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Rusthoven CG, Liu AK, Bui MM, Schefter TE, Elias AD, Lu X, Gonzalez RJ. Sarcomas of the Aorta: A Systematic Review and Pooled Analysis of Published Reports. Ann Vasc Surg 2014; 28:515-25. [DOI: 10.1016/j.avsg.2013.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 12/19/2022]
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2
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Nishida N, Yutani C, Ishibashi-Ueda H, Tsukamoto Y, Ikeda Y, Nakamura Y. Histopathological characterization of aortic intimal sarcoma with multiple tumor emboli. Pathol Int 2000; 50:923-7. [PMID: 11107072 DOI: 10.1046/j.1440-1827.2000.01144.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of aortic intimal sarcoma with multiple tumor emboli and distal metastasis is reported. All metastasis (adrenal, spleen) were via the arteries. This case also had independent lung cancer. Macroscopically, the aortic tumor did not form a bulged mass, but had linear ulceration with abundant mural thrombi. Poorly cohesive large atypical cells were seen in the intima of the abdominal aorta without invasion into the media. Tumor cells were disseminated into the mural thrombi on the aorta and embolized its branches. In the metastatic tumor or tumor emboli of the distal artery, there were not only large atypical cells, but also the foci of spindle-shaped cells or epithelioid differentiation. Tumor cells in the aorta were immunohistochemically positive for only vimentin. Muscle-specific actin was positive focally for spindle-shaped cells of tumor emboli and metastatic tumors. Furthermore, cytokeratin-positive cells were scatteredly seen. All tumor cells were negative for factor VIII and did not have a histologic or phenotypic analogy with lung cancer. The primary intimal sarcoma in the present case was of undifferentiated non-endothelial intimal stromal cell origin, and may have had multipotential for differentiation. Investigation of the metastatic site was useful for recognizing the features of this tumor.
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Affiliation(s)
- N Nishida
- Department of Pathology, National Cardiovascular Center, Suita, Osaka, Japan
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3
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Iorgulescu DG, White AL. Leiomyosarcoma of the thoracic aorta. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1999; 69:537-40. [PMID: 10442931 DOI: 10.1046/j.1440-1622.1999.01621.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- D G Iorgulescu
- Cardiothoracic Unit, St Vincent's Hospital, Melbourne, Australia.
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4
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Seelig MH, Klingler PJ, Oldenburg WA, Blackshear JL. Angiosarcoma of the aorta: report of a case and review of the literature. J Vasc Surg 1998; 28:732-7. [PMID: 9786274 DOI: 10.1016/s0741-5214(98)70104-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary malignant tumors of the thoracic and abdominal aortas are extremely rare. In most cases, a diagnosis is established either postmortem or after an emergency operation for embolic complications. We present the case of a thoracic aortic angiosarcoma in a 71-year-old man who initially was seen with peripheral embolization. The management of these tumors and the world literature are reviewed.
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Affiliation(s)
- M H Seelig
- Department of Surgery, Mayo Clinic Jacksonville, Fla 32224, USA
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5
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Nanjo H, Murakami M, Ebina T, Hoshi N, Sasaki T, Zhuang YJ, Kobayashi M, Kawamura K, Masuda H. Aortic intimal sarcoma with acute myocardial infarction. Pathol Int 1996; 46:673-81. [PMID: 8905877 DOI: 10.1111/j.1440-1827.1996.tb03671.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
An autopsy case of aortic sarcoma who died of acute myocardial infarction caused by coronary involvement is reported. The patient was a 54 year old woman who was admitted because of an undiagnosed fever and general fatigue of 6 months duration. Magnetic resonance imaging (MRI) showed a tumor in the aortic arch. Total aortic arch replacement was performed. It was diagnosed as a malignant mesenchymal tumor of the aorta. The patient died of acute myocardial infarction 10 months after the operation. At autopsy, the tumor had invaded the luminal surface and intima of the proximal anastomosis (the remnant ascending aorta and the graft), the aortic valves, the distal anastomosis (surgical line of the thoracic aorta plus the graft), and the coronary arteries. The left main coronary artery showed complete obstruction by fibrin thrombus with tumor invasion in the intima, which was responsible for acute myocardial infarction. Primitive and bizarre tumor cells proliferated with many slit-like tissue spaces. Most of the tumor except for its luminal surface showed necrosis. Ultrastructurally, there were spaces between tumor cells, suggesting lumen formation, and some of them had microvilli. This sarcoma was considered to be the so-called aortic intimal sarcoma.
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Affiliation(s)
- H Nanjo
- Second Department of Pathology, Akita University School of Medicine, Japan
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6
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Abstract
Primary malignancies of the aorta are extremely rare. A review of the literature indicates that 35 documented cases of primary tumors of the aorta have been reported over the past 120 years. The histologic and morphologic characteristics of these lesions may be variable. In this case, progressive claudication of the left leg and buttocks with absent femoral pulses in a middle-aged woman was found to be a primary leiomyosarcoma of the abdominal aorta. A magnetic resonance imaging study defined a retroperitoneal space-occupying mass on the left side of the aorta at the level of the fourth lumbar vertebrae. A magnetic resonance angiographic scan of the abdominal aorta and an aortogram revealed total occlusion of the distal abdominal aorta with reconstitution at the level of the common femoral arteries bilaterally, with normal vessels more distal to that region. The patient underwent surgical exploration and resection of the retroperitoneal, infrarenal, occluding aortic mass. The mass was found to be a high-grade sarcoma displaying smooth muscle cell differentiation. The resection of this lesion, perioperative management, and pathologic characteristics of a rare primary neoplasm of the aorta are discussed in this review.
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Affiliation(s)
- M D Malone
- Department of Surgery, Boston University School of Medicine, MA 02118, USA
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7
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Fonseca JL, Fernandez-Valderrama I, Gesto R, Laguna P, Merino R, Rodriguez J, Volo G, Lazaro T. Malignant fibrous histiocytoma of the aorta complicated by anuria. Ann Vasc Surg 1992; 6:164-7. [PMID: 1318066 DOI: 10.1007/bf02042739] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tumors of the aorta have been reported infrequently in the literature. We report a case of a 63-year-old woman diagnosed with malignant aortic fibrous histiocytoma (also known as fibroxanthosarcoma). She was referred to us with suspected occlusion of the right renal artery in a single functioning kidney, with a clinical picture of anuria during the previous 48 hours. We also review 31 previously published cases in the literature.
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Affiliation(s)
- J L Fonseca
- Servicio de Cirugia Vascular, Hospital Doce de Octubre, Madrid, Spain
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8
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Tejada E, Becker GJ, Waller BF. Malignant myxoid emboli as the presenting feature of primary sarcoma of the aorta (myxoid malignant fibrous histiocytoma): a case report and review of the literature. Clin Cardiol 1991; 14:425-30. [PMID: 1646697 DOI: 10.1002/clc.4960140512] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Primary sarcomas of the aorta are rare vascular tumors. About 26 cases have been reported between 1973 and 1989. They are seldom diagnosed antemortem. The present report describes a patient with a myxoid malignant fibrous histiocytoma arising in the intima of the lower thoracic aorta, which was diagnosed premortem in metastatic peripheral emboli. The clinical and pathologic features of this patient along with a summary of the 29 primary aortic tumors previously reported (26 malignant and 3 benign) are discussed. Although few of these tumors have been described histologically as benign, all of them behave as malignant tumors.
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Affiliation(s)
- E Tejada
- Department of Pathology, Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana
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9
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Nishikawa H, Miyakoshi S, Nishimura S, Seki A, Honda K. A case of aortic intimal sarcoma manifested with acutely occurring hypertension and aortic occlusion. Heart Vessels 1989; 5:54-8. [PMID: 2584179 DOI: 10.1007/bf02058360] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Primary tumor of the aorta is extremely rare. An instance of aortic intimal sarcoma, namely fibromyxosarcoma, which extended from the beginning of the descending aorta to 7 cm above the abdominal bifurcation, with clinical evidence of acutely occurring hypertension, arterial embolism of the lower extremities, renal infarction, and aortic occlusion in a 50-year-old male is reported. The tumor was limited to the intima and composed of spindle-shaped tumor cells with abundant myxoid extracellular matrices. The tumor cells were negative for Factor VIII, Desmin, or Myoglobin, but were positive for Vimentin or Factor XIIIa in immunoperoxidase studies. An electron microscopic examination revealed a large amount of rough endoplasmic reticulum in the cytoplasm. Parenchymal metastases were observed in both the lungs and thoracic vertebrae. A review of literature on the clinical and pathological aspects of the tumor was made.
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Affiliation(s)
- H Nishikawa
- Division of Cardiology, Toranomon Hospital, Tokyo, Japan
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Schipper J, van Oostayen JA, den Hollander JC, van Seyen AJ. Aortic tumours: report of a case and review of the literature. Br J Radiol 1989; 62:35-40. [PMID: 2644000 DOI: 10.1259/0007-1285-62-733-35] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We present a case of a leiomyosarcoma originating in the wall of the descending aorta and give a review of 27 previously reported cases of aortic neoplasms. An extraluminal aortic leiomyosarcoma has not been reported before in the literature.
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Affiliation(s)
- J Schipper
- Department of Radiology, University Hospital Leiden, Netherlands
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12
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Abstract
A case of primary malignant fibrous histiocytoma of the aorta is described.
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Affiliation(s)
- R L Bryan
- Department of Pathology, Medical School, University of Birmingham, UK
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13
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Pruszczynski M, Coronel CM, Naudin ten Cate L, Roholl PJ, van der Kley AJ. Immunohistochemical and ultrastructural studies of a primary aortic intimal sarcoma. Pathology 1988; 20:173-8. [PMID: 3211594 DOI: 10.3109/00313028809066629] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
An intimal sarcoma of the abdominal aorta in a 63-year-old woman is reported. The clinical symptoms consisted of chronic arterial hypertension, vomiting and epigastric pain. Treatment was operative, but the patient died 20 hours after surgery. The studies were performed on a surgical specimen and on autopsy material. The aortic tumour consisted of pleomorphic spindle-shaped and giant cells. In the vertebral metastases a storiform pattern of the tumour cells was found. No specific features characteristic for leiomyogenic, lipogenic or an endothelial nature of the tumour giant cells was disclosed in electron microscopy and the picture rather indicated their histiocytic character. Of the 18 cellular markers studied, the immunostainings for vimentin and alpha-1-antichymotrypsin were evidently positive. The tumour was classified as a pleomorphic intimal aortic sarcoma probably a malignant fibrous histiocytoma (MFH). The literature on 26 previously published aortal tumours is reviewed with emphasis on their topographical distribution and histological classification. In only 4 previous cases was the final diagnosis supported by electron microscopical or immunopathological findings. The role of marker studies in the classification of aortal tumours is discussed.
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Affiliation(s)
- M Pruszczynski
- Institute of Pathology, University of Nijmegen, The Netherlands
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Kanno J, Takemura T, Kasaga T. Malignant endothelioma of the aorta. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1987; 412:183-8. [PMID: 3122419 DOI: 10.1007/bf00716192] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
An untreated case of a malignant endothelial tumour of the thoracic aorta of a 67 year-old male is reported. A tumour, 7 x 6 x 1.5 cm in size occupied the lumen of the descending thoracic aorta and two daughter lesions, 0.5 cm in diameter, were located in the abdominal aorta and the left common iliac artery. Histologically, they were composed of a surface cellular lining and a underlying necrotic mass; the former was six to ten layers of bizarre epithelioid cells thick and the latter contained much nuclear debris. Innumerable tumour emboli of epithelioid tumour cells and producing ischaemic lesions were found in various organs and tissues. Ultrastructurally, tumour cells were arranged in acinar pattern with narrow lumena and immature basement membrane. There were ultrastructural appearances interpreted as Weibel-Palade bodies and immunohistochemically factor VIII related antigen and vimentin was seen in the tumour cells.
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Affiliation(s)
- J Kanno
- Department of Pathology, Faculty of Medicine, Tokyo Medical and Dental University, Japan
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Abstract
A rare case of malignant fibrous histiocytoma of the aorta is reported. Review of the literature revealed that primary tumors of the aorta are exclusively mesenchymal tumors that almost invariably pursue a fatal course.
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