178 DOI: 10.1186/1477-7819-11-53] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/16/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Primary angiosarcoma of the spleen is a rare mesenchymal malignant tumor of vascular origin often with a poor prognosis, due to its high metastatic potential. This disease often presents with atraumatic rupture and lethal hemorrhage. CASE PRESENTATION We report a case of a 65-year-old man who presented with abdominal pain, anemia, thrombocytopenia, and palpable abdominal mass with unstable blood pressure. Laparotomy revealed a huge actively bleeding spleen, thus splenectomy was performed. Some liver metastasis foci were also found during the procedure. Histopathology diagnosis of the removed spleen was primary splenic angiosarcoma. The patient was discharged on the 10th day post operation with no complication. CONCLUSIONS Splenic angiosarcoma should be considered one of the differential diagnoses in patients with spleen parenchymal lesions. Definitive diagnosis requires laparotomy followed by splenectomy. In the majority of the patients with spleen angiosarcoma, metastatic diseases have already occurred at the time of laparotomy, so splenectomy is an approach more for diagnostic purpose rather than curative purpose.
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Affiliation(s)
- Yun-Fei Duan
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Soochow University, 185 Juqian Street, 213000, Changzhou, Jiangsu, China
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Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med 2012; 12:11. [PMID: 22889306 PMCID: PMC3532171 DOI: 10.1186/1471-227x-12-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. METHODS Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. RESULTS We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. CONCLUSIONS Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.
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Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
| | - Nicholas Sowers
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Affiliation(s)
- Kazuhito Suzuki
- Department of Hematology, Yokohama Municipal Citizen's Hospital, Yokohama
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Manouras A, Giannopoulos P, Toufektzian L, Markogiannakis H, Lagoudianakis EE, Papadima A, Papanikolaou D, Filis K, Kekis P. Splenic rupture as the presenting manifestation of primary splenic angiosarcoma in a teenage woman: a case report. J Med Case Rep 2008; 2:133. [PMID: 18445294 PMCID: PMC2387157 DOI: 10.1186/1752-1947-2-133] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2007] [Accepted: 04/29/2008] [Indexed: 01/25/2023] Open
Abstract
Introduction Primary splenic angiosarcoma is a rare neoplasm of vascular origin carrying a very poor prognosis, partly due to its high metastatic potential. This disease presents frequently with splenic rupture and hemorrhage. We report the case of a 17-year-old woman who presented with rupture of a primary splenic angiosarcoma. Case presentation The patient presented with diffuse abdominal pain and distention. Clinical examination revealed severe tenderness in the left upper abdominal quadrant, a palpable abdominal mass, and hemodynamic instability with a systolic arterial blood pressure of 75 mmHg and heart rate of 135 beats per minute. Blood tests revealed anemia (hemoglobin 7.0 g/dl) and thrombocytopenia (platelets 70 × 109/liter). After initial fluid resuscitation and stabilization, abdominal ultrasound and computed tomography were performed, revealing a large quantity of intraperitoneal free fluid, an enlarged spleen, and a heterogeneous low-density signal within the splenic parenchyma, which showed varying degrees of contrast enhancement. At laparotomy a huge (weight 1530 g, diameter 19 cm) actively bleeding spleen was identified and splenectomy was performed. Histopathology showed a primary splenic angiosarcoma. After an uneventful recovery, the patient was discharged on the sixth postoperative day. Conclusion Primary splenic angiosarcoma is rare. Although this malignancy is usually encountered in advanced age, there have been a few reported cases among younger patients. The case reported here presented with splenic rupture, was treated by laparotomy and splenectomy, and the patient is disease free 16 months after surgery.
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Affiliation(s)
- Andreas Manouras
- 1st Department of Propaedeutic Surgery, Hippokrateion Hospital, Athens Medical School, University of Athens, Athens, Greece.
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den Hoed IDM, Granzen B, Granzen B, Aronson DC, Pauwels P, de Kraker J, van Heurn LWE. Metastasized angiosarcoma of the spleen in a 2-year-old girl. Pediatr Hematol Oncol 2005; 22:387-90. [PMID: 16020128 DOI: 10.1080/08880010590964228] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary angiosarcoma of the spleen is rare and the prognosis is very poor. The authors present a 2-year-old girl with spontaneous rupture of splenic angiosarcoma. At diagnosis there were liver metastases. After splenectomy she received chemotherapy with ifosfamide, vincristine, and actinomycine D combined with a partial liver resection. She remained in complete remission over 2 years from diagnosis.
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Affiliation(s)
- Irma D M den Hoed
- Department of Paediatric Surgery, Paediatrics, and Pathology, University Hospital, Maastricht, The Netherlands
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Mahesh B, Muwanga CL. Splenic infarct: a rare cause of spontaneous rupture leading to massive haemoperitoneum. ANZ J Surg 2005; 74:1030-2. [PMID: 15550109 DOI: 10.1111/j.1445-1433.2004.03227.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A 76-year-old woman presented to the accident and emergency department with an acute surgical abdomen. She did not have any significant medical history or history of trauma. Examination findings revealed generalized peritonitis. Preliminary investigations were unhelpful in revealing a cause. On urgent exploratory laparotomy, a ruptured spleen was found and splenectomy performed. The hollow viscera were normal. The gross and microscopic appearances were suggestive of splenic rupture occurring through areas of infarction. We proceed to analyse the causes of spontaneous rupture of the spleen in our discussion of this case.
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Affiliation(s)
- Balakrishnan Mahesh
- Department of Accident and Emergency and Trauma Surgery, Sunderland Royal Hospital, Sunderland, United Kingdom.
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Abstract
The management of any surgical condition in a haemophilia patient is a challenging problem for the surgeon. It is particularly difficult if the patient presents in extremis, with no apparent cause for their collapse. We report a case of successful management of spontaneous splenic rupture in a severe haemophiliac, and review the literature associated with this unusual condition.
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Aldemir M, Süner A, Kıdır V, Balakan O, Çelenk T. SPONTANEOUS RUPTURE OF THE SPLEEN IN A HEMODIALYSIS PATIENT. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2004. [DOI: 10.29333/ejgm/82210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Splenic vascular tumors are uncommon and are more typically encountered as benign incidental findings. By contrast, splenic angiosarcoma may present acutely and dramatically and typically pursues a very aggressive clinical course. Vascular tumors in the spleen may show conventional endothelial, specialized endothelial (sinusoidal/littoral cell) or lymphatic differentiation and there is morphologic overlap between some of the currently defined diagnostic categories, within which benign, intermediate, and malignant subsets are recognized. The greatest problem in trying to better define and analyze these tumors is the availability of only relatively small case numbers. This overview describes the diagnosis and differential diagnosis of splenic vascular tumors as presently understood.
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Affiliation(s)
- Jeffery L Kutok
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
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Aytaç S, Fitoz S, Atasoy C, Kuzu I, Cinar K, Erden I. Multimodality demonstration of primary splenic angiosarcoma. JOURNAL OF CLINICAL ULTRASOUND : JCU 1999; 27:92-95. [PMID: 9932256 DOI: 10.1002/(sici)1097-0096(199902)27:2<92::aid-jcu9>3.0.co;2-a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Angiosarcomas are rare, accounting for only 1-2% of all soft tissue sarcomas. Primary abdominal angiosarcomas usually arise in the liver or spleen. We report the first color Doppler findings of a rare, low-grade splenic angiosarcoma in a 52-year-old woman.
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Affiliation(s)
- S Aytaç
- Department of Radiology, Ankara University School of Medicine, Ibn-i Sina Hospital, Samanpazari, Ankara, Turkey
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Angiosarkom der Milz. Langenbecks Arch Surg 1997. [DOI: 10.1007/bf02391871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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