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Bahk WJ, Na SJ, Whang IY, Kim Y, Seo KJ. Aortic Angiosarcoma Manifesting as Multiple Musculoskeletal Metastases: A Case Report. Diagnostics (Basel) 2024; 14:805. [PMID: 38667451 PMCID: PMC11048742 DOI: 10.3390/diagnostics14080805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Aortic angiosarcomas are rare. Due to its rarity and metastatic presentation, it is difficult to diagnose metastatic aortic angiosarcoma. We describe the clinicopathological and radiologic features of a metastatic aortic angiosarcoma presenting as musculoskeletal metastases. A 59-year-old male patient presented with left thigh pain. Plain radiographs revealed multifocal osteolytic lesions in the left femur shaft. Abdominopelvic computed tomography showed a lobulated osteolytic lesion in the left iliac bone. Magnetic resonance images revealed multifocal soft tissue lesions in the thigh musculature. A positron emission tomography/computed tomography (PET/CT) scan demonstrated multiple foci of increased uptake in the left femur bone, pelvis, left thigh, and calf musculature. Focal increased uptake in the lower abdominal aorta was newly detected. Pelvis biopsy showed tumor cell nests of epithelioid cells. The tumor cells showed vasoformative features. Immunohistochemically, the tumor cells showed positivity for vimentin, CD31, and ERG. The pathologic diagnosis of epithelioid angiosarcoma was established. The origin of the tumor was presumed to be the aorta. This case underscores the importance of PET scans in identifying primary lesions. In terms of the histopathologic diagnosis of biopsy samples with tumor cells exhibiting epithelioid neoplastic morphology, employing appropriate ancillary techniques such as immunocytochemistry with vascular markers may assist in accurately diagnosing metastatic angiosarcoma.
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Affiliation(s)
- Won Jong Bahk
- Department of Orthopedic Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea;
| | - Sae Jung Na
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - In Yong Whang
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Yongju Kim
- Department of Radiology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kyung Jin Seo
- Department of Hospital Pathology, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Kara P, Cabrini E, Kuntz S, Lejay A, Chakfe N. Do Not Forget the Oncovascular: Acute Limb Ischaemia Due to Aortic Epithelioid Angiosarcoma. EJVES Vasc Forum 2023; 60:53-56. [PMID: 37811160 PMCID: PMC10551559 DOI: 10.1016/j.ejvsvf.2023.09.003] [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: 05/04/2023] [Revised: 08/06/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Aortic epithelioid angiosarcoma (AEA) is a rare malignant tumour and can cause acute limb ischaemia. Report A 66 year old man was admitted with acute pulmonary oedema due to bilateral renal artery stenosis. An incidental osteolytic left sacral lesion was found on computed tomography angiography, and extensive work up revealed an AEA. Follow up was marked by acute left lower limb ischaemia 13 months later and right chronic limb threatening ischaemia 15 months later. Discussion Physicians need to consider AEA as an aetiology for acute or chronic limb ischaemia in patients with altered general status but mostly with intra-aortic irregular vegetations without any calcification and parietal involvement on computed tomography angiography.
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Affiliation(s)
- Pierre Kara
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Elisa Cabrini
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
- Vascular Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Salomé Kuntz
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
| | - Nabil Chakfe
- Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, Strasbourg, France
- GEPROMED, Strasbourg, France
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Pecceu S, Van Herzeele I, Deolet E, Van Dorpe J, Moreels N, Desender L, Vermassen F, Randon C. Angiosarcoma after endovascular aneurysm repair: case report and literature review. Acta Chir Belg 2022; 123:317-324. [PMID: 34937527 DOI: 10.1080/00015458.2021.2021718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Epithelioid angiosarcoma is a rare soft tissue sarcoma with a poor prognosis. We report two cases of patients who presented with a history of lower back pain, inflammatory signs and weight loss 5 and 6 years after endovascular aortic repair (EVAR) of an elective infrarenal abdominal aortic aneurysm (AAA). Imaging suggested graft infection but tissue samples revealed an epithelioid angiosarcoma. The objective is to report the clinical presentation, investigative modalities and immunohistochemical findings of an angiosarcoma after EVAR. PATIENTS AND METHODS Two cases are described of an angiosarcoma of the aorta after EVAR. A literature search using PubMed, Embase and Web of Science was performed in English about angiosarcoma after EVAR published between 2007 and 2021. Relevant reports were selected and analysed. RESULTS Fifteen case reports were identified, including the current two cases. Time to tumour detection after EVAR ranged from 6 to 120 months with a mean interval of 68 months. Most patients underwent endovascular repair of an AAA (13/15). Males (13 male/2 female patients) were predominant with a median age of 72 years (IQR 68-78 years). Over half of the patients had metastases at the time of diagnosis (9/15), most frequently in bones and liver. CONCLUSION Diagnosis of angiosarcoma after EVAR remains challenging due to indistinctive clinical and radiological findings mimicking graft infection or endoleak. Angiosarcoma should be included in the differential diagnosis in patients previously treated with EVAR presenting with unintended weight loss, abdominal back pain and contrast enhancement of the aortic wall.AbbreviationsAAAabdominal aortic aneurysmCTAcomputed tomography angiographyCRPc-reactive proteinEVARendovascular aortic repairESRerythrocyte sedimentation rateFDGfluoro-deoxyglucoseMRImagnetic resonance imagingMeSHmedical subject headings.
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Affiliation(s)
- Stefanie Pecceu
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ellen Deolet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Moreels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Caren Randon
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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Nakamura H, Kanki A, Watanabe H, Ono K, Kuwada N, Saisho S, Nishimura H, Yamamoto A, Tamada T. A case of primary aortic sarcoma with tumor infarction after stent graft placement. Acta Radiol Open 2021; 10:20584601211063360. [PMID: 34900342 PMCID: PMC8664319 DOI: 10.1177/20584601211063360] [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: 08/19/2021] [Accepted: 11/12/2021] [Indexed: 12/02/2022] Open
Abstract
Primary aortic sarcoma is a very rare disease, and most primary aortic tumors are
malignant mesenchymal tumors. We present the case of a 62-year-old man with
sudden epigastric and back pain. Contrast-enhanced computed tomography (CT)
revealed a mass lesion about 33.8 mm in diameter, in contact with the left side
of the abdominal aorta. Impending rupture of an abdominal aortic aneurysm was
suspected, so cardiovascular surgery for stent graft placement was performed the
same day. Symptoms immediately improved and CT at 3 months postoperatively
showed a marked decrease in lesion size, but the lesion subsequently grew again.
Fluorodeoxyglucose (FDG)-positron emission tomography/CT was performed due to
the possibility of malignant solid tumor, revealing markedly increased FDG
accumulation (maximum standardized uptake value, 36.95) in the mass lesion.
Primary aortic sarcoma was diagnosed from thoracoscopic biopsy. Here, we report
a primary aortic sarcoma that shrank due to tumor infarction after stent graft
placement, followed by tumor regrowth.
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Affiliation(s)
- Hiroki Nakamura
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Akihiko Kanki
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Kentarou Ono
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Noriaki Kuwada
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan
| | - Shinsuke Saisho
- Department of General Thoracic Surgery, Kawasaki Medical School, Kurashiki, Japan
| | | | - Akira Yamamoto
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tsutomu Tamada
- Departments of Radiology, Kawasaki Medical School, Kurashiki, Japan
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Kordzadeh A, Askari A, Navi A, Patel S, Parsa AD, Charalabopoulos A. Primary angiosarcoma of aorta: A systematic review. Vascular 2021; 30:650-660. [PMID: 34238080 DOI: 10.1177/17085381211026491] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To elucidate the epidemiology, anatomical, presentation, classification, pathology, investigative modalities, management and prognosis of primary angiosarcoma of the aorta. MATERIAL AND METHODS A systematic review of literature from the database inception to January 2021 in PubMed and Embase, CINAHL and Cochrane Library in accordance to PRISMA was conducted. Retrieval and extraction was performed by two independent reviewers. The hierarchy of the evidence was assessed through the National Institute for Health and Care Excellence Checklist. Data were subjected to pooled prevalence analysis, Kaplan-Meier survival and test of probability using log-rank analysis. This review is registered with International Prospective Register of Systematic Reviews: RD42021231314. RESULTS 82 studies with n = 123 cases met the inclusion criterion. Abdominal (45%) aorta was the commonest anatomical site with female predominance in ascending aorta (4:1) and aortic arch (2:1). The longest survival was in the ascending aorta and the shortest in the abdominal aorta [540 (interquartile range [IQR], 7-1560 days vs. 180 (IQR, 1-5730 days)], respectively. The overall median survival was 210 days (IQR, 1-5730 days) or 7 months. Lack of metastasis (47%) was a marker of longer survival (p < 0.03) irrespective of other attributes. CONCLUSION The pathophysiology appears to be a trend of increasing fatigue, fever and weight loss associated with segmental dysfunction of the aorta projecting occlusive or destructive phenotypes. Computed tomography angiography features of volume-occupying, bulky, polypoid (intraluminal), protrusive vegetation, hyper vascular without atherosclerotic lesions are extremely suggestive of PA of the aorta at 5th and 6th decades of life.
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Affiliation(s)
- Ali Kordzadeh
- Mid & South Essex Foundation Trust, Broomfield Hospital, Chelmsford, UK
| | - Alan Askari
- 2152Cambridge UniversityHospitals NHS Foundation Trust, Cambridge, UK
| | - Ali Navi
- 2152Cambridge UniversityHospitals NHS Foundation Trust, Cambridge, UK
| | - Sandeep Patel
- Mid & South Essex Foundation Trust, Broomfield Hospital, Chelmsford, UK
| | - Ali D Parsa
- Faculty of Health, Education, Medicine and Social Sciences, Anglia Ruskin University, Cambridge, UK
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Vacirca A, Faggioli G, Pini R, Freyrie A, Indelicato G, Fenelli C, Bacchi Reggiani ML, Vasuri F, Pasquinelli G, Stella A, Gargiulo M. Predictors of survival in malignant aortic tumors. J Vasc Surg 2019; 71:1771-1780. [PMID: 31862201 DOI: 10.1016/j.jvs.2019.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/10/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Malignant aortic tumors (MATs) are exceedingly rare, and a comprehensive review of clinical and therapeutic aspects is lacking in the literature. The aim of this study was to analyze all known cases of MATs and to identify predictors of patients' survival. METHODS All patients diagnosed with an aortic tumor treated in a single center along with all case reports and reviews available in the literature through a specific PubMed search using keywords such as "malignant" and "aorta" or "aortic," "tumor," or "sarcoma" or "angiosarcoma" were analyzed. The tumor's primary location, clinical presentation, histologic subtype, and treatment choice were examined. Survival at 1 year, 3 years, and 5 years and the possible preoperative and operative outcome predictors were evaluated using Kaplan-Meier analysis with a log-rank test and by Cox regression for multivariate analysis. RESULTS In addition to the 5 cases treated in our center, 218 other cases of MAT were reported in the literature from 1873 to 2017. The mean age of the patients was 60.1 ± 11.9 years, and the male to female ratio was 1.59:1. The median overall survival from diagnosis was 8 (7-9) months; 1-, 3-, and 5-year survival rates were 26%, 7.6%, and 3.5%, respectively. Chronic hypertension (P = .03), fever (P = .03), back pain (P = .01), asthenia (P = .04), and signs of peripheral embolization (P = .007) were significant predictors of a poor result. Histologic subtypes had a different impact on survival, with no statistical significance. Compared with other treatment strategies, combined surgical-medical therapy had the best impact on the median survival rate (surgical-medical, 12 [8-24] months; medical, 8 [5-10] months; surgical 7 [2-16] months; no treatment, 2 [0.5-15] months; P = .001). Analyzing exclusively medical approaches, chemotherapy and radiotherapy had the best impact on median survival rate compared with untreated patients (chemotherapy-radiotherapy, 18 [10-26] months; radiotherapy, 16 [8-20] months; chemotherapy, 10 [7-24] months; no medical treatment, 6 [2-16] months; P = .005); these data were not sustained by multivariate analysis. CONCLUSIONS Aortic tumors are a malignant pathologic condition with a short survival rate after initial diagnosis. Survival is further diminished in the presence of clinical factors such as hypertension, fever, back pain, asthenia, and signs of peripheral embolization. Combined surgical and medical treatment, particularly with chemotherapy and radiotherapy, has shown the highest survival rate.
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Affiliation(s)
- Andrea Vacirca
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gianluca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy.
| | - Rodolfo Pini
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Antonio Freyrie
- Vascular Surgery, University of Parma, Azienda Ospedaliero-Universitaria, Parma, Italy
| | - Giuseppe Indelicato
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Cecilia Fenelli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Maria Letizia Bacchi Reggiani
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Francesco Vasuri
- Anatomical Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Gianandrea Pasquinelli
- Anatomical Pathology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Andrea Stella
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
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Shimogawara T, Ono S, Kobayashi K, Sasaki A, Shimizu H, Matsui J. Aortic sarcoma mimicking a mycotic aneurysm in the thoracoabdominal aorta. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:593-596. [PMID: 31872164 PMCID: PMC6909102 DOI: 10.1016/j.jvscit.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022]
Abstract
Aortic sarcoma is a rare primary tumor with dismal prognosis. Here, we report a case involving a 74-year-old female patient with aortic sarcoma masquerading as a mycotic aneurysm in the thoracoabdominal aorta. She underwent aortic resection with Dacron prosthetic graft replacement because of rapid growth. The postoperative pathological findings of the resected specimen confirmed the diagnosis of aortic mural sarcoma, which was an unexpected result based on repeat computed tomography angiography performed within 2 months preoperatively. The preoperative diagnosis of aortic sarcoma is often difficult because of its rarity, and this case demonstrates some of the diagnostic pitfalls.
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Affiliation(s)
- Tatsuya Shimogawara
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Shigeshi Ono
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Kanako Kobayashi
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Aya Sasaki
- Department of Pathology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Matsui
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
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Komatsu M, Hashimoto T, Hanioka K, Itoh T, Hirose T. A rare autopsy case of epithelioid angiosarcoma arising in the aorta in a patient with massive multi-organ embolization. Pathol Int 2018; 68:574-576. [DOI: 10.1111/pin.12690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/31/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Masato Komatsu
- Department of Diagnostic Pathology; Kobe University Hospital; 7-5-2 Kusunoki-cho Chuo-ku Kobe, 650-0017 Hyogo Prefecture Japan
- Department of Pathology; Hyogo Cancer Centre; 13-70 Kitaooji-cho Akashi 673-0021 Hyogo Prefecture Japan
| | - Tetsuya Hashimoto
- Department of Cardiology; Akashi City Hospital; 1033 Takasho-machi Akashi 673-8501 Hyogo Prefecture Japan
| | - Keisuke Hanioka
- Department of Diagnostic Pathology; Akashi City Hospital; 1033 Takasho-machi Akashi 673-8501 Hyogo Prefecture Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology; Kobe University Hospital; 7-5-2 Kusunoki-cho Chuo-ku Kobe, 650-0017 Hyogo Prefecture Japan
| | - Takanori Hirose
- Department of Pathology; Hyogo Cancer Centre; 13-70 Kitaooji-cho Akashi 673-0021 Hyogo Prefecture Japan
- Division of Pathology for Regional Communication; School of Medicine; Kobe University; 7-5-2 Kusunoki-cho Chuo-ku Kobe, 650-0017 Hyogo Prefecture Japan
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9
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Mo H, Kwon HM, Choi JS, Ahn SJ, Lee YS. Multiple Embolic Infarction Due to a Primary Aortic Intimal Sarcoma. J Stroke 2016; 18:358-360. [PMID: 27488976 PMCID: PMC5066427 DOI: 10.5853/jos.2016.00311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 05/09/2016] [Accepted: 06/23/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Heejung Mo
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Min Kwon
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Sung Choi
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seon Jae Ahn
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.,Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Yong-Seok Lee
- Department of Neurology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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10
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Lin SI, Su MI, Tsai CT. Primary Intimal Sarcoma of Thoracic Aorta Presenting as Hypertensive Crisis. ACTA CARDIOLOGICA SINICA 2016; 31:560-3. [PMID: 27122923 DOI: 10.6515/acs20150119g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED We report a 45-year-old woman who presented to our facility in a hypertensive crisis. Computed tomography (CT) revealed a thoracic aortic tumor, and tissues obtained via endovascular biopsy revealed undifferentiated sarcoma. A final diagnosis of intimal sarcoma was made by intra-operative pathological examination. Despite undergoing surgical resection followed by adjuvant chemotherapy, the patient died from progressive multiple metastasis and severe sepsis. Although aortic sarcoma is rarely diagnosed, it should be considered a possible etiology of hypertensive crisis. KEY WORDS Aortic tumor; Endovascular biopsy; Hypertension crisis; Intimal sarcoma.
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Affiliation(s)
- Shu-I Lin
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Min-I Su
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Ting Tsai
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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11
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Andersen RM, Eldrup N. Intra-operative Ultrasound as a Tool to Assess Free Borders of Primary Vascular Aortic Tumors During Resection. EJVES Short Rep 2016; 31:6-8. [PMID: 28856300 PMCID: PMC5573110 DOI: 10.1016/j.ejvssr.2016.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/18/2016] [Accepted: 03/06/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction Primary vascular tumors are rare and, in general, have a poor prognosis. Complete resection is associated with a better prognosis. Radical resection depends on safe discrimination of tumor borders. Technical summary A 54 year old woman presented with abdominal pain. Imaging revealed a mass in the thoracic aorta, highly suspicious of angiosarcoma which was confirmed post-operatively by histological analysis. Open surgery was performed. Prior to clamping of the aorta, intra-operative ultrasound established clear delineation of the tumor borders. Conclusion Intra-operative ultrasound was, in this case, a safe and easy method to determine the tumor borders, providing a simple guide to in toto tumor removal.
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Affiliation(s)
- R M Andersen
- Aarhus University Hospital, Department of Cardio-Thoracic and Vascular Surgery, Section for Vascular Surgery, Denmark
| | - N Eldrup
- Aarhus University Hospital, Department of Cardio-Thoracic and Vascular Surgery, Section for Vascular Surgery, Denmark
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12
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Scharl M, Bode B, Rushing E, Knuth A, Rordorf T. Uncommon case of brain metastasis in a patient with a history of heavy smoking. ACTA ACUST UNITED AC 2014; 21:e728-31. [PMID: 25302044 DOI: 10.3747/co.21.1880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary sarcomas of the aorta are extremely uncommon. Depending on histomorphology and immunohistochemical pattern, intimal sarcomas can show angiosarcomatous differentiation. Here, we describe the case of a 60-year-old woman with a primary intimal sarcoma of the aortic arch and signs of cerebral metastatic disease as the initial manifestation. After the patient experienced the onset of severe headaches, ataxia, and left-sided weakness, magnetic resonance imaging showed several brain lesions. Histologic assessment of a brain biopsy specimen revealed a malignant tumour composed of large pleomorphic cells that were positive for pancytokeratin and CD10. Radiation to the brain did not significantly improve the patient's symptoms, and cranial computed tomography (ct) imaging revealed several metastases, indicating lack of response. Because of the patient's smoking history, the presence of central nervous system and skeletal metastases on combined positron-emission tomography and ct imaging, and the focal pan-cytokeratin positivity of the tumour, carcinoma of the lung was favoured as the primary tumour. Despite chemotherapy with cisplatin and etoposide, the patient's neurologic symptoms and general condition deteriorated rapidly, and she died within a few days. At autopsy, an undifferentiated intimal sarcoma of the aortic arch was diagnosed. The primary tumour in the aorta consisted of large pleomorphic cells. Immunohistochemical analysis of the aortic tumour and brain metastases demonstrated diffuse positivity for vimentin and p53 and focal S-100 staining. In summary, we report a challenging case of advanced intimal sarcoma of the aortic arch with brain and bone metastases at initial presentation. Our report demonstrates the difficulties in diagnosing and treating this disease, and the need for multicentre studies to accrue more patients for investigations of optimal therapy.
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Affiliation(s)
- M Scharl
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - B Bode
- Institute for Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - E Rushing
- Institute for Neuropathology, University Hospital Zurich, Zurich Switzerland
| | - A Knuth
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - T Rordorf
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
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Ugurlucan M, Barburoglu M, Sayin OA, Beyaz MO, Ekiz F, Acunas B, Dayioglu E, Alpagut U. Endovascular Treatment for Primary Aortic Angiosarcoma to Relieve Thoracic Aortic Stenosis. Ann Vasc Surg 2014; 28:1799.e5-8. [DOI: 10.1016/j.avsg.2014.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/03/2014] [Accepted: 05/08/2014] [Indexed: 12/27/2022]
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14
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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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15
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Fatima J, Duncan AA, Maleszewski JJ, Kalra M, Oderich GS, Gloviczki P, Suri RM, Bower TC. Primary angiosarcoma of the aorta, great vessels, and the heart. J Vasc Surg 2013; 57:756-64. [DOI: 10.1016/j.jvs.2012.09.023] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 08/30/2012] [Accepted: 09/04/2012] [Indexed: 11/17/2022]
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16
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Choi SY, Min SK, Kim KI, Kim HY. Intimal angiosarcoma presenting with common femoral artery aneurysm. J Vasc Surg 2012; 56:819-21. [PMID: 22703974 DOI: 10.1016/j.jvs.2012.03.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/07/2012] [Accepted: 03/10/2012] [Indexed: 11/24/2022]
Abstract
Intimal angiosarcoma is a rare malignant vascular tumor with an aggressive natural history. Presenting symptoms vary according to the location of the lesion, but symptoms are typically due to intravascular obstruction or embolization. We present a case of an intimal angiosarcoma presenting with a common femoral artery aneurysm.
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Affiliation(s)
- Sun Young Choi
- Department of Radiology and Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
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17
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Park JH, Choi SI, Chun EJ. Multidetector CT evaluation of various aortic diseases: diagnostic tips, pitfalls, and remedies for imaging artifacts. Int J Cardiovasc Imaging 2012; 28 Suppl 1:45-60. [DOI: 10.1007/s10554-012-0071-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 05/10/2012] [Indexed: 11/28/2022]
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18
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Restrepo CS, Betancourt SL, Martinez-Jimenez S, Gutierrez FR. Aortic Tumors. Semin Ultrasound CT MR 2012; 33:265-72. [DOI: 10.1053/j.sult.2011.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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19
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Bendel EC, Maleszewski JJ, Araoz PA. Imaging sarcomas of the great vessels and heart. Semin Ultrasound CT MR 2012; 32:377-404. [PMID: 21963161 DOI: 10.1053/j.sult.2011.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary sarcomas of the aorta, pulmonary artery, superior vena cava, inferior vena cava, and the heart are rare neoplasms. Aortic sarcomas are broadly categorized as either primarily luminal or primarily mural, with luminal sarcomas more likely to be misdiagnosed as thrombus. Pulmonary artery sarcomas are often mistaken for pulmonary embolism both clinically and at imaging. Vena caval sarcomas appear as intraluminal or extraluminal masses connecting to or filling the veins. The most common are leiomyosarcomas of the inferior vena cava. Primary sarcomas of the heart are rare and usually appear as heterogeneous aggressive masses.
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Affiliation(s)
- Emily C Bendel
- Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester, MN 55905, USA
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20
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Angiosarcoma Mimicking a Recurrent Carotid Artery Aneurysm. Ann Vasc Surg 2011; 25:1142.e19-23. [DOI: 10.1016/j.avsg.2011.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/04/2011] [Accepted: 03/26/2011] [Indexed: 11/18/2022]
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21
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Epithelioid angiosarcoma with metastatic disease after endovascular therapy of abdominal aortic aneurysm. Cardiovasc Intervent Radiol 2011; 35:190-3. [PMID: 21735325 DOI: 10.1007/s00270-011-0219-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 06/09/2011] [Indexed: 10/18/2022]
Abstract
Malignancies of the aortic wall represent a rare condition, and only a few reports have covered cases of sarcomas arising at the site of a prosthesis made of Dacron. A coincidence with endovascular repair has only been reported in one case to date. We report a patient with epithelioid angiosarcoma and metastatic disease, which was found in an aneurysmal sac after endovascular aortic repair for abdominal aortic aneurysm.
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22
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Cardiovascular sources of systemic embolism: detection and characterization using multidetector CT and MR imaging. Int J Cardiovasc Imaging 2011; 27:727-44. [DOI: 10.1007/s10554-011-9878-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Accepted: 04/15/2011] [Indexed: 12/27/2022]
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23
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Naughton PA, Wandling M, Phade S, Garcia-Toca M, Carr JC, Rodriguez HE. Intimal angiosarcoma causing abdominal aortic rupture. J Vasc Surg 2011; 53:818-21. [DOI: 10.1016/j.jvs.2010.10.090] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/15/2010] [Accepted: 10/16/2010] [Indexed: 11/15/2022]
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24
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25
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Elawar A, Dandurand M, Jumez N, Delfour C, Branchereau P, Stoebner P, Meunier L. Métastases cutanées révélatrices d’un angiosarcome épithélioïde de l’aorte abdominale. Ann Dermatol Venereol 2010; 137:111-6. [DOI: 10.1016/j.annder.2009.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Accepted: 05/29/2009] [Indexed: 11/16/2022]
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26
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Aortic angiosarcoma masquerading as a thoracic aortic aneurysm. J Vasc Surg 2009; 50:1477-80. [DOI: 10.1016/j.jvs.2009.06.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 06/03/2009] [Accepted: 06/04/2009] [Indexed: 11/18/2022]
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