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Lim J, Hong SS, Hwang J, Kim HJ, Jin SY. Primary Colonic Epithelioid Angiosarcoma with Hepatic Metastasis: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:432-438. [PMID: 36237926 PMCID: PMC9514433 DOI: 10.3348/jksr.2021.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022]
Abstract
Colonic angiosarcoma is an extremely rare and aggressive malignant tumor with poor prognosis. We report a case of colonic epithelioid angiosarcoma with colonic obstruction and rapidly progressive hepatic metastasis in a 44-year-old female. Abdominal CT revealed a heterogeneously enhancing irregular mass in the ascending colon, causing proximal bowel distension. The patient underwent surgery, and histopathological examination revealed a poorly differentiated carcinoma. A follow-up liver dynamic MRI after 4 months revealed newly developed diffusely scattered numerous small nodules in both hepatic lobes with peripheral and nodular marked arterial hyperenhancement, raising the suspicion of hepatic angiosarcoma. A pathologic second opinion was obtained, and additional immunohistochemistry revealed colonic epithelioid angiosarcoma. The patient showed progressive hepatic metastasis on follow-up abdominal CT after 6 months and died 8 months after initial diagnosis. We describe an educational case of colonic angiosarcoma, a rare malignant tumor, with rapidly progressive hepatic metastasis that showed radiologic findings suggestive of angiosarcoma and enabled a re-diagnosis for proper treatment and prognosis prediction.
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Affiliation(s)
- Jiyun Lim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Seong Sook Hong
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Jiyoung Hwang
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hyun-joo Kim
- Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - So-Young Jin
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Bhaludin BN, Thway K, Adejolu M, Renn A, Kelly-Morland C, Fisher C, Jones RL, Messiou C, Moskovic E. Imaging features of primary sites and metastatic patterns of angiosarcoma. Insights Imaging 2021; 12:189. [PMID: 34921641 PMCID: PMC8684573 DOI: 10.1186/s13244-021-01129-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/14/2021] [Indexed: 12/14/2022] Open
Abstract
Angiosarcomas are rare, aggressive soft tissue sarcomas originating from endothelial cells of lymphatic or vascular origin and associated with a poor prognosis. The clinical and imaging features of angiosarcomas are heterogeneous with a wide spectrum of findings involving any site of the body, but these most commonly present as cutaneous disease in the head and neck of elderly men. MRI and CT are complementary imaging techniques in assessing the extent of disease, focality and involvement of adjacent anatomical structures at the primary site of disease. CT plays an important role in the evaluation of metastatic disease. Given the wide range of imaging findings, correlation with clinical findings, specific risk factors and patterns of metastatic disease can help narrow the differential diagnosis. The final diagnosis should be confirmed with histopathology and immunohistochemistry in combination with clinical and imaging findings in a multidisciplinary setting with specialist sarcoma expertise. The purpose of this review is to describe the clinical and imaging features of primary sites and metastatic patterns of angiosarcomas utilising CT and MRI.
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Benz MR, Crompton JG, Harder D. PET/CT variants and pitfalls in bone and soft tissue sarcoma. Semin Nucl Med 2021; 51:584-592. [PMID: 34238508 DOI: 10.1053/j.semnuclmed.2021.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sarcomas are rare tumors of mesenchymal origin and comprise only around 1% of adult cancers. The abundance of sarcoma histiotypes, with distinct imaging characteristics, biology, clinical behavior and treatment strategy, result in a complex disease presentation, requiring management by multidisciplinary specialized sarcoma centers. Oncologic and musculoskeletal radiology guidelines provide minimal guidance and only fragmentary information on the indications of 18F-FDG PET/CT in sarcoma. Therefore, knowledge of various phenotypes with preference for bone and lymph node metastases or higher incidence of local and distant recurrence is essential to select the appropriate diagnostic imaging tests and its interpretation. Benign and malignant soft tissue and bone tumors often share common radiographic and metabolic imaging characteristics. In addition, metastases of various histiotypes might exhibit a spectrum of atypical imaging appearances. Therefore, imaging specialists need to be aware of these variants and associated pitfalls of sarcoma imaging.
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Affiliation(s)
- Matthias R Benz
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA; Department of Radiology, University of California, Los Angeles, CA; Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany.
| | - Joseph G Crompton
- Division of Surgical Oncology, University of California, Los Angeles, CA
| | - Dorothee Harder
- Clinic of Radiology and Nuclear Medicine, University Hospital of Basel, Switzerland
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Gaballah AH, Jensen CT, Palmquist S, Pickhardt PJ, Duran A, Broering G, Elsayes KM. Angiosarcoma: clinical and imaging features from head to toe. Br J Radiol 2017; 90:20170039. [PMID: 28471264 DOI: 10.1259/bjr.20170039] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Angiosarcoma is a rare, aggressive subtype of soft-tissue sarcoma with a propensity for local recurrence and metastasis associated with a generally poor prognosis, unless diagnosed early. Given the vascular endothelial cell origin of angiosarcoma, tumours may develop in essentially any organ; however, there is a predilection for the skin where half of all tumours arise, increasing in prevalence with age. The most common risk factors are chronic lymphoedema and history of radiation. We review the most important radiological findings along the spectrum of angiosarcoma from head to toe throughout the body, including uncommon and rare locations. Key imaging features of angiosarcoma across multiple organ systems will be described, as well as the impact on management and prognosis.
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Affiliation(s)
- Ayman H Gaballah
- 1 Department of Diagnostic Radiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Corey T Jensen
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Palmquist
- 3 Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Perry J Pickhardt
- 4 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Alper Duran
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Broering
- 3 Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Elsayes
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Chiorean L, Caraiani C, Radziņa M, Jedrzejczyk M, Schreiber-Dietrich D, Dietrich CF. Vascular phases in imaging and their role in focal liver lesions assessment. Clin Hemorheol Microcirc 2016; 62:299-326. [PMID: 26444602 DOI: 10.3233/ch-151971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Liliana Chiorean
- Med. Klinik 2, Caritas Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
- Département d’Imagerie Médicale, Clinique des Cévennes Annonay, France
| | - Cosmin Caraiani
- Department of Radiology and Computed Tomography, “Octavian Fodor” Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania; “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Maija Radziņa
- Diagnostic Radiology Institute, Paula Stradins Clinical University Hospital, Riga, Latvia
| | - Maciej Jedrzejczyk
- Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland
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Kamatani T, Iguchi H, Okada T, Yamazaki H, Tsunoda H, Watanabe M, Oda M, Ohbu M, Yokomori H. Co-registered positron emission tomography/computed tomography and gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid magnetic resonance imaging features of multiple angiosarcoma of the liver. Hepatol Res 2014; 44:E297-303. [PMID: 24147907 DOI: 10.1111/hepr.12261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/03/2013] [Accepted: 10/14/2013] [Indexed: 12/24/2022]
Abstract
Hepatic angiosarcoma is a very rare disease, accounting for only 2% of primary liver malignancy. An 82-year-old man was admitted to our hospital because of jaundice and weight loss. Computed tomography (CT) and magnetic resonance imaging (MRI) showed diffuse and multiple space-occupying lesions. On gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI, the tumor was not enhanced intensely in the arterial phase following contrast injection, and was then gradually enhanced homogeneously. In the delayed phase and hepatobiliary phase, the tumor was completely washed out. Whole-body (18) F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT fusion scanning confirmed metabolic activity with maximum uptake value of 3.64 in the lesions. A liver biopsy showed spindle-shaped tumor cells proliferating along sinusoids, with elongated and hyperchromatic nuclei. Immunohistochemical studies showed tumor cells positive for von Willebrand factor and CD34. These findings were consistent with angiosarcoma of the liver. This case report is the first description of co-registered FDG-PET/CT images and Gd-EOB-DTPA-enhanced MRI of primary hepatic angiosarcoma.
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Affiliation(s)
- Takashi Kamatani
- Department of Internal Medicine, Kitasato University Medical Center, Saitama, Japan
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Abstract
OBJECTIVE The aim of this study was to define the clinical features and surgical treatment outcomes of patients with primary hepatic angiosarcoma. METHODS Data of the 6 patients diagnosed with primary hepatic angiosarcoma in Tianjin Medical University Cancer Institute and Hospital from January 1999 to December 2005 were retrospectively reviewed. RESULTS The median age of the patients was 49 years (range 45-78 years) with a male predominance. Laboratory tests showed a mild elevation of α-fetoprotein in 2 patients, and 2 had both hepatitis B and C. Liver resection was performed in all patients. For the 5 patients who received curative liver resection, the median follow-up duration was 41 months (range 23-84 months) and the overall 1-year, 3-year and 5-year survival rates were 100.0%, 80.0% and 40.0%, respectively. One patient who underwent a palliative operation died of tumor progression a month after operation. CONCLUSION Early diagnosis is necessary and complete surgical resection is the key to improve prognosis.
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Affiliation(s)
- Xiao Feng Duan
- Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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Sommer WH, Zech CJ, Bamberg F, Auernhammer CJ, Helck A, Paprottka PM, Notohamiprodjo M, Reiser MF, Herrmann KA. Fluid-fluid level in hepatic metastases: a characteristic sign of metastases of neuroendocrine origin. Eur J Radiol 2011; 81:2127-32. [PMID: 21978774 DOI: 10.1016/j.ejrad.2011.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 09/07/2011] [Accepted: 09/10/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study is to determine MRI characteristics which indicate liver metastases of neuroendocrine tumors (NET) rather than metastases of other origin (non-NET). METHODS Sixty-nine patients with histopathologically proven liver metastases from NET and 69 patients with known liver metastases of other origin underwent MRI of the liver using a 1.5 T MR-scanner. Two board certified radiologists assessed presence of fluid-fluid-levels, number and distribution pattern, signal intensity (SI) characteristics, lesion homogeneity, presence of central necrosis and intratumoral hemorrhage in T2w and T1w non-contrast imaging. A multivariate logistic regression analysis was performed to determine the independent association of image findings and occurrence of NET. RESULTS Fluid-fluid-levels were identified in 19/69 of patients with NET-metastases, and in none of the patients in the control group (p<0.0001). Hyperintense SI in T1w imaging, markedly hyperintense SI in T2w imaging, a disseminated distribution pattern and intratumoral hemorrhage were indicative of NET metastases (p<0.05). After statistical adjustment for all significant MRI findings, fluid-fluid-levels (OR: 17.6, 95% CI: 1.9-166.5), strongly hyperintense SI in T2w (OR: 4.7, 95% CI: 1.8-12.7) and a disseminated distribution pattern (OR: 2.9, 95% CI: 1.1-7.4) were independent predictors for NET metastases. CONCLUSIONS The presence of fluid-fluid-levels is highly indicative of NET liver metastases and can be used as an independent predictor to distinguish them from metastases of other origin.
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Affiliation(s)
- Wieland H Sommer
- Department of Clinical Radiology, University Hospitals-Grosshadern, Ludwig-Maximilians University, Munich, Germany.
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Diagnosis value of focal liver lesions with SonoVue®-enhanced ultrasound compared with contrast-enhanced computed tomography and contrast-enhanced MRI: a meta-analysis. J Cancer Res Clin Oncol 2011; 137:1595-605. [PMID: 21850382 DOI: 10.1007/s00432-011-1035-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 08/04/2011] [Indexed: 12/14/2022]
Abstract
PURPOSES This study is aimed at evaluating diagnostic value of focal liver lesions (FLLs) with SonoVue(®)-enhanced ultrasound compared with contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI). METHODS PubMed, EMBASE, and the Cochrane Central Register were searched for English language articles published from January 2000 to May 2011. Histopathologic analysis and/or close clinical and imaging follow-up (except CECT or CEMRI) for at least 6 months were used as golden reference. Sensitivity, specificity, summary receiver operating characteristic (SROC) curves, and area under the curve (AUC) were extracted to test heterogeneity. RESULTS In 21 included studies, for the SonoVue(®)-enhanced ultrasound studies, sensitivity was 88% (95% CI 87-90), specificity was 81% (95% CI 79-84), and 38.62 (95% CI 13.64-109.35) for diagnostic odds ratio (DOR); for the CECT studies, sensitivity was 90% (95% CI 88-92), specificity was 77% (95% CI 71-82), and 30.84 (95% CI 11.11-85.61) for DOR; for the CEMRI studies, sensitivity was 86% (95% CI 83-88), specificity was 81% (95% CI 76-85), and 27.63 (95% CI 11.28-67.70) for DOR. CONCLUSIONS In comparison, SonoVue(®)-enhanced ultrasound had high pooled sensitivity and pooled specificity. SROC analysis showed the diagnostic value of FLLs with SonoVue(®)-enhanced ultrasound has no significant difference compared with CECT and CEMRI. SonoVue(®)-enhanced ultrasound is highly sensitive and specific in the characterization of FLLs to support an effective diagnostic method.
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Xie L, Guang Y, Ding H, Cai A, Huang Y. Diagnostic value of contrast-enhanced ultrasound, computed tomography and magnetic resonance imaging for focal liver lesions: a meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:854-861. [PMID: 21531500 DOI: 10.1016/j.ultrasmedbio.2011.03.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 03/03/2011] [Accepted: 03/04/2011] [Indexed: 05/30/2023]
Abstract
The diagnostic performance of contrast-enhanced ultrasound (CEUS), contrast-enhanced computed tomography (CECT) and contrast-enhanced magnetic resonance imaging (CEMRI) was determined in patients with focal liver lesions (FLLs) in a meta-analysis. Meta-Disc version 1.4 was used to describe and calculate sensitivity, specificity, summary receiver operating characteristic (SROC) curves and area under the curve (AUC). In the 25 included studies, the pooled estimate of CEUS studies for sensitivity, specificity and diagnostic odds ratio (DOR) was 87% (95% CI 85-88), 89% (95% CI 87-91) and 78.84 (95% CI 29.40-211.40), respectively. Sensitivity, specificity and DOR were 86% (95% CI 84-88), 82% (95% CI 77-86) and 26.34 (95% CI 8.32-83.39), respectively, for the CECT studies. Sensitivity, specificity and DOR were 85% (95% CI 82-88), 87% (95% CI 83-91) and 48.37 (95% CI 15.87-147.45), respectively, for the CEMRI studies. SROC analysis indicated that the diagnostic value of CEUS for FLLs is not significantly different from that of CECT and CEMRI.
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Affiliation(s)
- Limei Xie
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China.
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Kim HR, Rha SY, Cheon SH, Roh JK, Park YN, Yoo NC. Clinical features and treatment outcomes of advanced stage primary hepatic angiosarcoma. Ann Oncol 2009; 20:780-7. [PMID: 19179547 DOI: 10.1093/annonc/mdn702] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Primary hepatic angiosarcoma is a very rare malignancy with a poor prognosis. While surgical resection has been validated as curative choice, most cases are diagnosed too late for resection. Nonetheless, treatment protocols have not been established and also there are very few reports on the clinical features and treatment outcomes. PATIENTS AND METHODS Among 11,939 patients diagnosed with primary hepatic tumors from January 1985 to December 2007 at two centers, five patients were diagnosed with primary hepatic angiosarcoma. We analyzed patients' demographics, tumor characteristics, treatment modality, and outcomes using imaging, serology, and pathology. RESULTS All five patients were diagnosed at advanced stage with distant metastases. The most common symptom was abdominal pain. The levels of the tumor markers were within the normal range and serological tests were negative for hepatitis B and C viruses. Two of four patients who received chemotherapy died <3 months after diagnosis, but the other two patients survived >6 months. CONCLUSIONS A combination of chemotherapy resulted in an improved outcome for two of four patients, suggesting the potential usefulness of palliative chemotherapy to improve survival. This case study may aid in planning chemotherapy for patients with advanced hepatic angiosarcoma.
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Affiliation(s)
- H R Kim
- Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seodaemun-Ku, Seoul, Korea
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Maeda T, Tateishi U, Hasegawa T, Ojima H, Arai Y, Sugimura K. Primary hepatic angiosarcoma on coregistered FDG PET and CT images. AJR Am J Roentgenol 2007; 188:1615-7. [PMID: 17515384 DOI: 10.2214/ajr.05.0830] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tetsuo Maeda
- Division of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
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