1
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Yun JS, McCracken J, Wadhwa V. Radiation-induced angiosarcoma-An unusual cause of recurrent pleural effusion. Respirol Case Rep 2024; 12:e70013. [PMID: 39253318 PMCID: PMC11381914 DOI: 10.1002/rcr2.70013] [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: 05/26/2024] [Accepted: 08/23/2024] [Indexed: 09/11/2024] Open
Abstract
Although rare, radiotherapy can induce secondary malignancies, such as radiation-induced angiosarcoma (RIAS), which is associated with a poor prognosis. Early detection is crucial for improving outcomes. The modified Cahan criteria are instrumental in diagnosing RIAS, which is ultimately confirmed through histological examination. We present a case of a middle-aged woman who developed RIAS after undergoing radiotherapy post-surgery and adjuvant chemotherapy for right-sided breast cancer. The patient presented with a rapidly reaccumulating right-sided pleural effusion, and RIAS was confirmed through pleural biopsy and aspirate. This case report highlights the pathway for establishing a diagnosis of RIAS and the need for early detection through clinical examination and surveillance imaging for patients following radiotherapy.
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Affiliation(s)
- Jenny Sw Yun
- Department of Medical Oncology Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - James McCracken
- Department of Medical Oncology Peter MacCallum Cancer Centre Melbourne Victoria Australia
| | - Vikas Wadhwa
- Department of Medical Oncology Peter MacCallum Cancer Centre Melbourne Victoria Australia
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2
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Wang X, Lu Z, Luo Y, Cai J, Wei J, Liu A, Zeng Z. Characteristics and outcomes of primary pleural angiosarcoma: A retrospective study of 43 published cases. Medicine (Baltimore) 2022; 101:e28785. [PMID: 35147108 PMCID: PMC8830823 DOI: 10.1097/md.0000000000028785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/21/2022] [Indexed: 01/04/2023] Open
Abstract
Primary pleural angiosarcoma (PPA) is an extremely rare malignancy for which there is no consensus on treatment. The clinical course of PPA is usually quickly fatal, regardless of the treatment used.We summarized and evaluated a relatively large population of published PPA cases to assess prognostic factors, diagnostic approaches, treatment methods and clinical outcomes. Using the CNKI, Embase, and PubMed databases, literature published in English and Chinese from 1988 through 2020 was searched using the terms "primary pleural angiosarcoma," "pleural angiosarcoma," and "pleuropulmonary angiosarcoma."A total of 43 patients with PPA were identified in retrospective case series and case reports. The median age at diagnosis was 64 years (range 24-87 years), and the median overall survival was 4 months (range 0.1-180 months). Approximately 80% of patients died from PPA within 10 months of diagnosis, and the 2-year survival rate was approximately 4.4%. In univariate analyses, the presence of pleural effusion and hemothorax were significant predictors of decreased survival, with hazard ratios (HRs) of 2.7 (P = .04) and 3.3 (P = .006), respectively. Sixteen patients received no therapy, and their prognosis was worse than patients who did receive therapy (P = .019). Radiation therapy improved survival more than no radiation therapy (P = .007). Patients appeared to derive clinical benefit from chemotherapy (P = .048). However, tumor resection did not seem to provide a survival benefit (P = .051). In multivariate analysis, tumor resection, and radiation were independent, statistically significant, positive predictors of better survival, with HRs of 0.3 (P = .017) and 0.1 (P = .006), respectively. The presence of hemothorax was an independent predictor of worse prognosis (P = .006).Primary angiosarcoma of the pleura is a rare, poorly understood malignancy with a poor prognosis; hence, the clinical spectrum of PPA is not completely defined. By multivariate analysis, this retrospective study showed a survival benefit of tumor resection or radiation therapy, and the presence of hemothorax was a significant prognostic factor for poor outcomes.
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Affiliation(s)
- Xia Wang
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Zhiqin Lu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Yuxi Luo
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Jing Cai
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Jianping Wei
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Anwen Liu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, China
| | - Zhimin Zeng
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, China
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3
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Woo JJ, Kim Y, An JK, Lee H. Primary pleural epithelioid angiosarcoma manifesting as a loculated hemothorax: A case report and literature review focusing on CT findings. Radiol Case Rep 2021; 16:3072-3075. [PMID: 34429805 PMCID: PMC8365445 DOI: 10.1016/j.radcr.2021.07.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022] Open
Abstract
Primary pleural angiosarcoma (PPA) is an extremely rare and clinically aggressive tumor. We report the case of a 66-year-old man having PPA with chest computed tomography (CT) scan showing a large oval-shaped, nonenhancing high attenuation cystic mass in the left hemithorax. Morphological and immunohistochemical findings supported the diagnosis of epithelioid angiosarcoma. Pleural angiosarcoma should be considered in the differential diagnosis of spontaneous hemothorax manifesting as high attenuation loculated pleural fluid on CT.
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Affiliation(s)
- Jeong Joo Woo
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yongsang Kim
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jin Kyung An
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Hojung Lee
- Department of Pathology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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4
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Yamazaki K, Minakata K, Nakane T, Kinoshita H, Tanizawa K, Sumiyoshi S, Sato H, Minatoya K, Sakata R. A rare case of primary angiosarcoma of the anterior mediastinum. Gen Thorac Cardiovasc Surg 2020; 69:766-769. [PMID: 33222090 DOI: 10.1007/s11748-020-01551-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 11/08/2020] [Indexed: 11/26/2022]
Abstract
A 32-year-old male patient was initially diagnosed with fibrosing mediastinitis. The patient subsequently developed severe dyspnea and was further diagnosed with constrictive pericarditis due to the extent of fibrosing mediastinitis around the heart. Therefore, the patient underwent surgical resection of the fibrotic tissue in the anterior mediastinum including the pericardium and the pleura. Postoperative histological and immunohistochemical analyses revealed angiosarcoma. Seven years after the diagnosis, he is still alive. Herein, we report a case of atypical primary angiosarcoma of the anterior mediastinum causing constrictive pericarditis and restrictive pulmonary dysfunction.
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Affiliation(s)
- Kazuhiro Yamazaki
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan.
| | - Kenji Minakata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Takeichiro Nakane
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Hideyuki Kinoshita
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kiminobu Tanizawa
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Sumiyoshi
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Sato
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan
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5
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Sinkler MA, Ullah A, Wehrle CJ, Ibrahim MA, White J. Primary Pleural Epithelioid Angiosarcoma With Extensive and Rapid Metastasis to Brain and Bilateral Adrenal Glands. Cureus 2020; 12:e9982. [PMID: 32983683 PMCID: PMC7511080 DOI: 10.7759/cureus.9982] [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: 07/30/2020] [Accepted: 08/24/2020] [Indexed: 11/05/2022] Open
Abstract
A 64-year-old male presents with shoulder pain, arm pain, and a chronic cough. CT imaging of the thorax shows a large 8.0 x 6.7 cm mass with central necrosis in the left upper lung lobe with invasion into the chest wall with partial destruction of the second and third ribs, and left axillary adenopathy. Bilateral adrenal nodules are identified via CT imaging and subsequently biopsied. Histologically, the mass reveals sheets of atypical epithelioid cells with round nuclei and abundant eosinophilic cytoplasm. Immunostaining is positive for CD31, CD34, FLI-1, AE1/AE3, and CK7, diagnostic of primary epithelioid angiosarcoma. The patient developed symptoms of confusion, dizziness, and ataxia. An MRI showed metastatic brain lesions. One month later, the patient had worsening symptoms. Repeat imaging demonstrates enlargement of the bilateral adrenal masses, a new lesion posterior to the left kidney, and doubling of the size of the brain lesions. This case illustrates the metastatic potential and pattern of the spread of an aggressive primary pleural angiosarcoma that is not described elsewhere in current literature. It also highlights the importance of timely intervention based on the rapid metastatic progression of this neoplasm.
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Affiliation(s)
- Margaret A Sinkler
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Asad Ullah
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Chase J Wehrle
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Muaz A Ibrahim
- Radiology, Medical College of Georgia - Augusta University, Augusta, USA
| | - Joseph White
- Pathology, Medical College of Georgia - Augusta University, Augusta, USA
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6
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Sedhai YR, Basnyat S, Golamari R, Koirala A, Yuan M. Primary pleural angiosarcoma: Case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20904595. [PMID: 32095244 PMCID: PMC7011321 DOI: 10.1177/2050313x20904595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
Primary pleural angiosarcoma is an exceptionally rare malignancy of pleura
originating from the vascular endothelial cells. Here, we present a 70-year-old
African-American female who presented with 1-month history of dyspnea on
exertion, loss of appetite, and loss of weight along with left-sided pleuritic
chest pain. Evaluation revealed hemorrhagic pleural effusion in the left pleural
cavity. Computed tomography of the chest performed after therapeutic
thoracocentesis revealed left upper lobe lung mass along with multiple nodules
in right lung. Mass was biopsied at video-assisted thoracoscopy. Histopathology
was consistent with high-grade angiosarcoma. Endothelial origin of the tumor
cells was confirmed with positive immunohistochemical staining with CD31
antibodies. Our patient was diagnosed with primary pleural angiosarcoma
metastatic to the lung. She opted for palliative care and had a rapidly
declining clinical course and expired within 5 weeks of the diagnosis. Here, we
present a case report and review the relevant literature.
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7
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Abstract
CONTEXT - Pleural pathology has been dominated by discussions relating to the diagnosis, prognosis, etiology, and management of malignant mesothelioma. However, there exists a diverse group of other neoplasms that involve the pleura; the most common by far is metastatic carcinoma, usually of pulmonary origin. Other metastatic tumors of varied histogenesis do occur but are less common. Primary pleural neoplasms other than diffuse malignant mesothelioma are either uncommon or rare and have received less attention. OBJECTIVE - To provide a review of those diverse tumors that can involve the pleura other than mesothelioma in order to facilitate their accurate diagnosis. DATA SOURCES - Review of relevant literature published via PubMed and other search engines. CONCLUSIONS - A wide variety of tumors can involve the pleura. In most cases, the approach of considering the morphologic features with appropriate immunohistochemistry, in the correct clinical context, allows for a confident diagnosis. For a number of those soft tissue tumors that are well recognized in the pleura, such as solitary fibrous tumor, desmoid-type fibromatosis, synovial sarcoma, and epithelioid hemangioendothelioma, novel markers now exist based on an understanding of the individual tumors' molecular characteristics. Primary pleural lymphomas are rare with poor prognosis. They represent localized specific diffuse large B-cell lymphomas, with either post-germinal center B-cell or plasma cell lineage, arising in the context of either immunodeficiency or immune sequestration and with viral infection.
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Affiliation(s)
| | - Matthew Richard Pugh
- From the Department of Cellular Pathology, Cardiff and Vale University Local Health Board, School of Medicine, Cardiff University, Cardiff, Wales
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8
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Durani U, Gallo de Moraes A, Beachey J, Nelson D, Robinson S, Anavekar NS. Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion. Respir Med Case Rep 2018; 24:77-80. [PMID: 29977765 PMCID: PMC6010620 DOI: 10.1016/j.rmcr.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 11/25/2022] Open
Abstract
Angiosarcomas are rare cancers accounting for less than 2% of all soft tissue sarcomas. We report the case of an unusual presentation of pleural epithelioid angiosarcoma in a patient with constrictive pericarditis and recurrent pleural effusion. A 62 year old smoker presented with acute chest pain. ECG showed diffuse elevation of ST segments in the precordial leads. After extensive evaluation, he was diagnosed with viral pericarditis and treated with colchicine. Two weeks later the patient presented to the emergency department with a large right pleural effusion. Evaluation of the pleural fluid obtained from a thoracentesis revealed an exudative effusion with negative microbial studies and no evidence of malignant cells. His pleural effusion re-accumulated rapidly, requiring repeated thoracenteses over several weeks. Medical thoracoscopy was performed and pleural biopsy revealed primary pleural epithelioid angiosarcoma. Staging PET scan revealed malignant enhancement of right pleura, pericardium, right iliac bone and right shoulder. He died suddenly within 6 weeks of diagnosis, prior to initiating palliative chemotherapy. Pleural angiosarcoma should be considered in the differential diagnosis of recurrent pleural effusions of unknown etiology. Negative cytology does not rule out the diagnosis; excisional biopsy is required. Reported risk factors include asbestos exposure, prior chest radiation, active smoking and history of complicated pleural tuberculosis. Pleural epithelioid angiosarcomas carry a very poor prognosis, with the majority of patients dying within months of diagnosis.
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Affiliation(s)
- Urshila Durani
- Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Alice Gallo de Moraes
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Joel Beachey
- Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Darlene Nelson
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Steven Robinson
- Department of Medicine, Division of Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
| | - Nandan S Anavekar
- Department of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.,Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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9
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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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10
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Cabibi D, Pipitone G, Porcasi R, Ingrao S, Benza I, Porrello C, Cajozzo M, Giannone AG. Pleural epithelioid angiosarcoma with lymphatic differentiation arisen after radiometabolic therapy for thyroid carcinoma: immunohistochemical findings and review of the literature. Diagn Pathol 2017; 12:60. [PMID: 28810922 PMCID: PMC5558755 DOI: 10.1186/s13000-017-0652-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
Background Pleural angiosarcoma is a rare tumor that causes diffuse pleural thickening and effusion, mimicking mesothelioma. Immunohistochemistry is needed to highlight endothelial differentiation. We describe the first case of pleural angiosarcoma with lymphatic differentiation following radiometabolic therapy for thyroid carcinoma. Case presentation A 50-year-old man showed diffuse pleural thickening and effusion. Nine years earlier, he underwent thyroidectomy and radiometabolic therapy for thyroid carcinoma with lymph node metastases. Histologically, the tumor consisted of a solid proliferation of atypical epithelioid cells and anastomosed vascular spaces, lacking of red blood cells and containing Alcian blue positive material. The tumor showed positive immunostaining for Vimentin, CD31, CK7, D2–40, c-MYC, Ki67, focal positivity for PanCK, and negative immunostaining for Factor VIII, CD34, WT1, CK5/6, Calretinin, EMA, HBME-1, CEA, p63, EpCAM, Bcl-2, TTF1 and Thyroglobulin. CD99 showed a granular/paranuclear pattern of positivity. The histological and immunohistochemical features were consistent with “pleural angiosarcoma with lymphatic differentiation, epithelioid variant”. Discussion and conclusions Epithelioid angiosarcoma with lymphatic differentiation is very rare and aggressive. Moreover, the positivity for c-MYC suggests the relationship with radiometabolic therapy. To our knowledge, this is the first case of pleural c-MYC-positive angiosarcoma with lymphatic differentiation reported in the literature and the first one arisen after radiometabolic therapy for thyroid carcinoma.
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Affiliation(s)
- Daniela Cabibi
- Department of Sciences for the Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Palermo, Italy. .,Anatomia Patologica, A.O.U. Policlinico 'P. Giaccone', Via del Vespro 129, 90127, Palermo, Italy.
| | - Giulia Pipitone
- Department of Sciences for the Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Rossana Porcasi
- Department of Sciences for the Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Sabrina Ingrao
- Department of Sciences for the Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Ignazio Benza
- Buccheri La Ferla Hospital, Unit of Radiology, Palermo, Italy
| | - Calogero Porrello
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Massimo Cajozzo
- Department of Surgical and Oncological Sciences, University of Palermo, Palermo, Italy
| | - Antonino Giulio Giannone
- Department of Sciences for the Promotion of Health and Mother and Child Care, Anatomic Pathology, University of Palermo, Palermo, Italy
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11
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Pulmonary Epithelioid Hemangioendothelioma Diagnosed With Endobronchial Biopsies. J Bronchology Interv Pulmonol 2016; 23:168-73. [DOI: 10.1097/lbr.0000000000000230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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12
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Ferreiro L, San-José E, Suárez-Antelo J, Abdulkader I, Martínez-de-Alegría A, González-Barcala FJ, Valdés L. Spontaneous bilateral haemothorax as presentation of primary pleural epithelioid haemangioendothelioma. CLINICAL RESPIRATORY JOURNAL 2015; 11:1079-1085. [PMID: 26620871 DOI: 10.1111/crj.12421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 10/05/2015] [Accepted: 11/13/2015] [Indexed: 12/26/2022]
Abstract
Pleural epithelioid haemangioendothelioma (EHE) is a rare tumour that originates in the vascular endothelium with an intermediate degree of malignancy between haemangioma and angiosarcoma. Smoking and asbestos exposure are unproven risk factors and diagnosis is usually confirmed by thoracoscopy, since pleural fluid (PF) cytology is often not conclusive. Immunohistochemistry can also help to confirm the diagnosis. We report an 85-year-old patient with bilateral pleural EHE diagnosed by thoracoscopy, who debuted with a spontaneous bilateral haemothorax, the second described so far, and we conducted a thorough review of the literature to describe the clinical, radiological and prognostic features, as well as the PF, of this rare tumour.
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Affiliation(s)
- Lucía Ferreiro
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Esther San-José
- Department of Clinical Analysis, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Juan Suárez-Antelo
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Ihab Abdulkader
- Department of Pathology, University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | | | - Francisco-Javier González-Barcala
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
| | - Luis Valdés
- Department of Pulmonology, University of Santiago Hospital Complex, Santiago de Compostela, Spain.,Interdisciplinary Pulmonology Research Group, Health Research Institute of Santiago (IDIS), University of Santiago Hospital Complex, Santiago de Compostela, Spain
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13
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Thway K, Jordan S, Fisher C, Nicholson AG. Updates in the approach to intrathoracic sarcomas. Histopathology 2015; 67:755-70. [DOI: 10.1111/his.12771] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Khin Thway
- Sarcoma Unit; Royal Marsden Hospital; London UK
| | - Simon Jordan
- Department of Surgery; Royal Brompton Hospital; London UK
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14
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Matsuda K, Yamaryo T, Akazawa Y, Kawakami K, Nakashima M. Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case. Pathol Int 2015; 65:603-7. [PMID: 26314557 DOI: 10.1111/pin.12347] [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: 12/18/2014] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Abstract
We report a case of pleural angiosarcoma in an adult male patient confirmed by autopsy and possibly associated with pneumoconiosis. The lesion was characterized by thickened pleura of both lungs with nodular tumors. Histologically, the tumor was composed of spindle-to-polygonal epithelioid cells that were positive for CD31, CD34, vimentin, and cytokeratin on immunohistochemical staining but were negative for calretinin. Further examination revealed mix-dust pathological findings consistent with the existence of pneumoconiosis; dystrophic ossification, anthracosis, and fractal small dust particles were observed in the lung parenchyma and a hilar lymph node. The current case suggests that pneumoconiosis-associated pathologies may be risk factors for the development of angiosarcoma in the pleura.
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Affiliation(s)
- Katsuya Matsuda
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Yamaryo
- Nagasaki Kawatana Medical Center, Surgery, National Hospital Organization, Nagasaki, Japan
| | - Yuko Akazawa
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Hospital, Nagasaki, Japan.,Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kenji Kawakami
- Nagasaki Kawatana Medical Center, Surgery, National Hospital Organization, Nagasaki, Japan
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Hospital, Nagasaki, Japan
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15
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Bruixola G, Díaz-Beveridge R, Jiménez E, Caballero J, Salavert M, Escoin C, Aparicio J. Pleuropulmonary angiosarcoma involving the liver, the jejunum and the spine, developed from chronic tuberculosis pyothorax: Multidisciplinary approach and review of literature. Lung Cancer 2014; 86:105-11. [PMID: 25097031 DOI: 10.1016/j.lungcan.2014.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/04/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
Abstract
Pleuropulmonary angiosarcomas are very rare, with less than fifty cases reported in the literature. In most cases, the etiology is unknown but the presence of a chronic tuberculous pyothorax has been reported in several Asian case reports as a possible risk factor. We report the case of a Caucasian 68-year old man who presented with a pleuropulmonary angiosarcoma that arose from a chronic tuberculous pyothorax and which involved the ribs and the vertebrae, the psoas muscle, and the jejunum. The patient received adapted anti-tuberculosis treatment, embolization of the mass in the small bowel, palliative external beam radiotherapy on the spine and systemic chemotherapy with liposomal non-pegylated doxorubicin and ifosfamide. With this multidisciplinary approach the patient's symptoms were well controlled and he achieved a complete metabolic response after six cycles of chemotherapy. Unfortunately, the patient died after eight months from the beginning of chemotherapy due to an acute lung injury secondary to extensive bilateral interstitial infiltrates. Opportunistic pathogens or drug-induced lung toxicity were the most probable causes. Treatment with liposomal non-pegylated doxorubicin and ifosfamide could be a reasonable option in pleuropulmonary angiosarcoma but it should be validated in clinical trials. Chronic pyothorax seems to be a predisposing factor for the development of pleural angiosarcoma but further investigations are required to assess a causal association.
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Affiliation(s)
- Gema Bruixola
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | | | - Enrique Jiménez
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Caballero
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit, Internal Medicine Department, University Hospital La Fe, Valencia, Spain
| | - Corina Escoin
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Jorge Aparicio
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
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16
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Primary pleural angiosarcoma in a 63-year-old gentleman. Case Rep Pulmonol 2013; 2013:974567. [PMID: 23844302 PMCID: PMC3697234 DOI: 10.1155/2013/974567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 06/03/2013] [Indexed: 11/25/2022] Open
Abstract
Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature. Herein, we report the case of a 63-year-old gentleman who presented with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. Chest X-ray showed bilateral pleural effusion with partial bibasilar atelectasis. Ultrasound-guided thoracocentesis showed bloody and exudative pleural fluid. Cytologic examination was negative for malignant cells. An abdominal contrast-enhanced computed tomography (CT) scan showed two right diaphragmatic pleural masses. Whole-body positron emission tomography/computed tomography (PET/CT) scan showed two hypermetabolic fluorodeoxyglucose- (FDG-) avid lesions involving the right diaphragmatic pleura. CT-guided needle-core biopsy was performed and histopathological examination showed neoplastic cells growing mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. Immunohistochemical analysis showed strong positivity for vimentin, CD31, CD68, and Fli-1 markers. The overall pathological and immunohistochemical features supported the diagnosis of epithelioid angiosarcoma. The patient was scheduled for surgery in three weeks. Unfortunately, the patient died after one week after discharge secondary to pulseless ventricular tachycardia arrest followed by asystole. Moreover, we also present a brief literature review on pleural angiosarcoma.
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Abstract
Primary pleural tumors other than mesothelioma account for fewer than 1% of all lung cancers, and consequently they pose diagnostic and management challenges. Their treatment must be targeted toward the specific tumor type and is often quite different from the treatment for mesothelioma or metastases. Despite the best efforts at diagnosing and treating these tumors, the prognosis associated with some of the benign and many of the malignant variants of these tumors remains poor. In this review, we describe the radiologic and pathologic features of the less common primary pleural tumors and propose a diagnostic approach to their evaluation.
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Affiliation(s)
- Christopher T Erb
- Section of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, 300 Cedar Street, TAC S-441, New Haven, CT 06520, USA
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18
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Ordóñez NG. Application of immunohistochemistry in the diagnosis of epithelioid mesothelioma: a review and update. Hum Pathol 2012; 44:1-19. [PMID: 22963903 DOI: 10.1016/j.humpath.2012.05.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/14/2012] [Accepted: 05/16/2012] [Indexed: 01/12/2023]
Abstract
A large number of immunohistochemical markers that can assist in the differential diagnosis of epithelioid mesotheliomas are currently available. Because these markers are expressed differently in the various types of carcinomas that can metastasize to the serosal membranes and can potentially be confused with epithelioid mesothelioma, their selection for inclusion in a diagnostic panel largely depends on the differential diagnosis, as well as on which ones work the best in a given laboratory. Traditionally, the panels used in the differential diagnosis of epithelioid mesothelioma have consisted of a combination of positive mesothelioma markers and broad-spectrum carcinoma markers. At present, a wide variety of organ-associated carcinoma markers such as thyroid transcription factor-1 and napsin A for the lung, PAX 8 and PAX 2 for the kidney, and Müllerian-derived tumors; gross cystic disease fluid protein-15 and mammaglobin for the breast; and CDX2 for intestinal differentiation are available, which can assist in establishing the site of origin of an adenocarcinoma when included in a diagnostic panel. This article provides updated information on the composition of the panels of markers recommended in the various differential diagnoses.
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Affiliation(s)
- Nelson G Ordóñez
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX 77030, USA.
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Abstract
Mesotheliomas with pleomorphic features are rare and only a few studies on this mesothelioma variant have been published. Little information regarding the immunoprofile of these tumors and none on their electron microscopic features was included in these studies. Herein are reported 10 cases of pleomorphic mesothelioma that were investigated using a large panel of immunohistochemical markers, 4 of which were also studied by electron microscopy. All of the patients were men and seven had a history of asbestos exposure. Nine of the cases originated in the pleura and one in the peritoneum. Histologically, the tumors were characterized by being composed of large, often discohesive, cells that varied in size and shape, had dense abundant eosinophilic cytoplasm, and single or multiple irregular nuclei, which often contained one or several large nucleoli. Mitotic activity was high and atypical mitoses frequent. Immunoreactivity for pan-keratin and keratin 7 was strong in all of the cases. Expression for calretinin, WT1, podoplanin, mesothelin and keratin 5/6 was also frequent, but variable. All cases were negative for MOC-31, carcinoembryonic antigen, CD15, TAG-72 and thyroid transcription factor-1. Electron microscopy often showed the presence of abundant long, slender microvilli on the cell membrane of the neoplastic cells. These findings demonstrate that, contrary to what has been suggested by some investigators, both immunohistochemistry and electron microscopy can be very helpful in assisting in the diagnosis of pleomorphic mesotheliomas. That the seven patients who underwent extrapleural pneumonectomy had extensive lymph node metastasis and that the median survival of those patients for whom follow-up information was available was only 8.2 months indicates that mesotheliomas with pleomorphic features are associated with highly aggressive clinical behavior. Therefore, when this subtype of epithelioid mesothelioma is present, it should be reported as it can significantly affect the prognosis and treatment of the patient.
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Affiliation(s)
- Nelson G Ordóñez
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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20
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Giant diaphragmatic angiosarcoma of adult: a case report and review of literature. Case Rep Med 2012; 2012:950856. [PMID: 22431944 PMCID: PMC3295565 DOI: 10.1155/2012/950856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 10/28/2011] [Indexed: 01/03/2023] Open
Abstract
Angiosarcoma is a rare vascular malignant soft tissue tumor, with highly malignant, invasive, and multifocal characteristics of biology, which is prone to local recurrence and distant metastasis, so the prognosis is extremely poor. It rarely involves the diaphragm. We present the case of an adult patient who had a primary giant angiosarcoma of the left-sided diaphragm.
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Kao YC, Chow JM, Wang KM, Fang CL, Chu JS, Chen CL. Primary pleural angiosarcoma as a mimicker of mesothelioma: a case report **VS**. Diagn Pathol 2011; 6:130. [PMID: 22208720 PMCID: PMC3260116 DOI: 10.1186/1746-1596-6-130] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 12/30/2011] [Indexed: 11/24/2022] Open
Abstract
Primary pleural angiosarcoma is a rare and clinically aggressive tumor. Patients usually present with chest pain, dyspnea, hemoptysis and/or cough. Radiologic studies reveal diffuse pleural thickening and pleural effusion with or without mass lesion. The clinical and radiological features both resemble those of mesothelioma, and its definite diagnosis requires careful histologic examination. However, frequent epithelioid feature and immunoreactivity to cytokeratin in primary pleural angiosarcoma further complicate the pathologic diagnosis. The use of proper immunohistochemical stains is often needed to support endothelial differentiation in the tumor cells and to exclude metastatic carcinoma and mesothelioma. We report the case of a 49-year-old male patient with primary pleural angiosarcoma, who presented with initial hemothorax, followed by a rapid progress to an inoperable status.
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Affiliation(s)
- Yu-Chien Kao
- Department of Pathology, Wan Fang Hospital, Taipei Medical University, Taiwan
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22
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Thoracic neoplasms at the Jena reference center for soft tissue tumors. J Cancer Res Clin Oncol 2011; 138:415-24. [PMID: 22160181 DOI: 10.1007/s00432-011-1108-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Accepted: 11/24/2011] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The Jena Soft Tissue Tumor Reference Center is the major German pathology institute for consultation of malignant mesenchymal tumors. Here, we present the clinicopathological data on thoracic soft tissue tumors of a two-year period. METHODS The tumors were analyzed according to their localization, type (soft tissue tumor, other tumor type, non-neoplastic lesion) and biological behavior. The frequency of the defined soft tissue tumor entities were considered after categorizing the cases according to the WHO Classification of Tumors. Gender and age were also assessed. RESULTS In total, 1,071 cases of thoracic tumors were recorded within the 2 years. The majority were non-epithelial lesions (75.3%, n = 806/1,071), of which 68.1% (n = 549/806) were malignant or intermediate malignant. 107 non-epithelial lesions involved the lung and 37 the pleura. By far the most common lung and pleural tumors were undifferentiated sarcomas. In the lung, other frequent entities were solitary fibrous tumors, synovial sarcomas and leiomyosarcomas. We also recorded 13 non-epithelial tumors of the heart and 66 tumors of the breast with angiosarcomas being the most frequent subtype. There was a female predominance for vascular neoplasms, while men prevailed for adipocytic tumors. CONCLUSIONS Our study provides information about the frequency, distribution, age and gender of patients with thoracic soft tissue tumors including several rare entities. Thus, it may help in the differential diagnosis of these neoplasms. In addition, we present a model highlighting the potential progression of lung carcinoma to undifferentiated sarcoma via the process of epithelial-mesenchymal transition.
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Baisi A, Raveglia F, De Simone M, Cioffi U. Primary multifocal angiosarcoma of the pleura. Interact Cardiovasc Thorac Surg 2011; 12:1069-70. [PMID: 21429871 DOI: 10.1510/icvts.2011.267708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alessandro Baisi
- Thoracic Surgery Unit, University of Milan, Ospedale San Paolo, 20142 Milan, Italy.
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Liu JX, Shiau MC, Nonaka D. An 80-year-old man with shortness of breath and large right-sided pleural effusion. Chest 2011; 138:1247-52. [PMID: 21051402 DOI: 10.1378/chest.09-2439] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- James X Liu
- Department of Medicine, New York University School of Medicine, 334 E 26 St, New York, NY 10016, USA.
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