1
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Randhawa TS, Aggarwal A, Chatterjee D, Gharat MG, Singla R, Ahuja C. Pediatric primary intracranial angiosarcoma with epithelioid differentiation: a surgeon's dilemma. Childs Nerv Syst 2024; 40:267-271. [PMID: 37563363 DOI: 10.1007/s00381-023-06114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
Angiosarcoma is a rare form of soft tissue sarcoma originating from endothelial tissue, accounting for < 1% of all sarcomas. Primary epithelioid angiosarcomas of the central nervous system (CNS) are even more elusive, with only four reports described in the literature. In this article, we describe the first case in pediatric population, with a brief literature review regarding this entity. A 13-year-old girl presented to emergency services with raised intracranial pressure. MRI demonstrated a heterogenous lesion in the temporal lobe. She underwent emergency craniotomy and subtotal excision of the tumor. Eventually the patient developed multiple infarcts and succumbed post operatively. Pre-operative diagnosis on radiology is difficult considering the rarity of this entity and heterogeneity in radiological appearance. One needs to have a high degree of suspicion to consider angiosarcoma as a radiological differential. Overall prognosis remains poor. Early adjuvant treatment may improve overall survival.
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Affiliation(s)
- Tejasvi Singh Randhawa
- Deparment of Neurosurgery, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Ashish Aggarwal
- Deparment of Neurosurgery, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Debyajyoti Chatterjee
- Department of Pathology, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Mayur Gopichand Gharat
- Deparment of Neurosurgery, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Raghav Singla
- Deparment of Neurosurgery, Post Graduate Institute of Medical Sciences, Chandigarh, India.
| | - Chirag Ahuja
- Deparment of Neuroradiology, Post Graduate Institute of Medical Sciences, Chandigarh, India
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2
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Kuang R, Li S, Wang Y. Primary cerebral epithelioid angiosarcoma: a case report. BMC Neurol 2023; 23:49. [PMID: 36721255 PMCID: PMC9887824 DOI: 10.1186/s12883-023-03085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Primary cerebral epithelioid angiosarcoma (PCEA) is a rare malignant tumor of the central nervous system. To the best of our knowledge, only three cases have been reported in the English language literature thus far. CASE PRESENTATION Here, we report a fourth case in a 73-year-old man admitted for headache. Radiological examination revealed a mass in the right occipital lobe, which was removed by right occipital craniotomy. Histopathological examination revealed epithelioid angiosarcoma. The patient received radiotherapy after resection but survived for only nine months due to recurrence of the tumor and his declining further surgery. CONCLUSIONS In this report, we add to the knowledge base on this exceedingly rare tumor, review the small number of relevant cases published previously, and analyze and summarize the clinical and pathological characteristics, treatment options and prognosis of this cancer.
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Affiliation(s)
- Renzhao Kuang
- grid.413387.a0000 0004 1758 177XDepartment of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
| | - Shun Li
- grid.413387.a0000 0004 1758 177XDepartment of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
| | - Yuanchuan Wang
- grid.413387.a0000 0004 1758 177XDepartment of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
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3
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Yıldırım S, Erdemoğlu Y, Öztürk Durmaz E, Erfan G, Duman D, Dikicioğlu Çetin E. Primary Cutaneous Angiosarcoma of the Scalp with Cranial Invasion in a Patient with Metastatic Breast Cancer. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2021; 14:22-24. [PMID: 34804351 PMCID: PMC8594530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Idiopathic cutaneous angiosarcoma (CA) of the head and neck is a distinct subtype of angiosarcoma most commonly presenting as a single or multiple purple, bruise-like patches that arise de novo and enlarge over several months. In clinical practice, both misdiagnosis and delayed diagnosis are frequently encountered. Here, we present a case of idiopathic CA on the scalp with invasion to the cranium in a patient with breast cancer metastatic to the brain. The patient was initially misdiagnosed and mistreated with herpes zoster and breast cancer metastatic to the skin, which led to a delayed diagnosis by two months until dermatologic evaluation. The diagnosis was then firmly established as CA based on consistent clinical and histological features. Since the tumor was inoperable, radiotherapy and chemotherapy were been considered as the appropriate adjuvant modes of therapy. Despite an initial favorable response, the disease demonstrated a rapidly progressive course and the patient succumbed to the disease within six months. This report briefly reviews the clinical and histological portrait and management options for this aggressive tumor.
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Affiliation(s)
- Selda Yıldırım
- Drs. Yildirim, Erdemoğlu, Durmaz, Erfan, and Duman are with the Department of Dermatology at Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
- Dr. Çetin is with the Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
| | - Yeliz Erdemoğlu
- Drs. Yildirim, Erdemoğlu, Durmaz, Erfan, and Duman are with the Department of Dermatology at Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
- Dr. Çetin is with the Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
| | - Emel Öztürk Durmaz
- Drs. Yildirim, Erdemoğlu, Durmaz, Erfan, and Duman are with the Department of Dermatology at Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
- Dr. Çetin is with the Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
| | - Gamze Erfan
- Drs. Yildirim, Erdemoğlu, Durmaz, Erfan, and Duman are with the Department of Dermatology at Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
- Dr. Çetin is with the Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
| | - Deniz Duman
- Drs. Yildirim, Erdemoğlu, Durmaz, Erfan, and Duman are with the Department of Dermatology at Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
- Dr. Çetin is with the Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
| | - Emel Dikicioğlu Çetin
- Drs. Yildirim, Erdemoğlu, Durmaz, Erfan, and Duman are with the Department of Dermatology at Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
- Dr. Çetin is with the Department of Pathology, Acıbadem Mehmet Ali Aydınlar University School of Medicine in Istanbul, Turkey
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4
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Endoglin in the Spotlight to Treat Cancer. Int J Mol Sci 2021; 22:ijms22063186. [PMID: 33804796 PMCID: PMC8003971 DOI: 10.3390/ijms22063186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/06/2021] [Accepted: 03/17/2021] [Indexed: 01/02/2023] Open
Abstract
A spotlight has been shone on endoglin in recent years due to that fact of its potential to serve as both a reliable disease biomarker and a therapeutic target. Indeed, endoglin has now been assigned many roles in both physiological and pathological processes. From a molecular point of view, endoglin mainly acts as a co-receptor in the canonical TGFβ pathway, but also it may be shed and released from the membrane, giving rise to the soluble form, which also plays important roles in cell signaling. In cancer, in particular, endoglin may contribute to either an oncogenic or a non-oncogenic phenotype depending on the cell context. The fact that endoglin is expressed by neoplastic and non-neoplastic cells within the tumor microenvironment suggests new possibilities for targeted therapies. Here, we aimed to review and discuss the many roles played by endoglin in different tumor types, as well as the strong evidence provided by pre-clinical and clinical studies that supports the therapeutic targeting of endoglin as a novel clinical strategy.
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5
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Neoadjuvant Systemic Treatment of Primary Angiosarcoma. Cancers (Basel) 2020; 12:cancers12082251. [PMID: 32806524 PMCID: PMC7464310 DOI: 10.3390/cancers12082251] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/03/2020] [Accepted: 08/07/2020] [Indexed: 12/13/2022] Open
Abstract
Angiosarcoma is an extremely rare and aggressive malignancy. Standard of care of localized tumors includes surgery ± radiation. Despite this multimodal treatment, >50% of the angiosarcoma patients develop local or distant recurrent disease. The role of neoadjuvant systemic therapy is still controversial and we therefore performed a systematic review of the literature to define the role of neoadjuvant systemic therapy based on available evidence. We focused on the effects of neoadjuvant systemic therapy on: 1. The success of surgical resection and 2. the long-term survival. All articles published before October 2019 on Ovid Medline, Ovid Embase, Cochrane library and Scopus were evaluated. Eighteen case reports and six retrospective cohort studies were included. There were no randomized controlled trials. This literature showed a beneficial role of neoadjuvant chemotherapy on downsizing of the tumor resulting in an improvement of the resection margins, especially in patients with cardiac or cutaneous angiosarcoma. However, no definitive conclusions on survival can be drawn based on the available literature lacking any prospective randomized studies in this setting. We advise that neoadjuvant chemotherapy should be considered, since this could lead to less mutilating resections and a higher rate of free resection margins. An international angiosarcoma registry could help to develop guidelines for this rare disease.
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Kang Y, Bae J, Choi S, Jang KT, Yu J, Hong JY, Lim SY, Jeong HS. Regional Lymph Node Metastasis of Scalp Angiosarcoma: A Detailed Clinical Observation Study of 40 Cases. Ann Surg Oncol 2020; 27:3018-3027. [PMID: 32458324 DOI: 10.1245/s10434-020-08408-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of lymph node metastasis (LNM) of angiosarcomas is reported to be less than 15%, and elective neck management has not been indicated. This study evaluated the incidence and pattern of regional LNM in patients with scalp angiosarcomas using the clinical data of its full course to understand time-event sequences of scalp angiosarcomas. METHODS This retrospective study included all consecutive cases of pathology-confirmed angiosarcomas and analyzed 40 cases of scalp angiosarcomas. The survival plots were estimated using the Kaplan-Meier method, and the results are presented mainly in a descriptive manner. RESULTS The overall survival rate for the patients was 35.8% at 2 years. In contrast to previous reports, regional LNM was observed in more than half of the patients (52.5%) with scalp angiosarcoma. Meanwhile, a direct spread to distant organs occurred in only 27.5% of the patients. Regional LNM could predict clinical manifestation of systemic disease within 3 to 6 months. No differences in survival rates between patients with and without LNM were observed in this series. Occurrence of LNM seemed to be correlated with a high mitotic rate of primary tumors, but not with tumor grade or tumor dimension. The first-echelon lymph nodes from scalp angiosarcoma were peri-parotid, post-auricular, and level 2 lymph nodes. CONCLUSIONS For a localized scalp angiosarcoma, it seems reasonable for initial curative surgery to include prophylactic evaluation of regional lymph nodes for pathologic nodal staging, prognosis estimation, and the decision for systemic treatments.
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Affiliation(s)
- Yungjee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juyoung Bae
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangjoon Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeongil Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Yong Hong
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Young Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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7
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Panda SP, Panigrahy UP, Prasanth D, Gorla US, Guntupalli C, Panda DP, Jena BR. A trimethoxy flavonoid isolated from stem extract of Tabebuia chrysantha suppresses angiogenesis in angiosarcoma. J Pharm Pharmacol 2020; 72:990-999. [PMID: 32311118 DOI: 10.1111/jphp.13272] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 03/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This research aimed to evaluate the antiangiogenic activity of isolated flavonoid 4a,5,8,8a-tetrahydro-5-hydroxy-3,7,8-trimethoxy-2-(3,4-dimethoxyphenyl) chromen-4-one (TMF) from Tabebuia chrysantha. STAT3-MMP9 signalling is a signal transduction mechanism that promotes angiogenesis in various cancers. METHODS The tumour xenografting chicken embryo chorioallantoic membrane (CAM) model-based ex vivo assay was used to evaluate the activity of TMF. The Western blot, densitometric analysis and quantitative real-time polymerase chain reaction (qRT-PCR) were performed to evaluate the activity of the MMP9. Zebrafish embryos were used to evaluate embryotoxicity, and in vitro free radical scavenging activity of flavonoid was also elucidated. KEY FINDINGS This research assessed the high level of STAT3, p-ERK, VEGF-R and MMP9 in the tissue extract of the control group, and also, the suppression of angiogenesis in the treatment groups was due to scavenged ROS and RNS, dephosphorylation of STAT3 and ERK, and suppression of MMP9 gene expression. CONCLUSION The isolated flavonoid named TMF from T. chrysantha functions as specific regulators of target proteins of angiosarcoma. The STAT3-MMP9 signalling may be used as an effective prognostic marker of angiosarcoma.
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Affiliation(s)
- Siva Prasad Panda
- Pharmacology research division, College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, India
| | | | - Dsnbk Prasanth
- Pharmacology research division, College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, India
| | - Uma Sankar Gorla
- Pharmacology research division, College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, India
| | - Chakravarthi Guntupalli
- Pharmacology research division, College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, India
| | | | - Bikash Ranjan Jena
- Southern Institute of Medical Sciences (SIMS college of Pharmacy), Guntur, India
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8
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Gao M, Li P, Tan C, Liu J, Tie X, Pang C, Guo Z, Lin Y. Primary Central Nervous System Angiosarcoma. World Neurosurg 2019; 132:41-46. [DOI: 10.1016/j.wneu.2019.08.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 11/24/2022]
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9
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Cao J, Wang J, He C, Fang M. Angiosarcoma: a review of diagnosis and current treatment. Am J Cancer Res 2019; 9:2303-2313. [PMID: 31815036 PMCID: PMC6895451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023] Open
Abstract
Angiosarcoma is a highly malignancy of endothelial tumor and represents 1-2% of all soft tissue sarcomas in humans. The aetiology of angiosarcoma is not clear but there are definite risk factors including chronic lymphoedema, history of radiation, environmental carcinogens and certain familial syndromes. Ultrasound, CT and MR are diagnostic tools, but final diagnosis requires pathological and immunohistochemical confirmation. The conventional options of treatment include surgery, radiotherapy and chemotherapy. Targeted medicines and immunotherapy have been studied as promising treatment of angiosarcoma. The goal of this review is to summarize the current data regarding of angiosarcoma and its clinical presentation and management, providing a useful clinical tool to explore the optimal treatment.
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Affiliation(s)
- Jun Cao
- Department of Comprehensive Medical Oncology, Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhou, Zhejiang, China
| | - Jiale Wang
- Second Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou, Zhejiang, China
| | - Chiyu He
- Second Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou, Zhejiang, China
| | - Meiyu Fang
- Department of Comprehensive Medical Oncology, Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhou, Zhejiang, China
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10
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Zhang Y, Yan Y, Zhu M, Chen C, Lu N, Qi F, Liu J. Clinical outcomes in primary scalp angiosarcoma. Oncol Lett 2019; 18:5091-5096. [PMID: 31612020 PMCID: PMC6781493 DOI: 10.3892/ol.2019.10886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 06/25/2019] [Indexed: 12/25/2022] Open
Abstract
Scalp angiosarcoma is a rare, extremely aggressive cutaneous malignancy with poor patient prognosis. The present study reviewed the cases of 42 patients who presented scalp angiosarcoma and were treated at the Zhongshan Hospital of Fudan University between January 2002 and December 2013. The clinical characteristics, demographics, treatment regimens and outcomes of patients were analyzed, and the overall survival (OS) and recurrence-free survival (RFS) rates were calculated. A total of 42 patients were examined in this study. Surgery was the most common therapeutic measure, and was performed in 39 patients, alone (12 patients), in combination with chemotherapy (14 patients), radiotherapy (6 patients) or 3-modality-therapy (7 patients). The median follow-up time of patients was 28.5 months. The 5-year OS rate was 19%, and the 5-year RFS rate was 10%. Taken together, the results of the present study suggested that patients whose tumor presented a nodular localized lesion had a significantly improved OS rate (P=0.0078). Patients aged ≥70 years were associated with a lower 5-year OS (P=0.0071) and RFS rates (P=0.0095) vs. patients aged <70 years. Different treatments were not identified to be significantly associated with an improved OS or RFS. The present results also indicated that if the tumor presented nodular localized lesions, the patients exhibited a better prognosis than those with a diffuse lesion. Although younger patients had better clinical outcomes, the likelihood of recurrence and mortality remained high for all patients.
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Affiliation(s)
- Yong Zhang
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Yanwen Yan
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Ming Zhu
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Cheng Chen
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Nanhang Lu
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Fazhi Qi
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Jiaqi Liu
- Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
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Bernstock JD, Shafaat O, Hardigan A, Fox BM, Moore LS, Chagoya G, Elsayed G, Gessler F, Ilyas A, Yamashita D, McGrew B, Fisher WS, Hackney J, Sotoudeh H. Angiosarcoma of the Temporal Bone: Case Report and Review of the Literature. World Neurosurg 2019; 130:351-357. [PMID: 31330332 DOI: 10.1016/j.wneu.2019.07.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Angiosarcomas are rare malignant tumors of endothelial origin. Nearly one half of all angiosarcomas occur in the head and neck. Temporal bone angiosarcomas are extremely uncommon. We present a case of temporal bone angiosarcoma and a review of the relevant data. CASE DESCRIPTION We present the case of a 20-year-old man with a painful right postauricular mass after a closed head injury. Radiologic studies demonstrated a large right osteolytic and heterogeneously enhancing mass. The patient underwent right transpetrosal craniectomy for resection. Histologic studies confirmed high-grade sarcoma. Immunohistochemical staining demonstrated a uniformly positive ERG endothelial marker, CD31 staining with cytoplasmic and membranous patterns of immunopositivity, positive nuclear staining for FLI-1, positive cytoplasmic and membranous staining for CD99 and STAT6, and negative smooth muscle actin stains in the neoplastic cells. Ki-67 staining showed ∼94% positivity in the neoplastic cell nuclei. Postoperative follow-up imaging studies demonstrated evidence of metastatic right cervical lymphadenopathy. CONCLUSIONS Angiosarcoma of the temporal bone is extremely uncommon. In the present case report, we explored a relationship between trauma and angiosarcoma of the temporal bone. We reviewed the reported data regarding the pathogenesis, diagnosis, treatment, radiologic findings, and histologic characteristics of angiosarcoma of the temporal bone.
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Affiliation(s)
- Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Omid Shafaat
- Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Andrew Hardigan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandon M Fox
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindsay S Moore
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daisuke Yamashita
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Benjamin McGrew
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Winfield S Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James Hackney
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Houman Sotoudeh
- Department of Neuroradiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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12
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Drosos E, Kalyvas A, Komaitis S, Skandalakis GP, Kalamatianos T, Liouta E, Neromyliotis E, Alexiou GA, Stranjalis G, Koutsarnakis C. Angiosarcoma-related cerebral metastases: a systematic review of the literature. Neurosurg Rev 2019; 43:1019-1038. [PMID: 31165296 DOI: 10.1007/s10143-019-01127-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/01/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
Abstract
Angiosarcoma-related cerebral metastases have only been recorded in a few case reports and case series and have not been systematically reviewed to date. Our objective was therefore to perform a systematic literature review on cases of angiosarcomas metastasizing to the brain to inform current practice. All three major libraries-PubMed/MEDLINE, Embase, and Cochrane-were systematically searched, until January 2019. Articles in English reporting angiosarcoma-related cerebral metastases via hematogenous route were included. Our search yielded 45 articles (38 case reports, 5 retrospective studies, 1 case series and 1 letter to the editor), totaling 48 patients (mean age 47.9 years). The main primary site was the heart. The mean time of diagnosis of cerebral metastases following primary tumor identification was 4.9 months. In 15 cases, the brain was the only metastatic site. In cases of multiple extracerebral metastases, the most common sites were the lung and bone. Acute intracerebral supratentorial hemorrhage was the most common presenting radiological feature. Treatment strategies were almost equally divided between the surgical (with or without adjuvant treatment) and the medical arm. Mean overall survival was 7.2 months while progression-free survival was 1.5 months. To our knowledge, this is the first systematic literature review on angiosarcoma-related cerebral metastases. This pathology proves to be an extremely rare clinical entity and carries a poor prognosis, and no consensus has been reached regarding treatment.
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Affiliation(s)
- Evangelos Drosos
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | | | - Theodosis Kalamatianos
- Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Evangelia Liouta
- Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Eleftherios Neromyliotis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece
| | - George A Alexiou
- Neurosurgery Department, University of Ioannina, Leof. Stavrou Niarchou, Ioannina, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece. .,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece. .,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece.
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Potent and PPARα-independent anti-proliferative action of the hypolipidemic drug fenofibrate in VEGF-dependent angiosarcomas in vitro. Sci Rep 2019; 9:6316. [PMID: 31004117 PMCID: PMC6474884 DOI: 10.1038/s41598-019-42838-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/05/2019] [Indexed: 01/13/2023] Open
Abstract
Angiosarcomas are highly aggressive tumors of endothelial origin, which carry a poor prognosis. Fenofibrate is a hypolipidemic drug, which acts by activating the transcription factor PPARα. It has also been widely reported to have ‘anti-cancer’ activity. The current study investigated its effect in a murine VEGF-dependent angiosarcoma cell-line, MS1 VEGF. The study utilised assays to monitor cell proliferation and viability, apoptosis, cell cycle progression, mitochondrial membrane potential, changes in protein expression, and changes in miRNA expression using microarrays. Fenofibrate showed potent anti-proliferative action in MS1 VEGF angiosarcoma cells, without inducing apoptosis. It enriched cells in G2/M cell cycle phase and hyperpolarised mitochondria. Other PPARα activators failed to mimic fenofibrate action. Inhibitors of PPARα and NFκB failed to reverse the inhibitory effect of fenofibrate and their combination with fenofibrate was cytotoxic. Fenofibrate downregulated the expression of key VEGF-effector proteins, including Akt, ERK, Bcl-2 and survivin, and a chemical inhibitor screen discovered relevance of these proteins to cell proliferation. A miRNA microarray revealed that fenofibrate differentially regulated cellular miRNAs with known roles in cancer and angiogenesis. The data raise the possibility that fenofibrate could be useful in angiosarcoma therapy, especially considering its well-established clinical safety and tolerability profile.
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Lazăr DC, Avram MF, Romoșan I, Văcariu V, Goldiș A, Cornianu M. Malignant hepatic vascular tumors in adults: Characteristics, diagnostic difficulties and current management. World J Clin Oncol 2019; 10:110-135. [PMID: 30949442 PMCID: PMC6441663 DOI: 10.5306/wjco.v10.i3.110] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/23/2019] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation (LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma (HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation Association-European Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma (HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient. Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches, alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.
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Affiliation(s)
- Daniela Cornelia Lazăr
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Mihaela Flavia Avram
- Department of Surgery X, 1st Surgery Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Ioan Romoșan
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Violetta Văcariu
- Department of Internal Medicine I, University Medical Clinic, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Adrian Goldiș
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
| | - Mărioara Cornianu
- Department of Pathology, University of Medicine and Pharmacy “Victor Babeş”, Timişoara 300041, Romania
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Clinical Outcomes and Prognostic Features of Angiosarcoma: Significance of Prior Radiation Therapy. Clin Oncol (R Coll Radiol) 2019; 31:232-241. [PMID: 30718086 DOI: 10.1016/j.clon.2019.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/14/2018] [Accepted: 12/04/2018] [Indexed: 02/06/2023]
Abstract
AIMS Angiosarcoma is a rare and aggressive malignancy with a poor prognosis. There is limited literature describing prognostic factors and guidelines for treatment. We aim to describe outcomes in angiosarcoma, including the impact of patient-, tumour- and treatment-related factors on prognosis. MATERIALS AND METHODS Patients with non-metastatic angiosarcoma diagnosed between 2008 and 2017 were retrospectively reviewed. Univariable and multivariable Cox proportional hazards methods were used to evaluate factors associated with locoregional recurrence, distant failure and overall survival. The Kaplan-Meier method and log-rank statistics were used to compare outcomes among patients with and without a history of prior radiation therapy. RESULTS The cohort included 65 patients. The median age at diagnosis was 68 years (35-93). Nineteen patients had a history of receiving prior radiation therapy at the anatomic location of their angiosarcoma. Treatment modalities included surgery (n = 19), surgery + radiation therapy (n = 12), surgery + chemotherapy (n = 8), chemotherapy + radiation therapy (n = 7) and all three modalities (n = 14). The median follow-up was 18 (2-192) months. The 2-year locoregional control, distant control and overall survival were 61.8, 63.6 and 58.9%, respectively. On multivariable analysis, a history of previous radiation therapy was associated with inferior outcomes with respect to locoregional recurrence (hazard ratio 89.67, 95% confidence interval 8.45-951.07, P < 0.001), distant failure (hazard failure 3.74, 95% confidence interval 1.57-8.91, P = 0.003) and overall survival (hazard ratio 3.89, 95% confidence interval 1.56-9.60, P = 0.003). In patients with primary angiosarcoma, the rates of locoregional control, distant control and overall survival were 72.4, 73.4 and 65.1%, respectively, compared with 31.9, 41.1 and 45.1% in patients with radiation therapy-induced angiosarcoma (P = 0.001). CONCLUSION Angiosarcomas that arise as a result of previous radiation therapy have worse outcomes compared with primary angiosarcomas. Although selection bias and compromise of clinical care in radiation therapy-induced angiosarcoma are partially to blame, differences in genomic profiles of the tumours need to be characterised to evaluate the underlying biological differences, as this may guide future treatment management. This study adds to the existing body of literature on angiosarcoma. Results from the current study are presented alongside previously published data to further characterise outcomes and prognostic factors on this rare and aggressive malignancy.
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Lerut J, Iesari S. Vascular tumours of the liver: a particular story. Transl Gastroenterol Hepatol 2018; 3:62. [PMID: 30363746 DOI: 10.21037/tgh.2018.09.02] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Vascular tumours of the liver represent an underrated chapter of medical and surgical hepatology. These tumours cover a wide spectrum ranging from the frequent and most benign hepatic haemangioma (HH), via the rare and intermediately aggressive hepatic epithelioid haemangioendothelioma (HEHE) to the rare and most malignant hepatic haemangiosarcoma (HHS). In contrast to the treatment algorithms for hepatocellular and cholangiocellular cancer, the diagnostic and therapeutic approaches to HEHE and HHS are not well developed. The related uncertainty is explained by their rare occurrence and their protean clinical, morphological (imaging) and histopathological presentation and behaviour. This article gives an update about these particular tumours based on the analysis of the recent literature and of the studies on vascular tumours published by the European Liver Intestine Transplantation Association (ELITA)-European Liver Transplant Registry (ELTR). It focuses also on the place of liver transplantation (LT) in the respective therapeutic algorithms. The differential diagnosis between these vascular and other tumour types may be very difficult. Correct diagnosis is of utmost importance and is based on a high index of clinical suspicion and on the integration of clinical, radiological, histological [including immunohistochemistry (IHC) and molecular biology findings]. Surgery, be it partial or total hepatectomy (LT), should be proposed whenever possible, because it is the therapeutic mainstay. In HEHE, LT provides excellent results, with long-term disease-free survivals (DFS) reaching 75%. Good results can be obtained even in case of (frequent) extrahepatic spread. Based on the extensive ELITA-ELTR study a HEHE-LT prognostic score has been proposed in order to estimate the risk of recurrence after LT. In contrast, results of surgery and LT are extremely poor for HHS, for the almost invariably rapid recurrence (within 6 months) and related death within 2 years. LT remains a contraindication for HHS. Due to the still important recurrence rate after surgical resection (25% in HEHE and almost 100% in HHS), there is an urgent need to develop pharmacological treatments targeting angiogenic and non-VEGF angiogenic pathways. To date, some prospective pilot studies and case reports have shown some short-term stabilisation of the disease in small groups of patients. In order to make progress, combination of surgery, anti-angiogenic and immunotherapy seems worthwhile. To complete the panel of vascular liver tumours, infantile haemangioendothelioma, haemangiopericytoma, nodular regenerative hyperplasia (NRH) and hepatic small vessel neoplasms (HSVN) are also discussed.
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Affiliation(s)
- Jan Lerut
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Samuele Iesari
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCL), Brussels, Belgium.,Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Shirey L, Coombs D, Talwar A, Mickus T. Pulmonary epithelioid angiosarcoma responsive to chemotherapy: A case report. Radiol Case Rep 2018; 13:479-484. [PMID: 29682139 PMCID: PMC5906771 DOI: 10.1016/j.radcr.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 02/03/2018] [Indexed: 11/25/2022] Open
Abstract
Primary pulmonary epithelioid angiosarcoma (AS) is an extremely rare cancer with a poor prognosis. The presenting symptoms and imaging results are nonspecific and hold similarities with more common lung pathology, contributing to missed or delayed diagnosis. Complementing radiological imaging with patient information, such as presenting symptoms and exposures, is important for early consideration of pulmonary epithelioid AS. Even with supportive imaging findings and clinical suspicion for pulmonary epithelioid AS, the most reliable and definitive method for diagnosis is through immunohistochemistry. We describe the case of a 65-year-old patient who presented with dyspnea, cough, and hemoptysis in whom pauci-immune vasculitis was initially suspected before immunohistochemical diagnosis of primary pulmonary epithelioid AS. Due to the rarity of this disease, treatment options have not been well-studied and consist of any combination of surgical resection, chemotherapy, and radiation therapy. Although typically poorly responsive to chemotherapy, our patient achieved a reduction in size of his pulmonary nodules after a course of steroids followed by cyclophosphamide and was later maintained with gemcitabine and docetaxel until his death nearly a year after presentation.
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Affiliation(s)
- Lora Shirey
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Aditya Talwar
- Department of Pathology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Timothy Mickus
- Department of Radiology, Allegheny Health Network, Pittsburgh, PA, USA
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Pircher A. Revival of anti-angiogenic therapies in cancer—news on an old therapeutic concept. MEMO-MAGAZINE OF EUROPEAN MEDICAL ONCOLOGY 2017. [DOI: 10.1007/s12254-017-0363-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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