1
|
Yu L, Sun Y, Wang M, Yuan L, Wang Q, Qian X. Primary pulmonary epithelioid angiosarcoma with thyroid tumor history: A case report and literature review. Exp Ther Med 2022; 24:471. [PMID: 35761817 PMCID: PMC9214694 DOI: 10.3892/etm.2022.11398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Primary pulmonary epithelioid angiosarcoma is a rare tumor type without any specific clinical and imaging features. Therefore, it is associated with high rates of misdiagnosis. The present study reports the case of a 54-year-old female patient who was admitted after complaining of cough, expectoration and bloody sputum for >5 months in May 2021. The patient reported a previous history of papillary thyroid carcinoma in 2003 and had undergone treatment through surgery, postoperative chemotherapy and iodine131 therapy. Chest computed tomography (CT) was performed in May 2021, which indicated that the disease had progressed rapidly since February 2021. CT-guided lung biopsy and immunohistochemical staining of the tumor indicated positivity for CD31, CD34 and E26 transformation-specific-related gene markers. The tumor was negative for thyroid cancer-associated antibodies; thus, a diagnosis of primary pulmonary epithelioid angiosarcoma was made. The patient died 3 months after the diagnosis. Primary pulmonary epithelioid angiosarcoma is a rare tumor type with high recurrence and metastasis rates. This tumor has no specific clinical symptoms and signs and is thus easily misdiagnosed. Biopsy is essential for diagnosis of the disease, particularly if patients have a tumor history.
Collapse
Affiliation(s)
- Lu Yu
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Yuhui Sun
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Meifang Wang
- Department of 1Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Lingling Yuan
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Qiang Wang
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Xin Qian
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| |
Collapse
|
2
|
Tang X, Zhu J, Zhu F, Tu H, Deng A, Lu J, Yang M, Dai L, Huang K, Zhang L. Case Report: Primary Pulmonary Angiosarcoma With Brain Metastasis. Front Bioeng Biotechnol 2022; 9:803868. [PMID: 35071212 PMCID: PMC8776831 DOI: 10.3389/fbioe.2021.803868] [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: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
Primary pulmonary angiosarcoma (PPA) is a rare malignant vascular tumor, of which early diagnosis is challenging due to lack of specific clinical manifestations and a low level of suspicion. Here, we report a case of PPA presented with advanced brain metastasis. A 21-year-old patient with 1 week history of headache and mild cough was hospitalized for a head injury. Head MRI showed multiple intracranial lesions with brain edema. Chest CT displayed bilateral pulmonary infiltrates with mediastinal lymph node enlargement. After 2 months of anti-tuberculosis treatment, the patient was readmitted for persistent headache and cough with occasional hemosputum along with worsening pulmonary and intracranial lesions. Despite seizure prophylaxis and control of intracranial pressure and brain edema, his symptoms progressively aggravated, accompanied by cough with bloody sputum, frequent epileptic seizures, and hypotension. He eventually developed coma and died within 3 months of onset of symptoms. An autopsy confirmed PPA with brain metastasis.
Collapse
Affiliation(s)
- Xiangjun Tang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fangcheng Zhu
- School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Hanjun Tu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Aiping Deng
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Junti Lu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Minghuan Yang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Longjun Dai
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Kuanming Huang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Li Zhang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| |
Collapse
|
3
|
Khalid K, Khan A, Lomiguen CM, Chin J. Clinical Detection of Primary Pulmonary Angiosarcoma. Cureus 2021; 13:e17059. [PMID: 34522537 PMCID: PMC8428157 DOI: 10.7759/cureus.17059] [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: 07/24/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022] Open
Abstract
Pulmonary angiosarcomas (PAS) are rare malignant vascular tumors that due to their aggressive and metastatic nature, are often diagnosed at a late stage, resulting in a poorer prognosis. Here we present a 53-year-old male who was initially found to have recurring episodes of dyspnea and syncope, with initial workup showing bilateral saddle pulmonary embolisms on computerized tomography, presumed secondary to newly discovered atrial fibrillation with sinus node dysfunction. Further investigation over subsequent months and subsequent biopsy of a potential lung mass ultimately revealed pulmonary angiosarcoma of the spindle cell line. This case emphasizes findings in the current literature, which reveal the time between the onset of symptoms and definitive diagnosis ranges from two to six months, with a median survival time of seven months or two months, with solitary lesions or multiple lesions at the time of diagnosis, respectively. With the limited incidence of PAS, this case suggests benefits in the development of screening and detection criteria for earlier detection and treatment.
Collapse
Affiliation(s)
- Kaynat Khalid
- Department of Primary Care, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Anas Khan
- Department of Primary Care, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Christine M Lomiguen
- Department of Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA.,Department of Family Medicine, Millcreek Community Hospital, Erie, USA
| | - Justin Chin
- Department of Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA.,Department of Family Medicine, LifeLong Medical Care, Richmond, USA
| |
Collapse
|
4
|
Sayan M, Valiyev E, Akarsu I, Esendagli G, Korpeoglu T, Celik A. Primary pulmonary angiosarcoma presenting as Pancoast tumor. Asian Cardiovasc Thorac Ann 2021; 29:434-437. [PMID: 33435693 DOI: 10.1177/0218492320988456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A primary pulmonary angiosarcoma is an extremely rare entity with fewer than 30 cases reported in the literature. We found no reports of primary pulmonary angiosarcoma presenting as a Pancoast tumor. We describe a case of pulmonary angiosarcoma located in the right superior sulcus that was treated by surgery.
Collapse
Affiliation(s)
- Muhammet Sayan
- Department of Thoracic Surgery, Gazi University, Ankara, Turkey
| | - Elgun Valiyev
- Department of Thoracic Surgery, Gazi University, Ankara, Turkey
| | - Irmak Akarsu
- Department of Thoracic Surgery, Gazi University, Ankara, Turkey
| | | | | | - Ali Celik
- Department of Thoracic Surgery, Gazi University, Ankara, Turkey
| |
Collapse
|
5
|
Yu M, Huang W, Wang Y, Wang G, Wang L, Tao W, Faiz SA, Ng FH, Li H. Pulmonary angiosarcoma presenting with diffuse alveolar hemorrhage: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:74. [PMID: 33553367 PMCID: PMC7859806 DOI: 10.21037/atm-20-7441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to analyze the diagnosis and treatment of one case of pulmonary angiosarcoma (PPA) retrospectively. The main manifestation of this female patient was cough, hemoptysis and dyspnea. Computed tomography (CT) of the chest revealed multiple small nodules and ground-glass patches in both lungs suggesting of diffuse alveolar hemorrhage (DAH). Laboratory examination revealed decreased hemoglobin and platelet counting, normal coagulation function. Results of rheumatic markers testing including antinuclear antibody (ANA), anti-extractable nuclear antigen antibody (ENA), vasculitis marker, and antiphospholipid antibody were negative. Tumor markers were negative. Sputum smear, sputum culture, and alveolar lavage fluid culture showed negative results. The bone marrow smear was essentially normal. The patient received methylprednisolone pulse therapy (250 mg daily × 5 days) and immunoglobin (20 d daily × 7 days) treatment, but her hemoptysis persisted. Bilateral pleural effusion drainage found a large amount of bloody effusion, but cytology of the pleural fluid showed negative results. The clinical symptoms, laboratory results, imaging findings, and pathological features of the patient were summarized, and problems in diagnosis and treatment were discussed. A thoracoscopic lung biopsy was performed and the diagnosis of PPA was confirmed by pathology and immunohistochemistry (IHC) staining. This case suggested that the possibility of PPA should be considered in patients with DAH, but with negative findings in routine examinations, lung biopsy is usually required.
Collapse
Affiliation(s)
- Min Yu
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Weibin Huang
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Yan Wang
- Department of Pathology, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Lingwei Wang
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Weihua Tao
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Saadia A Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fung Him Ng
- Department of Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Huiping Li
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| |
Collapse
|
6
|
Aramini B, Masciale V, Bianchi D, Manfredini B, Banchelli F, D'Amico R, Bertolini F, Dominici M, Morandi U, Maiorana A. ALDH Expression in Angiosarcoma of the Lung: A Potential Marker of Aggressiveness? Front Med (Lausanne) 2020; 7:544158. [PMID: 33195295 PMCID: PMC7662079 DOI: 10.3389/fmed.2020.544158] [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: 06/05/2020] [Accepted: 10/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Primary angiosarcoma of the lung is a very aggressive rare malignant disease resulting in a severe prognosis (1). This type of cancer represents about 2% of all soft tissue sarcomas and has a high rate of metastasis through the hematogenous route. For the rarity of this malignant vascular tumor it is still challenging to set a diagnosis (1). The diagnostic features that have thus far been considered include primarily clinical and radiological findings. In some cases, immunohistochemical characteristics based on the most common markers used in pathology have been described. The aim of this report is to present two cases of angiosarcoma of the lung in which the aldehyde dehydrogenase (ALDH) marker was analyzed by immunohistochemistry. Methods: We report two cases of angiosarcoma of the lung in patients underwent lung surgery at our Unit. In addition to the standard histopathological analysis for this disease, immunohistochemistry using an ALDH1A1 antibody was performed in both of the cases. For ALDH quantification, a semi-quantitative method based on the positivity of the tumor cells was used: 0 (<5%), 1 (5–25%), 2 (>25–50%), 3 (>50–75%), 4 (>75%). Results: One patient with recurrent lung disease survived, achieving complete remission after chemo- and radiotherapy. The second patient died of recurrent disease within 5 years of diagnosis. ALDH1A1 was evaluated in both of these cases using an immunohistochemistry scoring system based on the positivity for this marker. The scores were consistent with the patients' clinical outcomes, as the lower (score 1) was observed in the patient with the better clinical outcome, while the higher (score 3) was seen in the patient with the worse outcome. Conclusion: Our data suggest that ALDH may be an important clinical marker in angiosarcoma of the lung. Although further studies need to be performed in a larger cohort of patients, we believe that, if the results will be confirmed, ALDH1A1 may be used to stratify patients in terms of prognosis and for targeted therapy.
Collapse
Affiliation(s)
- Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Masciale
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniel Bianchi
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Beatrice Manfredini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Banchelli
- Department of Medical and Surgical Sciences, Center of Statistic, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Department of Medical and Surgical Sciences, Center of Statistic, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Bertolini
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Uliano Morandi
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Maiorana
- Department of Medical and Surgical Sciences, Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
7
|
Faiek S, Tariq H, Upparapalli D, Bansal A, Sompalli S. Primary Pulmonary Epithelioid Angiosarcoma: A Rare Case Presentation of Bilateral Pneumothoraces. Cureus 2019; 11:e6514. [PMID: 32025433 PMCID: PMC6988729 DOI: 10.7759/cureus.6514] [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] [Indexed: 02/06/2023] Open
Abstract
Angiosarcoma is a rare malignant neoplasm with a very poor prognosis that originates from the vascular endothelium and accounts for only 1%-2% of all sarcomatous malignancies. It is most commonly present in the deep soft tissues. Still, a wide range of primary sites, including the adrenals, thyroid, skin, and bone, are encountered. Here, we report a 52-year-old female with a past medical history of hypertension who presented with chest pain. Her chest images showed bilateral pneumothoraces with diffuse cystic lung disease. She underwent bilateral video-assisted thoracoscopy with a tissue biopsy, which was consistent with epithelioid angiosarcoma.
Collapse
Affiliation(s)
- Saif Faiek
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Hafsa Tariq
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Deepti Upparapalli
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Aditya Bansal
- Critical Care Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Sreeja Sompalli
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| |
Collapse
|
8
|
Virarkar M, Tayyab S, Thampy R, Bhosale P, Viswanathan C. Primary pulmonary angiosarcoma: case reports and review of the literature. Asian Cardiovasc Thorac Ann 2019; 27:347-352. [PMID: 30857394 DOI: 10.1177/0218492319836910] [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] [Indexed: 11/15/2022]
Abstract
Pulmonary artery angiosarcoma is a rare malignant vascular tumor with an aggressive clinical course and a poor prognosis. Hemoptysis and shortness of breath have been reported as common clinical presentations. The exact clinicopathology is unknown. A tissue specimen obtained by percutaneous fine-needle aspiration cytology or open/thoracoscopic biopsy can confirm the diagnosis based on histopathological and immunohistochemical features. The differential diagnosis includes pulmonary thromboembolism, vascular malformations, and lung carcinoma. There is a paucity of literature describing this tumor, with only a few case reports available. There is also a lack of standardized guidelines for management, which further worsens the survival outcome. We report 3 cases of pulmonary artery angiosarcoma and review the recent literature.
Collapse
Affiliation(s)
- Mayur Virarkar
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sidra Tayyab
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rajesh Thampy
- 2 Department of Diagnostic Radiology, The University of Texas Health Science Center, Houston, Texas, USA
| | - Priya Bhosale
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chitra Viswanathan
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| |
Collapse
|