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Prasad AS, Shanbhogue KP, Ramani NS, Balasubramanya R, Surabhi VR. Non-gastrointestinal stromal tumor, mesenchymal neoplasms of the gastrointestinal tract: a review of tumor genetics, pathology, and cross-sectional imaging findings. Abdom Radiol (NY) 2024; 49:1716-1733. [PMID: 38691132 DOI: 10.1007/s00261-024-04329-1] [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: 02/16/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
There is a diverse group of non-gastrointestinal stromal tumor (GIST), mesenchymal neoplasms of the gastrointestinal (GI) tract that demonstrate characteristic pathology and histogenesis as well as variable imaging findings and biological behavior. Recent advancements in tumor genetics have unveiled specific abnormalities associated with certain tumors, influencing their molecular pathogenesis, biology, response to treatment, and prognosis. Notably, giant fibrovascular polyps of the esophagus, identified through MDM2 gene amplifications, are now classified as liposarcomas. Some tumors exhibit distinctive patterns of disease distribution. Glomus tumors and plexiform fibromyxomas exhibit a pronounced affinity for the gastric antrum. In contrast, smooth muscle tumors within the GI tract are predominantly found in the esophagus and colorectum, surpassing the incidence of GISTs in these locations. Surgical resection suffices for symptomatic benign tumors; multimodality treatment may be necessary for frank sarcomas. This article aims to elucidate the cross-sectional imaging findings associated with a wide spectrum of these tumors, providing insights that align with their histopathological features.
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Affiliation(s)
| | | | - Nisha S Ramani
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, USA
| | | | - Venkateswar R Surabhi
- Department of Abdominal Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1473, Houston, TX, 77030, USA.
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Ikeda H, Isozaki S, Kakimoto Y, Ueda A, Tsuboi A, Osawa M. A case of a motor vehicle collision suspected as associated with development of angiosarcoma. Leg Med (Tokyo) 2024; 67:102332. [PMID: 37833210 DOI: 10.1016/j.legalmed.2023.102332] [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: 08/30/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
Trauma has been suspected as a factor leading to development of angiosarcoma, a malignant soft-tissue tumor. We conducted a forensic autopsy to investigate a putative relation between a motor vehicle collision and the driver's later death from angiosarcoma. A vehicle operated by a man in his 60 s collided with an oncoming vehicle at a curve. The victim noticed no injury at the scene. However, 45 days later, he was transferred to an emergency room with dyspnea and bloody sputum. After diagnosis of angiosarcoma, he died of respiratory failure 132 days later. The bereaved family speculated about a relation between the collision and angiosarcoma onset. At autopsy, tumor cells of the scalp had metastasized to the lung, pleura, liver, and spleen. Histopathological examinations revealed characteristic features of angiosarcoma with positive immune-staining for CD31, CD34, and factor VIII. When a person dies some time after a collision, it is designated as a delayed death. In such cases, the relevance of trauma to the person's death is often an issue of concern. Because the interval between trauma and angiosarcoma development was short, only 45 days, the angiosarcoma might be coincidental. Therefore, we rejected the relation. Forensic experts sometimes need to investigate such inquiries.
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Affiliation(s)
- Haruka Ikeda
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Shotaro Isozaki
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Yu Kakimoto
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Atsushi Ueda
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Akio Tsuboi
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Motoki Osawa
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.
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3
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Salehi M, Rehman S, Davis S, Jafari HR. Angiosarcoma of gallbladder, a literature review. J Med Case Rep 2024; 18:62. [PMID: 38291481 PMCID: PMC10829334 DOI: 10.1186/s13256-023-04323-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Angiosarcoma of the gallbladder is a rare diagnostic entity rarely encountered by pathologists and has rarely been reported in literature. This review aimed to examine the clinicopathological features, immunohistochemistry, treatment, and outcomes of gallbladder angiosarcoma. METHODS A search of the PubMed, Science Direct and Google Scholar was done with the search terms ("angiosarcoma" OR "angiosarcomas") AND ("gallbladder" OR "gallbladders"). Based on inclusion and exclusion criteria, only case reports could be used for this review. RESULT 8 case reports were chosen in the end for analysis. The mean age of the patients at presentation was 65 years. It was most frequently observed in males. Abdominal pain and palpable mass were the most commonly reported symptoms. Cholelithiasis and anemia were also reported. On histopathology morphologically epithelioid appearance of angiosarcoma was evident. Cytokeratin (CK) AE1/AE3, Von willebrand factor, Factor VIII antigen, Vimentin, CD31 were positive. Meanwhile, UEA, CD34, CD117, S-100, Keratin, EMA, and CEA showed negative outcome. Surgery was the preferred method of treatment and a mean 10-months follow-up was done. CONCLUSION Despite the unavailability of convincing data, histological and immunohistochemical analyses play a major role in the diagnosis of gallbladder angiosarcoma. Nevertheless, more comprehensive clinical studies are required to provide universal guidelines for the treatment and diagnosis of angiosarcoma of the gallbladder.
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Affiliation(s)
- Mahsa Salehi
- Mazandaran University of Medical Sciences, Mazandaran, Iran.
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Booth AL, Voltaggio L, Waters R, Goldblum J, Feely MM, Agostini-Vulaj D, Pezhouh M, Gonzalez RS. Lobular capillary hemangioma (pyogenic granuloma) of the gastrointestinal tract: Clinicopathologic analysis of 34 cases. Am J Clin Pathol 2023; 160:411-416. [PMID: 37289424 DOI: 10.1093/ajcp/aqad064] [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: 02/16/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Lobular capillary hemangioma (LCH) rarely involves the gastrointestinal (GI) tract. This study describes clinicopathologic features of LCH in a cohort of GI cases. METHODS We defined lobular capillary hemangioma as "a proliferation of capillary-sized blood vessels arranged at least focally in a lobular configuration," searched departmental archives for cases, and recorded clinicopathologic findings. RESULTS We identified 34 GI tract LCHs from 16 men and 10 women; 4 patients had multiple lesions. Mean age was 64 years. Cases arose in the esophagus (n = 7), stomach (n = 3), small bowel (n = 7), and colorectum (n = 17). Twelve patients had anemia or rectal bleeding. No patients had a known genetic syndrome. The lesions manifested as mucosal polyps, with median size of 1.3 cm. Microscopically, 20 lesions were ulcerated, and most involved the mucosa, with 9 extending into the submucosa. Vessel dilation was present in 27 patients, endothelial hobnailing in 13, hemorrhage in 13, and focal reactive stromal atypia in 2. Follow-up information was available for 10 patients, none of whom developed same-site recurrence. Six of the 26 cases (23%) were extradepartmental consultations, including 2 of the multifocal cases. CONCLUSIONS Gastrointestinal tract LCHs often arise as colorectal polyps. They are typically small but can reach a few centimeters in size and can be multifocal.
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Affiliation(s)
- Adam L Booth
- Department of Pathology, Northwestern University, Chicago, IL, US
| | | | - Rebecca Waters
- Department of Pathology, MD Anderson Cancer Center, Houston, TX, US
| | - John Goldblum
- Department of Pathology, Cleveland Clinic, Cleveland, OH, US
| | - Michael M Feely
- Department of Pathology, University of Florida, Gainesville, FL, US
| | - Diana Agostini-Vulaj
- Department of Pathology and Laboratory Medicine, University of Rochester, Rochester, NY, US
| | - Maryam Pezhouh
- Department of Pathology, University of California San Diego, San Diego, CA, US
| | - Raul S Gonzalez
- Department of Pathology, Emory University Hospital, Atlanta, GA, US
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Menz A, Gorbokon N, Viehweger F, Lennartz M, Hube-Magg C, Hornsteiner L, Kluth M, Völkel C, Luebke AM, Fraune C, Uhlig R, Minner S, Dum D, Höflmayer D, Sauter G, Simon R, Burandt E, Clauditz TS, Lebok P, Jacobsen F, Steurer S, Krech T, Marx AH, Bernreuther C. Pan-keratin Immunostaining in Human Tumors: A Tissue Microarray Study of 15,940 Tumors. Int J Surg Pathol 2023; 31:927-938. [PMID: 35946088 PMCID: PMC10492441 DOI: 10.1177/10668969221117243] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/20/2022] [Accepted: 07/15/2022] [Indexed: 11/15/2022]
Abstract
To evaluate the efficiency of pan-keratin immunostaining, tissue microarrays of 13,501 tumor samples from 121 different tumor types and subtypes as well as 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry. In normal tissues, strong pan-keratin immunostaining was seen in epithelial cells. Staining intensity was lower in hepatocytes, islets of Langerhans, and pneumocytes but markedly reduced in the adrenal cortex. Pan-keratin was positive in ≥98% of samples in 62 (83%) of 75 epithelial tumor entities, including almost all adenocarcinomas, squamous cell and urothelial carcinomas. Only 17 of 121 tumor entities (13%) had a pan-keratin positivity rate between 25% and 98%, including tumors with mixed differentiation, endocrine/neuroendocrine tumors, renal cell carcinomas, adrenocortical tumors, and particularly poorly differentiated carcinoma subtypes. The 15 entities with pan-keratin positivity in 0.9%-25% were mostly of mesenchymal origin. Reduced/absent pan-keratin immunostaining was associated with high UICC stage (p = 0.0001), high Thoenes grade (p = 0.0183), high Fuhrman grade (p = 0.0049), advanced tumor stage (p < 0.0001) and lymph node metastasis (p = 0.0114) in clear cell renal cell carcinoma, advanced pT stage (p = 0.0007) in papillary renal cell carcinoma, and with advanced stage (p = 0.0023), high grade (p = 0.0005) as well as loss of ER and PR expression (each p < 0.0001) in invasive breast carcinoma of no special type (NST). In summary, pan-keratin can consistently be detected in the vast majority of epithelial tumors, although pan-keratin can be negative a fraction of renal cell, adrenocortical and neuroendocrine neoplasms. The data also link reduced pan-keratin immunostaining to unfavorable tumor phenotype in in epithelial neoplasms.
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Affiliation(s)
- Anne Menz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Natalia Gorbokon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Viehweger
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Hornsteiner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cosima Völkel
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas M. Luebke
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ria Uhlig
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Dum
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Doris Höflmayer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till S. Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Krech
- Institute of Pathology, Clinical Center Osnabrueck, Osnabrueck, Germany
| | - Andreas H. Marx
- Department of Pathology, Academic Hospital Fuerth, Fuerth Germany
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ruz Zafra P, Ruz Zafra MA, Araujo Míguez Á, Bozada García JM. Diagnosis of metastatic angiosarcoma of the aorta in colonic lesion biopsies. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:94-95. [PMID: 35748464 DOI: 10.17235/reed.2022.8780/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Angiosarcomas are rare tumors that usually entail a poor prognosis because of extensive invasiveness and high rates of distant metastasis. Gastrointestinal tract involvement is uncommon but may cause digestive bleeding. A definitive diagnosis requires histological and immunohistochemical testing. Metastatic lesions to the gut usually have a typical morphology, which must be identified in order to avoid delay in the diagnosis and potential treatment of this malignant condition.
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Affiliation(s)
- Pilar Ruz Zafra
- UGC de Aparato Digestivo, Hospital Universitario Virgen del Rocío, España
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Ma XM, Yang BS, Yang Y, Wu GZ, Li YW, Yu X, Ma XL, Wang YP, Hou XD, Guo QH. Small intestinal angiosarcoma on clinical presentation, diagnosis, management and prognosis: A case report and review of the literature. World J Gastroenterol 2023; 29:561-578. [PMID: 36688020 PMCID: PMC9850938 DOI: 10.3748/wjg.v29.i3.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/03/2022] [Accepted: 12/23/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Angiosarcoma is a highly malignant soft-tissue sarcoma derived from vascular endothelial cells that mainly occurs in the skin and subcutaneous tissues. Small-intestinal angiosarcomas are rare, and the prognosis is poor.
CASE SUMMARY We reported a case of primary multifocal ileal angiosarcoma and analyze previously reported cases to improve our understanding of small intestinal angiosarcoma. Small intestinal angiosarcoma is more common in elderly and male patients. Gastrointestinal bleeding, anemia, abdominal pain, weakness, and weight loss were the common symptoms. CD31, CD34, factor VIII-related antigen, ETS-related gene, friend leukemia integration 1, and von Willebrand factor are valuable immunohistochemical markers for the diagnosis of small-intestinal angiosarcoma. Small-intestinal angiosarcoma most commonly occurs in the jejunum, followed by the ileum and duodenum. Radiation and toxicant exposure are risk factors for angiosarcoma. After a definite diagnosis, the mean and median survival time was 8 mo and 3 mo, respectively. Kaplan-Meier survival analysis showed that age, infiltration depth, chemotherapy, and the number of small intestinal segments invaded by tumor lesions were prognostic factors for small intestinal angiosarcoma. Multivariate Cox regression analysis showed that chemotherapy and surgery significantly improved patient prognosis.
CONCLUSION Angiosarcoma should be considered for unexplained melena and abdominal pain, especially in older men and patients with a history of radiation exposure. Prompt treatment, including surgery and adjuvant chemotherapy, is essential to prolonging patient survival.
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Affiliation(s)
- Xiao-Mei Ma
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Bao-Shun Yang
- General Surgery Ward 5, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yuan Yang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Guo-Zhi Wu
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ying-Wen Li
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xiao Yu
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xiao-Li Ma
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yu-Ping Wang
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xu-Dong Hou
- General Surgery Ward 5, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Qing-Hong Guo
- Department of Gastroenterology, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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Ferre R, Kuzmiak CM. A rare presentation of pregnancy associated primary angiosarcoma of the breasts. Radiol Case Rep 2022; 17:2708-2713. [PMID: 35669222 PMCID: PMC9162934 DOI: 10.1016/j.radcr.2022.02.061] [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: 01/15/2022] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 11/27/2022] Open
Abstract
Primary angiosarcoma of the breast is a rare malignancy that is important for radiologists to recognize in young patients because its imaging appearance may mimic benign lesions resulting in advanced stages of disease and overall decreased patient survival. We present a unique case of a bilateral primary angiosarcoma in a pregnant patient in her twenties. She presented with a self-detected, rapidly enlarging, non-tender right breast mass while in her third trimester.
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Affiliation(s)
- Romuald Ferre
- Guelph Medical Imaging, 54 Cardigan Street, Guelph, Ontario, Canada
| | - Cherie M Kuzmiak
- Division of Breast Imaging, Department of Radiology, Breast Imaging Fellowship Program, UNC School of Medicine, Chapel Hill, NC
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Nguyen CL, Vu TK, Nguyen HH, Nguyen TK, Luong TH, Tran TT, Le VK, Nguyen CH. Pancreatic angiosarcoma with synchronous pancreatic ductal adenocarcinoma leading to hemosuccus pancreaticus: A surgical case report and review of literature. Ann Med Surg (Lond) 2022; 76:103547. [PMID: 35495404 PMCID: PMC9052231 DOI: 10.1016/j.amsu.2022.103547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/11/2022] [Accepted: 03/25/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Angiosarcoma of pancreas is an extremely rare disease with a poor prognosis. The clinical signs and symptoms of pancreatic angiosarcoma are nonspecific, and it is occasionally diagnosed at an advanced stage. Pancreatic angiosarcoma and Pancreatic ductal adenocarcinoma in one patient was never ever known in English literature. Case presentation A 56-year-old female was admitted with clinical and laboratory signs of gastrointestinal (GI) bleeding. Upper gastrointestinal endoscopy revealed bleeding from the ampulla of Vater. Besides, abdominal computed tomographic (CT) revealed a solid mass in the region of the pancreatic tail, which was considered the origin of bleeding. Distal pancreatectomy and splenectomy were performed because of persistent GI bleeding, and the final histological diagnosis of tumor in pancreatic tail was pancreatic ductal adenocarcinoma. After 30 days, she developed recurrent bleeding in ampulla and the abdominal CT-scan revealed a huge hematoma in omentum harem. We conducted transcatheter arterial embolization, but anemia continued to worsen. Therefore, pancreaticoduodenectomy was recommended to remove this mass, and based on postoperative histological findings, pancreatic angiosarcoma was diagnosed. After few days, laparotomy was indicated again because of persistent intra-abdominal bleeding. Despite all critical care and surgical therapeutic attempts, the patient died within two weeks after operation. Discussion A pancreatic angiosarcomas primary origin is especially rare, with the present case being the tenth accounted in the English literature. Angiosarcomas is creating a disorganized mass of cells with extravasated blood that led to characteristics, extensive amounts of hemorrhage. The clinical manifestations of pancreatic angiosarcoma are variable, and immunohistochemistry staining is mandatory, with positive staining for vascular markers, which include CD31, CD34, von Willebrand factor (vWF), factor-VIII, Ulex europaeus agglutinin 1 (UEA-1), Friend leukemia integration 1 (Fli-1) and vascular endothelial growth factor receptor (VEGFER). Conclusion We here present a report of an extremely rare case with had pancreatic angiosarcoma and synchronous pancreatic ductal adenocarcinoma with clinical picture of GI bleeding secondary to hemosuccus pancreaticus (HP).
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Affiliation(s)
- Cong Long Nguyen
- Department of Gastroenterology & Hepatology, Bach Mai Hospital, Ha Noi, Viet Nam
- School of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi, Viet Nam
| | - Truong Khanh Vu
- Department of Gastroenterology & Hepatology, Bach Mai Hospital, Ha Noi, Viet Nam
- School of Medicine and Pharmacy, Vietnam National University Hanoi, Hanoi, Viet Nam
| | - Ham Hoi Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Viet Nam
| | - Thanh Khiem Nguyen
- Department of Gastrointestinal and Hepato-pancreato-biliary Surgery, Bach Mai Hospital, Hanoi, Viet Nam
| | - Tuan Hiep Luong
- Department of Surgery, Hanoi Medical University, Viet Nam
- Corresponding author. Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam.
| | - Thi Tan Tran
- Department of Gastroenterology & Hepatology, Bach Mai Hospital, Ha Noi, Viet Nam
| | - Van Khang Le
- Radiology Center, Bach Mai Hospital, Hanoi, Viet Nam
| | - Canh Hiep Nguyen
- Pathology Center, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Takaramachi 13-1, Kanazawa, Japan
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Angiosarcoma of the Pancreas in a Pediatric Patient With an Activating KDR-Internal Tandem Duplication: A Case Report and Review of the Literature. J Pediatr Hematol Oncol 2022; 44:e751-e755. [PMID: 34224514 DOI: 10.1097/mph.0000000000002248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022]
Abstract
Pancreatic angiosarcoma is an exceedingly rare malignancy accounting for <1% of pancreatic neoplasms. A very limited number of pancreatic angiosarcomas have been reported in the literature without any cases described in children. We present the case of a 17-year-old female diagnosed with angiosarcoma of the pancreas following pancreaticoduodenectomy for a pancreatic mass, initially presumed to be a solid pseudopapillary neoplasm of the pancreas. The angiosarcoma was found to have a novel activating internal tandem duplication in the KDR gene (KDR-internal tandem duplication). We discuss the current literature on this disease process. This is the first reported case of pancreatic angiosarcoma in a pediatric patient and the first with an activating KDR-internal tandem duplication.
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Sakamoto S, Okabayashi T, Tabuchi M, Sui K, Murokawa T, Iwata J. Epithelioid angiosarcoma of the duodenum: a case report. Surg Case Rep 2022; 8:35. [PMID: 35224706 PMCID: PMC8882486 DOI: 10.1186/s40792-022-01391-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 02/22/2022] [Indexed: 12/04/2022] Open
Abstract
Background Angiosarcomas are rare malignant tumors that arise from the endothelium of blood vessels. They occur most commonly in the skin and soft tissue, and less commonly in the breast, liver, bone, and spleen. Gastrointestinal angiosarcomas are extremely rare. Herein, we present a case of duodenal epithelioid angiosarcoma that was treated with surgical resection. Case presentation A 68-year-old man presented with a 1-month history of fatigue and hypotension. He visited the outpatient clinic for a routine follow-up. Laboratory examination revealed anemia. Esophagogastroduodenoscopy revealed multiple duodenal lesions with central ulceration. A biopsy showed a sheet-like arrangement of large round and spindle-shaped tumor cells that were positive for CD31. Based on the histological and immunohistochemical staining findings, an epithelioid angiosarcoma was diagnosed. Computed tomography (CT) and positron emission tomography–CT revealed no lymph node metastasis or distant metastasis. Radical subtotal stomach-preserving pancreatoduodenectomy with lymphadenectomy was performed. After removing the specimen, reconstruction was performed using the Child procedure. Grossly, two dark-red polypoid tumors were found in the second portion of the duodenum. Histological evaluation revealed proliferation of malignant round and polygonal cells arranged in sheets and spindle-like cells arranged in bundles. Vasoformative structures were recognized as slit-like spaces containing red blood cells. Immunohistochemical staining demonstrated that the tumor cells were positive for CD31. These findings confirmed the diagnosis of epithelioid angiosarcoma in the duodenum. The patient’s postoperative course was uneventful. The patient was discharged on postoperative day 19 without any complications. At a follow-up examination in the outpatient clinic at postoperative 4 months, no evidence of recurrence was detected. Conclusion The present report describes a case of duodenal epithelioid angiosarcoma. Duodenal angiosarcomas may cause anemia and gastrointestinal bleeding. Because angiosarcomas sometimes show epithelioid cytomorphology, immunohistochemical analysis is useful for confirming the diagnosis.
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Affiliation(s)
- Shinya Sakamoto
- Department of Gastroenterological Surgery at Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Takehiro Okabayashi
- Department of Gastroenterological Surgery at Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan.
| | - Motoyasu Tabuchi
- Department of Gastroenterological Surgery at Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Kenta Sui
- Department of Gastroenterological Surgery at Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Takahiro Murokawa
- Department of Gastroenterological Surgery at Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
| | - Jun Iwata
- Department of Diagnostic Pathology at Kochi Health Sciences Center, 2125-1 Ike, Kochi-City, Kochi, 781-8555, Japan
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Multiple Primary Angiosarcomas of the Colon. Case Rep Pathol 2021; 2021:7237379. [PMID: 34545314 PMCID: PMC8449722 DOI: 10.1155/2021/7237379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Gastrointestinal angiosarcomas are rare and represent less than 1% of all gastrointestinal tract malignancies, with most occurring in the stomach and small intestine. Occurrence in the colorectal segments is considered extremely rare. Case Report. We describe the case of a 61-year-old male with multiple primary angiosarcomas of the colon who presented with fever and abdominal pain. The patient was initially hospitalized and treated as having an infectious disease. A multislice computed tomography (MSCT) scan revealed multiple soft tissue tumors in the region of the left iliopsoas and gluteus medius muscles. After developing hematochezia, a colonoscopy was performed which found an ulcerated tumor in the sigmoid colon. The small tissue biopsy taken during the procedure presented diagnostic difficulties and was given a preliminary diagnosis of gastrointestinal stromal tumor (GIST). Examination of the resected colon segment and surrounding fat tissue revealed four separate tumors. Microscopically, the tumors were composed of solid sheets of spindle and epithelioid neoplastic cells with prominent nucleoli and numerous mitotic figures and immunohistochemically positive for ERG, CD31, CD34, vimentin, and CD117, while negative for CK7, CK20, CD20, CD3, CD45, TTF-1, PAN-CK, ALK, Mpox, S-100, and DOG1, leading to the final diagnosis of multiple colonic angiosarcomas. The patient's condition declined rapidly and he passed away from multiple organ failures 60 days after initial hospitalization. Conclusion Both clinical and pathological diagnoses of colorectal angiosarcoma are challenging. Patients are present with nonspecific symptoms leading to mismanagement and late diagnosis. A definitive pathological diagnosis relies on immunohistochemical staining for endothelial markers. Misdiagnosis as poorly differentiated adenocarcinoma or GIST is possible in limited tissue biopsies.
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Squillaci S, Marasco A, Pizzi G, Chiarello M, Brisinda G, Tallarigo F. Primary post-radiation angiosarcoma of the small bowel. Report of a case and review of the literature. Pathologica 2021; 112:93-101. [PMID: 32760052 PMCID: PMC7931569 DOI: 10.32074/1591-951x-3-20] [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: 01/11/2020] [Accepted: 02/19/2020] [Indexed: 01/12/2023] Open
Abstract
Angiosarcomas developing in unusual sites such as the small bowel are rare, and fewer than 65 cases have been reported in the literature. They are not uncommonly associated with a known eliciting factor. Thus, among hitherto described cases of angiosarcoma of the small bowel, 16 were radiation-induced. One additional example of ileal post-irradiation angiosarcoma (PRA) in a 72-year-old female patient with a past history of uterine leiomyosarcoma is herein reported as a reminder of this causal association. The morphologic and immunohistochemical clues leading to the correct diagnosis of PRA of the small bowel and the differential diagnostic problems are discussed; a comprehensive review of the literature has also been performed with a focus on survival.
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Affiliation(s)
- Salvatore Squillaci
- Division of Anatomic Pathology, Hospital of Vallecamonica, Esine (Bs), Italy
| | - Angela Marasco
- Division of Anatomic Pathology, Hospital "San Giovanni di Dio", Crotone, Italy
| | - Giandomenico Pizzi
- Division of Anatomic Pathology, Hospital "San Giovanni di Dio", Crotone, Italy
| | | | | | - Federico Tallarigo
- Division of Anatomic Pathology, Hospital "San Giovanni di Dio", Crotone, Italy
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14
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Zhang Y, Chen Y, Li J, Li S, Wu Y, Zhan D, Wen X, Wang M. Poor prognosis of primary duodenum angiosarcoma: a case report. ANZ J Surg 2021; 91:E600-E602. [PMID: 33577107 DOI: 10.1111/ans.16589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Yuanchuan Zhang
- Department of Gastrointestinal Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Yuanyuan Chen
- Department of Pathology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Junpeng Li
- Department of Radiology, The Third People's Hospital of Chengdu, Chengdu, China
| | - Shihong Li
- Department of Gastrointestinal Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Yingxin Wu
- Department of Gastrointestinal Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Dafang Zhan
- Department of Gastrointestinal Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Xing Wen
- Department of Gastrointestinal Surgery, The Third People's Hospital of Chengdu, Chengdu, China
| | - Meng Wang
- Department of Gastrointestinal Surgery, The Third People's Hospital of Chengdu, Chengdu, China
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15
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Schizas D, Mastoraki A, Giannakodimos I, Giannakodimos A, Ziogou A, Katsaros I, Frountzas M, Koutelidakis I, Vassiliu P, Pikoulis E. Primary Angiosarcoma of the Gastrointestinal Tract: A Systematic Review of the Literature. J INVEST SURG 2020; 35:400-408. [PMID: 33342318 DOI: 10.1080/08941939.2020.1853283] [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: 01/20/2023]
Abstract
Primary Gastrointestinal Angiosarcoma (PGAS) constitutes a rare malignant tumor arising from vascular or lymphatic endothelial cells. The aim of this study was to review the available literature on PGAS and to elucidate its biological behavior and optimal therapeutic approach. PubMed and Embase bibliographical databases were systematically searched (last search April 8th, 2020) for studies concerning PGAS. Ninety-eight studies met our inclusion criteria, involving 110 patients (male/female = 1.5) with an age of 62.40 ± 17.84 (mean, SD) years. They were most frequently located at small (44.5%) and large intestine (35.5%), while 12.7% were multifocal. Surgical resection of the tumor was conducted at 84.0% of the cases combined with adjuvant therapy at 12.3%. One-year cumulative survival was 55.18% (95% CI: 34.33%-71.84%) for large intestine, 30.2% (95% CI: 17.1%-44.5%) for small intestine, whereas multifocal PGAS had a 6-months cumulative survival of 23.08% (95% CI: 5.58%-47.46%). Therefore, PGAS is an extremely rare entity with atypical clinical presentation, challenging diagnosis and aggressive behavior. High clinical suspicion is crucial for its prompt management. Further studies and the development of novel therapeutic agents are required in order to improve survival.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ilias Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Alexios Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Afroditi Ziogou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece
| | - Ioannis Koutelidakis
- Second Department of Surgery, Aristotle University of Thessaloniki, G.Gennimatas General Hospital, Thessaloniki, Greece
| | - Pantelis Vassiliu
- Fourth Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Greece
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16
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Zheng CH, Wang Y, Liu TT, Ding XY, Qu JJ, Su ZD. Is Pathologic Complete Response the Surrogate in Primary Gastric Angiosarcoma Undergoing Doxorubicin-Based Neoadjuvant Chemotherapy? A Case Report. Int J Gen Med 2020; 13:1515-1521. [PMID: 33363400 PMCID: PMC7754096 DOI: 10.2147/ijgm.s280375] [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: 09/09/2020] [Accepted: 11/24/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Angiosarcoma is a malignant tumor with low incidence. Especially in the advanced tumors, there is still a lack of knowledge of evidence-based medicine. Case Presentation We report a case of a 55-year-old woman with abdominal pain of 2 months of duration, which had increased in severity for 2 weeks prior to the presentation. The diagnosis is primary gastric angiosarcoma. We performed multiple disciplinary team (MDT), and doxorubicin-based neoadjuvant chemotherapy (NAC) was proposed. After two cycles of NAC, a computed tomography (CT) scan showed complete regression compared with the previous scan. An open surgery was done, and surgical specimens were confirmed as a pathological complete response (PCR) by pathological and immunohistochemical examination, but unfortunately, the patient suffered a relapse after the surgery in 3 months. Conclusion Repeated endoscopic biopsy and biopsy specimen examinations can improve accuracy in diagnosis. It seems that NAC could be a candidate for advanced primary gastric angiosarcomas. But after the rapid relapse, we are wondering whether pathologic complete response is the surrogate in primary gastric angiosarcoma undergoing NAC.
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Affiliation(s)
- Chun-Hui Zheng
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.,Department of Oncology Surgery, Weifang People's Hospital, Weifang, Shandong, People's Republic of China
| | - Yang Wang
- Department of General Surgery, Weifang People's Hospital, Weifang, Shandong, People's Republic of China
| | - Ting-Ting Liu
- Department of Breast Surgery, Tai'an Central Hospital, Tai'an, Shandong, People's Republic of China
| | - Xiao-Yan Ding
- Department of Laboratory Medicine, Weifang Medical University, Weifang, Shandong, People's Republic of China
| | - Jian-Jun Qu
- Department of Oncology Surgery, Weifang People's Hospital, Weifang, Shandong, People's Republic of China
| | - Zhi-De Su
- Department of Pharmacy, Weifang People's Hospital, Weifang, Shandong, People's Republic of China
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17
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Bleeding "sarcomatosis" as a rare presentation of vascular graft-related angiosarcoma: case report and review of the literature. BMC Surg 2020; 20:291. [PMID: 33218319 PMCID: PMC7678180 DOI: 10.1186/s12893-020-00966-7] [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: 05/16/2020] [Accepted: 11/15/2020] [Indexed: 01/21/2023] Open
Abstract
Background Angiosarcoma is a rare malignant tumor, originating from vascular endothelial cells, accounting for approximatively 1–2% of soft tissue sarcomas. It is characterized by a rapid proliferation and high metastatic potential. Some cases of angiosarcoma are described in association with vascular prosthesis, orthopedic devices and foreign bodies. Hereby, we report a case of a patient treated with the endovascular placement of a PTFE aorto bis-iliac prosthesis for aortic aneurysm, who developed a graft-related angiosarcoma with bone and peritoneal localizations. The peritoneal “sarcomatosis” led to an acute presentation with hemoperitoneum and anemia. We perform a thorough review of the literature summarizing the description of similar cases, their epidemiology and the possibilities for treatment. Case presentation An 84-year-old male with a history of abdominal aortic aneurysm endovascular repair presented to our emergency department complaining with low back pain radiating to the left limb. He underwent a type II endoleak embolization of the aneurysmal sac nine days before. During hospitalization he underwent a spine MRI which documented a vertebral alteration of non-univocal interpretation. Vertebral biopsy was performed revealing groups of cells of uncertain nature. He lately underwent percutaneous L2–L4 arthrodesis. Forty-two days after admission, he developed acute anemia. Emergency laparotomy revealed a massive hemoperitoneum and actively bleeding peritoneal nodules. Abdominal packing was performed, and several nodules were sent for definitive histological examination. After surgery, he developed progressive and severe hypovolemic shock and expired on postoperative day 5. Conclusions Angiosarcoma associated with foreign bodies, especially vascular prosthesis, is a very rare entity. In patients who have a history of prosthetic vascular graft placement that present with lumbar pain, osteolytic changes at radiologic imaging or the development of ascites, angiosarcoma should be considered in the differential diagnosis. Despite the poor prognosis, a prompt diagnosis might give access to an adequate treatment planning, with the aim for disease control and increased survival.
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18
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Gutnik L, Goold E, Madsen J, Clayton F, Varghese T, Glasgow R. Primary Esophageal Angiosarcoma. Ann Thorac Surg 2020; 111:e365-e367. [PMID: 33096067 DOI: 10.1016/j.athoracsur.2020.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 07/10/2020] [Accepted: 07/18/2020] [Indexed: 11/19/2022]
Abstract
Primary esophageal angiosarcoma is an extremely rare cancer. Thus, evidence-based guidance on diagnosis and treatment is lacking. The current workup and management is extrapolated from other esophageal and angiosarcoma pathology. We describe a case report that depicts unique diagnostic and therapeutic challenges.
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Affiliation(s)
- Lily Gutnik
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - Eric Goold
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Jared Madsen
- School of Medicine, University of Utah, Salt Lake City, Utah
| | - Frederic Clayton
- Department of Pathology, University of Utah, Salt Lake City, Utah
| | - Thomas Varghese
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Robert Glasgow
- Department of Surgery, University of Utah, Salt Lake City, Utah
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19
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Abstract
RATIONALE Angiosarcoma is a highly invasive tumour with a low incidence rate but high rates of local recurrence and distant metastasis and a poor prognosis. Understanding the endoscopic characteristics of angiosarcoma will help with early diagnosis and treatment of this disease. PATIENT CONCERNS The patient was a 77-year-old female who was admitted to the hospital due to recurring melena for 3 months. Outpatient gastroscopy showed that the patient had multiple gastric erosions. Colonoscopy revealed the presence of multiple protruding lesions in the colon and multiple rectal polyps. Pathological biopsy indicated that the patient had a tubular adenoma, which was removed by endoscopic resection. DIAGNOSES Postsurgical pathologic assessment suggested that the histological subtype was epithelioid angiosarcoma. Positron emission tomography-computed tomography (PET-CT) revealed multiple metastases in the lymph nodes and bone. INTERVENTIONS The patient underwent acid suppression to protect the stomach, fluid supplementation and red blood cell infusion, and subsequently, surgery, radiotherapy and chemotherapy were recommended. The patient's family refused further treatments for the patient and requested discharge. OUTCOMES The patient refused further treatment and was not followed-up. LESSONS Colorectal angiosarcoma is an extremely rare and highly malignant tumour, and understanding its endoscopic morphology will help aid in its diagnosis.
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Affiliation(s)
| | | | - XiaoGang Wang
- Department of Nuclear Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Province, China
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20
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Lee HE, Torbenson MS, Wu TT, Chandan VS. Aberrant keratin expression is common in primary hepatic malignant vascular tumors: A potential diagnostic pitfall. Ann Diagn Pathol 2020; 49:151589. [PMID: 32947230 DOI: 10.1016/j.anndiagpath.2020.151589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022]
Abstract
Malignant vascular neoplasms such as epithelioid hemangioendothelioma (EHE) and angiosarcoma (AS) can arise within the liver. The aim of this study was to study the expression of keratins CK7, AE1/AE3 and OSCAR in primary hepatic EHE and AS. 9 cases of hepatic EHE and 13 cases of hepatic AS were stained with ERG, CK7, keratin AE1/AE3 and keratin OSCAR. Their expression was graded as 1+ (1-25% of tumor cells positive), 2+ (26-50%), 3+ (51-75%) or 4+ (>75%). ERG was positive in all 9 (100%) EHEs and all 13 (100%) ASs. CK7 was positive in 5/9 (56%) EHEs (2, 1+; 1, 2+; 1, 3+; 1, 4+) and 1/13 (8%) AS (2+). Keratin OSCAR was positive in 6/9 (67%) EHEs (5, 1+; 1, 2+) and 4/13 (31%) ASs (2, 1+; 1, 2+; 1, 4+). Keratin AE1/AE3 was positive in 6/9 (67%) EHEs (3, 1+; 3; 2+) and 4/13 (31%) ASs (2, 1+; 1, 2+; 1, 4+). Overall, 6/ 9 (67%) EHEs were positive for at least one keratin marker, of which 5 were positive for all 3 keratins (AE1/AE3, OSCAR and CK7) while 1 was positive only for 2 keratins (OSCAR and AE1/AE3). 4/13 (31%) of ASs were positive for both keratins OSCAR and AE1/AE3, of which 1 case was also positive for CK7. Aberrant keratin expression is common in primary hepatic EHEs (67%) and ASs (31%). Awareness of this diagnostic pitfall is important for avoiding misdiagnosis of these primary hepatic malignant vascular tumors as carcinomas.
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Affiliation(s)
- Hee Eun Lee
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Michael S Torbenson
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Tsung-Teh Wu
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Vishal S Chandan
- Department of Pathology and Laboratory Medicine, University of California-Irvine, CA, United States of America.
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Apatinib for Treatment of Locally Advanced Rectal Angiosarcoma: A Case Report. IRANIAN RED CRESCENT MEDICAL JOURNAL 2020. [DOI: 10.5812/ircmj.102087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Introduction: Primary colorectal angiosarcoma is a highly rare malignant tumor. There is no standard treatment method for this disease. No treatment of rectal angiosarcoma with apatinib has been reported so far. Case Presentation: In the current study, an 87-year-old male presented with the symptoms of frequent defecation for more than one month in Hangzhou, China, in 2018. The patient was initially diagnosed with a rectal stromal tumor. The patient underwent ultrasound-guided transrectal mass puncture in the next treatment. However, immunohistochemical examinations confirmed the initial diagnosis of rectal angiosarcoma. The patient had advanced age and rectal angiosarcoma with metastasis; he had no surgical indications, and we tried to use apatinib 250 mg/d treatment to control the progression of the lesion. Then, he received apatinib, a novel tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2). The patient has been stable to apatinib with a dose of 250 mg daily by now. Conclusions: Apatinib may play an important role in the treatment of unresectable angiosarcoma.
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22
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Kang HW, Shin JY, Choi JW. Primary Angiosarcoma of the Mesentery: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:423-427. [PMID: 36237378 PMCID: PMC9431807 DOI: 10.3348/jksr.2020.81.2.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/10/2019] [Accepted: 08/04/2019] [Indexed: 11/15/2022]
Abstract
혈관육종은 림프관 및 혈관 내피세포에서 기원하는 피부와 연부조직에서 흔히 발생하는 악성종양으로, 장간막에서 발생한 혈관육종은 드물게 보고되어 왔다. 저자들은 CT와 MRI에서 점진적으로 조영증강되는 종괴로 내부에 출혈과 괴사 부분을 포함한 원발성 장간막 혈관육종의 1예를 경험하여 이를 보고하는 바이다.
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Affiliation(s)
- Hyeon Wook Kang
- Department of Radiology, Daegu Fatima Hospital, Daegu, Korea
| | - Ji Yeol Shin
- Department of Radiology, Daegu Fatima Hospital, Daegu, Korea
| | - Ju Wan Choi
- Department of Radiology, Daegu Fatima Hospital, Daegu, Korea
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23
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Tan NJH, Keh CHL, Lui SA, Thamboo TP. Epithelioid angiosarcoma in a perforated appendix. Pathology 2019; 52:276-278. [PMID: 31883674 DOI: 10.1016/j.pathol.2019.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/04/2019] [Accepted: 09/11/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nicholas Jin Hong Tan
- Department of Pathology, National University Hospital, National University Health System, Singapore.
| | - Christopher Hang Liang Keh
- Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Su Ann Lui
- Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore
| | - Thomas Paulraj Thamboo
- Department of Pathology, National University Hospital, National University Health System, Singapore
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Ricchetti T, Paci M, Cavazza A, Ferrari G, Annessi V, De Franco S, Sgarbi G. A Case of Metastatic Epithelioid Angiosarcoma in the Lamina Propria of a Sigmoid Tubulovillous Adenoma. TUMORI JOURNAL 2019; 91:210-2. [PMID: 15948556 DOI: 10.1177/030089160509100222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Epithelioid angiosarcoma is an extremely rare tumor. It is generally a secondary tumor and the preferred sites of such metastases are the heart, pericardium, lung, breast, liver, spleen, bone, and brain. In rare cases the lung has been described as the primary site. The prognosis of this neoplasm is extremely poor. We report a case of epithelioid angiosarcoma with multiple bilateral lung infiltration, bone metastasis, and metastasis of the lamina propria of a tubulovillous adenoma of the colon.
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Affiliation(s)
- Tommaso Ricchetti
- Department of Thoracic Surgery and Pathology, Santa Maria Nuova Hospital, Reggio Emilia, Italy.
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25
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Wu WH, Ji QL, Li ZZ, Wang QN, Liu SY, Yu JF. Mammography and MRI manifestations of breast angiosarcoma. BMC WOMENS HEALTH 2019; 19:73. [PMID: 31182098 PMCID: PMC6558876 DOI: 10.1186/s12905-019-0769-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/20/2019] [Indexed: 01/18/2023]
Abstract
Background Breast angiosarcoma is rare and previous studies only focus on its pathology. This study aimed to summarize its imaging features. Methods Overall 17 patients pathologically confirmed with breast angiosarcoma were recruited. Eight patients underwent preoperative mammography, and 13 received preoperative MRI scan. The mammography and MRI findings were classified according to the ACR-BI-RADS-mammography/MR lexicon. Results Mammography showed that 3 cases developed diffuse asymmetry occupying two or more quadrants of the affected breast and that 5 patients had lobulated or oval masses. The 13 patients’ lesions presented as diffuse and slightly/significantly high homogeneous or heterogeneous signals on T1-weighted images, while the necrotic and cystic parts had relatively low signals. The hemorrhagic lesions in 7 cases had high signals on both T1- and T2-weighted images. A hemosiderin ring at the edge of an old hemorrhagic lesion had long and short signals on the T1- and T2-weighted images, respectively. Contrast-enhanced MRI revealed that the 13 patients’ lesions had significant heterogeneous enhancement. Significant enhancement was observed in the early phase, and varying degrees of concentric enhancement was seen in the delayed phase. Conclusions The mammography findings are nonspecific. MRI scan is helpful in determining the malignancy of the lesions. Breast angiosarcoma usually shows heterogeneous signals on both T1-weighted and T2-weighted images. Due to their incomplete lumens and lack of thrombocytes, patients with angiosarcoma have a higher incidence of bleeding (nearly 50% in this study) than those with other malignant tumors. The pattern of the enhancement curve helps to distinguish this disease from the typical types of breast cancer.
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Affiliation(s)
- Wen-Hai Wu
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Qing-Lin Ji
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Zhi-Zheng Li
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Qian-Nan Wang
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Shu-Ying Liu
- Department of Radiology, JiNan ZhangQiu maternal and child health hospital, ShanDong, 250200, China
| | - Jin-Fen Yu
- Magnetic Resonance Room, JiNan ZhangQiu District Hospital of TCM, ShanDong, 250200, China.
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26
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Agostini-Vulaj D, Whitney-Miller CL, Cellini C, Huber AR. Florid Vascular Proliferation of the Small Bowel and Colon, a Potential Masquerader of Malignancy: Report of Three Cases. Int J Surg Pathol 2019; 27:609-612. [PMID: 30942096 DOI: 10.1177/1066896919837665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Vascular abnormalities and lesions of the small bowel and colon are rare. A florid vascular proliferation (FVP) associated with colon obstruction and intussusception has been described and can mimic malignant vascular tumors such as angiosarcoma. In this article, we report a case of colonic FVP associated with colon obstruction, a case of small bowel FVP associated with a Meckel's diverticulum, and a case of small bowel FVP with intussusception. All cases occurred in older adults (mean 73 years of age, range 62-80 years of age). FVP grossly appeared as a mass-like lesion in one small bowel case, while the other cases did not demonstrate a grossly identifiable mass. Histologically, all cases demonstrated a transmural vascular proliferation with plump endothelial cells. No significant cytologic atypia was seen, and mitotic figures were rare. No recurrence was seen in all cases with an average follow-up of 22 months. It is important to be aware of this entity as it appears to be a nonneoplastic reactive process, unlike some of its histologic mimics.
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Affiliation(s)
| | | | | | - Aaron R Huber
- 1 University of Rochester Medical Center, Rochester, NY, USA
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27
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Nai Q, Ansari M, Liu J, Razjouyan H, Pak S, Tian Y, Khan R, Broder A, Bagchi A, Iyer V, Hamouda D, Islam M, Sen S, Yousif A, Hu M, Lou Y, Duhl J. Primary Small Intestinal Angiosarcoma: Epidemiology, Diagnosis and Treatment. J Clin Med Res 2018; 10:294-301. [PMID: 29511417 PMCID: PMC5827913 DOI: 10.14740/jocmr3153w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/09/2017] [Indexed: 02/06/2023] Open
Abstract
Angiosarcoma is an aggressive mesenchymal sarcoma of endothelial cell origin with high mortality. Its occurrence in the small intestine is exceedingly low. In addition to the rarity of small intestine angiosarcoma, the nonspecific early clinical symptoms obscure the suspicion of such tumors and thereby delay the diagnosis. In a hope to improve the knowledge of this rare but fatal neoplasm, we report one case of angiosarcoma of duodenum and jejunum in a 73-year-old man. Furthermore, we summarize and analyze the common clinical features, tumor markers, treatment, and survival of previous reported cases of this malignancy. Small bowel angiosarcoma occurs more often in men than women (1.6:1). The median age at diagnosis is 68.5 years. The overall median survival time is 150 days; the median survival time in female (300 days) is longer than that of male patients (120 days). Von Willebrand factor (vWF), CD31, CD34, vimentin, and Ulex europaeus agglutinin 1 appear to be the most useful markers for the diagnosis. The majority of the patients underwent surgical resection alone or surgery with subsequent chemotherapy. The patients treated with surgery plus chemotherapy survive longer than those underwent surgical resection only (median 420 days, n = 7 vs. 96.5 days, n = 26, respectively; P = 0.0275). Further studies of more cases are needed for a better understanding of this rare entity, as well as the development of effective strategies for prevention, early diagnosis, and treatment.
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Affiliation(s)
- Qiang Nai
- University of Toledo Medical Center, Toledo, OH 43614, USA
- These authors contributed equally
| | - Mohammad Ansari
- Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
- These authors contributed equally
| | - Jing Liu
- School of Public Health, Shandong University, Jinan 250012, China
| | - Hadi Razjouyan
- Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
| | - Stella Pak
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Yufei Tian
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Rafay Khan
- Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | - Arkady Broder
- Saint Peter's University Hospital, New Brunswick, NJ 08901, USA
| | - Arindam Bagchi
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Veena Iyer
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | - Danae Hamouda
- University of Toledo Medical Center, Toledo, OH 43614, USA
| | | | - Shuvendu Sen
- Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
| | | | - Man Hu
- Department of Radiation Oncology and Shandong Province Key Laboratory of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
- Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Yali Lou
- Department of Neurology, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
| | - Jozsef Duhl
- Raritan Bay Medical Center, Perth Amboy, NJ 08861, USA
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28
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Wang Q, Zhao T, Mi BT, Zhang YL, Wei R, Tong HL, Wu M. Primary Colonic Angiosarcoma Seen in a Patient on Calcium Channel Blocker: A Case Report with Summary Analysis of 32 Other Cases from the Literature. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:254-261. [PMID: 29511155 PMCID: PMC5850845 DOI: 10.12659/ajcr.907287] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Patient: Female, 54 Final Diagnosis: Primary colonic angiosarcoma Symptoms: Rectal bleeding Medication: Levamlodipine Besylate Clinical Procedure: Hemicolectomy Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Qi Wang
- Division of Gastroenterology, Department of Internal Medicine, Second Hospital of Shanxii Medical University, Taiyuan, Shanxi, China (mainland)
| | - Ting Zhao
- Division of Gastroenterology, Department of Internal Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Bian-Tao Mi
- Division of Gastroenterology, Department of Internal Medicine, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Yong-Lin Zhang
- Department of Radiology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Rong Wei
- Department of Pathology, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Hong-Lin Tong
- Department of Surgery, Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China (mainland)
| | - Maoxin Wu
- Department of Pathology, Stony Brook University Hospital, Stony Brook, NY, USA
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29
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Worth PJ, Turner M, Hammill CW. Incidental Angiosarcoma of the Pancreas: A Case Report of a Rare, Asymptomatic Tumor. J Pancreat Cancer 2017. [DOI: 10.1089/crpc.2017.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick J. Worth
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Michael Turner
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Chet W. Hammill
- Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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30
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Gaballah AH, Jensen CT, Palmquist S, Pickhardt PJ, Duran A, Broering G, Elsayes KM. Angiosarcoma: clinical and imaging features from head to toe. Br J Radiol 2017; 90:20170039. [PMID: 28471264 DOI: 10.1259/bjr.20170039] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Angiosarcoma is a rare, aggressive subtype of soft-tissue sarcoma with a propensity for local recurrence and metastasis associated with a generally poor prognosis, unless diagnosed early. Given the vascular endothelial cell origin of angiosarcoma, tumours may develop in essentially any organ; however, there is a predilection for the skin where half of all tumours arise, increasing in prevalence with age. The most common risk factors are chronic lymphoedema and history of radiation. We review the most important radiological findings along the spectrum of angiosarcoma from head to toe throughout the body, including uncommon and rare locations. Key imaging features of angiosarcoma across multiple organ systems will be described, as well as the impact on management and prognosis.
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Affiliation(s)
- Ayman H Gaballah
- 1 Department of Diagnostic Radiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Corey T Jensen
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Palmquist
- 3 Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Perry J Pickhardt
- 4 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Alper Duran
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Broering
- 3 Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Elsayes
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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31
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Worth PJ, Turner M, Hammill CW. Incidental Angiosarcoma of the Pancreas: A Case Report of a Rare, Asymptomatic Tumor. J Pancreat Cancer 2017; 3:24-27. [PMID: 30631836 PMCID: PMC5933483 DOI: 10.1089/pancan.2017.0007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Angiosarcoma of the pancreas is a very rare neoplasm accounting for 0.1% of pancreatic malignancies. This tumor is biologically very aggressive and frequently diagnosed at an unresectable stage. Case Presentation: Herein, we report a case of an incidentally discovered angiosarcoma that was removed with a robotic distal pancreatectomy and discuss the current literature on this rare disease. Conclusion: This is the fifth reported case of primary angiosarcoma of the pancreas and the first case to be identified incidentally. Unlike the other cases where survival was limited due to advanced disease, the patient presented here underwent surgical resection and remains disease free after 1 year of follow-up.
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Affiliation(s)
- Patrick J Worth
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Michael Turner
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Chet W Hammill
- Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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32
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Jehangir A, Le BH, Shogbesan O. Angiosarcoma of the Colon Presenting with Chronic Diarrhea, Rectal Bleeding, and Pelvic Discomfort. Cureus 2017; 9:e1117. [PMID: 28451476 PMCID: PMC5406170 DOI: 10.7759/cureus.1117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/26/2017] [Indexed: 01/31/2023] Open
Abstract
Colonic angiosarcoma is a rare malignancy representing only 0.0012% of all colorectal malignancies. Due to its non-specific symptoms, diagnosis is often delayed. However, because of the aggressive nature of this malignancy, it is important to keep it in the differential diagnosis of rectal bleeding, pelvic discomfort, chronic diarrhea, and weight loss in patients with risk factors. We present a case of angiosarcoma of the colon in a 74-year-old female with a remote history of chemo-radiation for anal squamous cell carcinoma (ASCC).
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Affiliation(s)
- Asad Jehangir
- Hospitalist Services, Reading Health System, Reading Hospital
| | - Brian H Le
- Pathology, Reading Health System, Reading Hospital
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33
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Sousa MO, Viveiros RC, Fernandes D, Ribeiro R, Ferreira L, Capelinha AF. Primary angiosarcoma of the small bowel: A case report. ACTA ACUST UNITED AC 2017. [DOI: 10.5348/crint-2017-37-cr-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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34
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Meeks M, Grace S, Veerapong J, Chen Y, Cao D, Zhou Y, Lai JP. Primary Angiosarcoma of the Pancreas. J Gastrointest Cancer 2016; 48:369-372. [PMID: 27228987 DOI: 10.1007/s12029-016-9837-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Marshall Meeks
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
| | - Shane Grace
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
| | - Jula Veerapong
- Department of Surgery, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Yongxin Chen
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA
| | - Dengfeng Cao
- Department of Pathology and Immunology, Washington University School of Medicine, Saint Louis, MO, USA
| | - Yihua Zhou
- Department of Radiology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Jin-Ping Lai
- Department of Pathology, Saint Louis University School of Medicine, 1402 S. Grand Blvd, St Louis, MO, 63104, USA.
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35
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Wang B, Song B, Oster C, Cao J, Raza A, Wang J. Coexistence of intestinal Kaposi sarcoma and plasmablastic lymphoma in an HIV/AIDS patient: case report and review of the literature. J Gastrointest Oncol 2016; 7:S88-95. [PMID: 27034819 PMCID: PMC4783623 DOI: 10.3978/j.issn.2078-6891.2015.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 01/26/2015] [Indexed: 12/19/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection or acquired immunodeficiency disease (AIDS) is associated with increased risk for various malignancies including Kaposi sarcoma (KS) and lymphoma. We report a rare case of coexistence of KS and plasmablastic lymphoma (PBL) in the gastrointestinal (GI) tract in a HIV/AIDS patient. A brief review of literature is also presented.
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Affiliation(s)
- Bing Wang
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Bingbing Song
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Cyrus Oster
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Jeffery Cao
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Anwar Raza
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
| | - Jun Wang
- Department of Pathology, Loma Linda University Medical Center, CA 92354, USA
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36
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Agaimy A, Ben-Izhak O, Lorey T, Scharpf M, Rubin BP. Angiosarcoma arising in association with vascular Dacron grafts and orthopedic joint prostheses: clinicopathologic, immunohistochemical, and molecular study. Ann Diagn Pathol 2016; 21:21-8. [PMID: 27040926 DOI: 10.1016/j.anndiagpath.2016.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/06/2016] [Indexed: 01/18/2023]
Abstract
Angiosarcoma may rarely arise near an inert foreign body material including vascular grafts and metal joint prostheses. Sixteen such cases have been reported since 1972 but mostly in the radiologic or surgical literature without detailed histologic or molecular analyses. We herein describe the clinicopathologic and molecular features of 2 new cases and reanalyzed 3 previously reported cases of angiosarcoma that developed in association with Dacron grafts for vascular repair (n=3) or related to orthopedic metal prostheses for joint replacement (n=2). All patients were men aged 50 to 84 years (median, 71 years). Mean time to development of angiosarcoma was 9 years (range, 4.6-17 years). Symptoms were recurrent bleeding/loosening of prosthesis for suspected infection (in the joint prosthesis cases) and fatigue, weight loss, and abdominal symptoms in the Dacron-associated cases. Four patients died of disease within 1 to 24 months (mean, 8 months). One patient was alive after radical surgery, radiochemotherapy, and embolization of pulmonary metastases (17 months). Histologically, all tumors were high-grade epithelioid neoplasms with a predominant solid growth pattern and variable vasoformation. All tumors expressed CD31, ERG, FLI-1, and variably pancytokeratin (diffuse in 3 cases), but none expressed D2-40, MDM2, or CDK4. Fluorescence in situ hybridization analysis revealed no MDM2 or CDK4 alterations. MYC was expressed in all cases, but only 1 case was MYC amplified by fluorescence in situ hybridization. Angiosarcomas are exceedingly rare fatal complications of long-standing metal and Dacron prostheses. Awareness of their morphology and frequent cytokeratin expression is necessary to avoid misdiagnosis as metastatic carcinoma. Limited awareness of their existence explains delayed clinical diagnosis in most of cases. Absence of MDM2/CDK4 alterations underlines their distinction from intimal-type sarcomas.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nuremberg, University Hospital, Erlangen, Germany.
| | - Ofer Ben-Izhak
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Thomas Lorey
- Institute of Pathology, Caritas-Krankenhaus, Bad Mergentheim gGmbH, Bad Mergentheim, Germany
| | - Marcus Scharpf
- Institute of Pathology, University Hospital, Tübingen, Germany
| | - Brian P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
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37
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The Impact of Radiation on an Unusual Case of Omental Epithelioid Angiosarcoma. Case Rep Surg 2015; 2015:849059. [PMID: 26290766 PMCID: PMC4531202 DOI: 10.1155/2015/849059] [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: 06/15/2015] [Accepted: 07/15/2015] [Indexed: 12/15/2022] Open
Abstract
Epithelioid angiosarcoma is a rare high-grade tumor with irregular vascular morphology. We report an unusual case of intra-abdominal epithelioid angiosarcoma affecting the omentum and peritoneal surfaces resulting in significant hemorrhagic and inflammatory changes. As in other cases of this tumor this patient had previously undergone radiation treatment for a history of cervical cancer.
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38
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Lu J, Xiong XZ, Cheng NS. An Unusual Cause of Upper Gastrointestinal Bleeding. Gastroenterology 2015; 149:e5-6. [PMID: 26026744 DOI: 10.1053/j.gastro.2014.11.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Jiong Lu
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Xian-Ze Xiong
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Nan-Sheng Cheng
- Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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39
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Huntington JT, Jones C, Liebner DA, Chen JL, Pollock RE. Angiosarcoma: A rare malignancy with protean clinical presentations. J Surg Oncol 2015; 111:941-50. [PMID: 26031299 DOI: 10.1002/jso.23918] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/19/2015] [Indexed: 02/06/2023]
Abstract
Angiosarcoma is a rare form of soft tissue sarcoma. Primary small intestinal angiosarcomas are especially uncommon. The clinical presentations of small intestinal angiosarcomas vary but gastrointestinal (GI) bleeding is a frequent finding. We present a case of persistent GI bleeding of unknown etiology culminating in operative exploration demonstrating a primary small intestinal angiosarcoma. A discussion of the diagnosis, pathology, and management of angiosarcoma with a review of the current literature is provided including molecular genetics, difficult cases, and current treatment options.
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Affiliation(s)
- Justin T Huntington
- Department of General Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Christian Jones
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - David A Liebner
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - James L Chen
- Division of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio
| | - Raphael E Pollock
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center - James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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40
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Keyser D, Masoumy M, Ham PB, Biddinger P, Rahardja A, Legostaev A, Holsten S. Angiosarcoma of the Colon. Am Surg 2015. [DOI: 10.1177/000313481508100412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Daria Keyser
- Department of Surgery Georgia Regents University Augusta, Georgia
| | - Mohamad Masoumy
- Department of Surgery Georgia Regents University Augusta, Georgia
| | - P. Benson Ham
- Department of Surgery Georgia Regents University Augusta, Georgia
| | - Paul Biddinger
- Department of Pathology Georgia Regents University Augusta, Georgia
| | - Andy Rahardja
- Department of Pathology Georgia Regents University Augusta, Georgia
| | - Anna Legostaev
- Medical College of Georgia Georgia Regents University Augusta, Georgia
| | - Steven Holsten
- Department of Surgery Georgia Regents University Augusta, Georgia
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41
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Primary angiosarcoma of the pancreas mimicking severe acute pancreatitis--case report. Pancreatology 2014; 15:84-7. [PMID: 25541144 DOI: 10.1016/j.pan.2014.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 12/11/2022]
Abstract
Primary angiosarcoma of the pancreas is an extremely rare neoplasm that often mimicks severe acute pancreatitis. A 58-year-old man was admitted with clinical and laboratory signs of severe acute pancreatitis. Contrast enhanced CT scan demonstrated haemorrhagic necrotizing inflammation of the pancreas involving the pancreatic tail, splenic hilum and small bowels with multiple peripancreatic and free abdominal fluid collection. Percutaneous drainage was performed. After 13 days, laparotomy was indicated because of persistent intra-abdominal bleeding, fever and a palpable, rapidly growing mass in the left upper quadrant of the abdomen. During the operation a necrotic, haemorrhagic mass was found in the pancreatic tail; a frozen section showed malignancy, although the tumour was unresectable. Despite all conservative and surgical therapeutic attempts, the patient died within four weeks after diagnosis. Final histology justified primary angiosarcoma of the pancreas. If a patient with signs of severe acute pancreatitis has fever without elevated PCT, the presence of a malignant tumour of the pancreas should be considered.
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42
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Arora TK, Terracina KP, Soong J, Idowu MO, Takabe K. Primary and secondary angiosarcoma of the breast. Gland Surg 2014; 3:28-34. [PMID: 25083491 DOI: 10.3978/j.issn.2227-684x.2013.12.03] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Accepted: 12/19/2013] [Indexed: 01/31/2023]
Abstract
Angiosarcoma is a rare soft tissue tumor of the breast. It occurs in both a primary form without a known precursor, and a secondary form that has been associated to a history of irradiated breast tissue. These forms differ in many ways including median age, precipitating factors, and presentation. Both forms have a malignant behavior and a poor prognosis. The endeavor of this paper is to review what is known about the presentation, diagnostic and therapeutic modalities to date.
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Affiliation(s)
- Tania K Arora
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Krista P Terracina
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - John Soong
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Michael O Idowu
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
| | - Kazuaki Takabe
- 1 Division of Surgical Oncology, Department of Surgery, 2 Department of Pathology, Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA 23298-0011, USA
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43
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Katsurahara M, Horiki N, Takei Y. Duodenal metastasis from subcutaneous angiosarcoma of the head: rare cause of obscure gastrointestinal bleeding. Dig Endosc 2014; 26:291. [PMID: 24219309 DOI: 10.1111/den.12198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Masaki Katsurahara
- Department of Endoscopic Medicine, Mie University Graduate School of Medicine, Tsu, Japan
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44
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Ni Q, Shang D, Peng H, Roy M, Liang G, Bi W, Gao X. Primary angiosarcoma of the small intestine with metastasis to the liver: a case report and review of the literature. World J Surg Oncol 2013; 11:242. [PMID: 24067058 PMCID: PMC3851255 DOI: 10.1186/1477-7819-11-242] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/03/2013] [Indexed: 02/08/2023] Open
Abstract
Angiosarcoma is a rare disease with a poor prognosis; significantly, patients with intestinal angiosarcomas who survive over 1 year after diagnosis are extraordinarily rare. This article describes the case of a 33-year-old gentleman who presented with abdominal pain of 4 months duration, which had increased in severity 2 weeks prior to presentation. After a complicated diagnostic and therapeutic process, the diagnosis of primary angiosarcoma of the small intestine with metastasis to the liver was made by pathological and immunohistochemical examinations. We reviewed previous cases of angiosarcoma described in the English literature to determine their risk factors, diagnosis and treatment, and we found that angiosarcoma is extremely rare, especially in the small intestine. To the best of our knowledge, this may be the youngest case of primary angiosarcoma of the small intestine with metastasis to the liver reported in the English literature.
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Affiliation(s)
- Qingqiang Ni
- Department of General Surgery, First Affiliated Hospital, Dalian Medical University, Dalian, Liaoning 116011, P,R, China.
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45
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Sherid M, Sifuentes H, Brasky J, Shah DA, Ehrenpreis ED. Clinical and endoscopic features of angiosarcoma of the colon: two case reports and a review of the literature. J Gastrointest Cancer 2013; 44:12-21. [PMID: 23397573 DOI: 10.1007/s12029-012-9431-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Angiosarcoma of the gastrointestinal tract is an extremely rare tumor. We present two cases of angiosarcoma of the colon. One patient developed syncope and anemia and the other had rectal bleeding. DISCUSSION Endoscopic findings of the colon were different; the first case demonstrated a reddened colonic fold without an obvious mass and the other had an ulcerated friable mass. Both of the tumors had positive immunohistochemical stains for CD31 and CD34 (one was also positive for CD117). Surgery was not performed in either case. Treatment included chemotherapy with imatinib for the first patient and paclitaxel for the second. Prognosis for this tumor is generally poor; in our cases, one patient was still alive after 5 months of follow-up and the other died within 2 months of diagnosis. After presenting our cases, we reviewed the current literature on angiosarcoma of the colon.
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Affiliation(s)
- Muhammed Sherid
- Saint Francis Hospital, 355 Ridge Avenue, Evanston, IL 60202, USA
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Hanaoka M, Hashimoto M, Sasaki K, Matsuda M, Fujii T, Ohashi K, Watanabe G. Retroperitoneal cavernous hemangioma resected by a pylorus preserving pancreaticoduodenectomy. World J Gastroenterol 2013; 19:4624-4629. [PMID: 23901241 PMCID: PMC3725390 DOI: 10.3748/wjg.v19.i28.4624] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 04/03/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
A retroperitoneal hemangioma is a rare disease. We report on the diagnosis and treatment of a retroperitoneal hemangioma which had uncommonly invaded into both the pancreas and duodenum, thus requiring a pylorus preserving pancreaticoduodenectomy (PpPD). A 36-year-old man presented to our hospital with abdominal pain. An enhanced computed tomography scan without contrast enhancement revealed a 12 cm × 9 cm mass between the pancreas head and right kidney. Given the high rate of malignancy associated with retroperitoneal tumors, surgical resection was performed. Intraoperatively, the tumor was inseparable from both the duodenum and pancreas and PpPD was performed due to the invasive behavior. Although malignancy was suspected, pathological diagnosis identified the tumor as a retroperitoneal cavernous hemangioma for which surgical resection was the proper diagnostic and therapeutic procedure. Reteoperitoneal cavernous hemangioma is unique in that it is typically separated from the surrounding organs. However, clinicians need to be aware of the possibility of a case, such as this, which has invaded into the surrounding organs despite its benign etiology. From this case, we recommend that combined resection of inseparable organs should be performed if the mass has invaded into other tissues due to the hazardous nature of local recurrence. In summary, this report is the first to describe a case of retroperitoneal hemangioma that had uniquely invaded into surrounding organs and was treated with PpPD.
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Saad A, Cappell MS, Amin M. Endoscopic findings with GI angiosarcoma correspond with the propensity of these vascular tumors to cause GI bleeding: two case reports and review of the literature. Dig Dis Sci 2013; 58:1797-801. [PMID: 23400736 DOI: 10.1007/s10620-013-2582-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 01/17/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Abdulhassan Saad
- Internal Medicine, William Beaumont Hospital, Royal Oak, MI, USA
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Nassif MO, Trabulsi NH, Bullard Dunn KM, Nahal A, Meguerditchian AN. Soft tissue tumors of the anorectum: rare, complex and misunderstood. J Gastrointest Oncol 2013; 4:82-94. [PMID: 23450454 DOI: 10.3978/j.issn.2078-6891.2012.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 08/27/2012] [Indexed: 12/28/2022] Open
Abstract
Anorectal soft tissue tumors are uncommon and often present both diagnostic and therapeutic challenges. Although many of these tumors are identified with imaging performed for unrelated reasons, most present with nonspecific symptoms that can lead to a delay in diagnosis. Historically, radical surgery (abdominoperineal resection) has been the mainstay of treatment for both benign and malignant anorectal soft tissue tumors. However, a lack of proven benefit in benign disease along with changes in technology has called this practice into question. In addition, the role of radiation and/or chemotherapy remains controversial. In this manuscript, we review the history and current status of anorectal soft tissue tumor management, with a particular focus on challenges in optimizing survival.
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Affiliation(s)
- Mohammed O Nassif
- Division of Experimental Surgery, McGill University, 845 Sherbrooke Street West Montreal, Quebec, Canada H3A 2T5; ; Department of Surgery, King Abdulaziz University, P.O. Box 80205, Zip Code 21589, Jeddah, Saudi Arabia
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Gu MJ, Choi JH, Kim SH. Atypical florid vascular proliferation in appendix: a diagnostic dilemma. Diagn Pathol 2013; 8:12. [PMID: 23347775 PMCID: PMC3567979 DOI: 10.1186/1746-1596-8-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/19/2013] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED Vascular abnormality of the intestine is rare, except angiodysplasia. We report on an unusual case of atypical florid vascular proliferations of the appendix. A 41-year old male presented with melena. Adhesioned blood clots in the appendiceal orifice were observed by colonoscopy. He underwent laparoscopic appendectomy. Microscopically, a tiny exophytic polypoid mass was observed. The mass showed pyogenic granuloma-like features in the superficial portion and infiltrative florid vascular proliferations in the deeper portion. Endothelial cells showed minimal nuclear atypia, and mitotic figures were observed infrequently and showed positivity for CD31 and CD34 and negativity for HHV-8. Differential diagnoses include from benign vascular tumor to angiosarcoma or Kaposi's sarcoma, but this lesion does not fit the description of any defined vascular entity. We diagnosed atypical florid vascular proliferations and the patient has been well during the five-month postoperative follow-up. VIRTUAL SLIDE The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1386921325843104.
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Affiliation(s)
- Mi Jin Gu
- Department of Pathology, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu, Rep of Korea.
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Watson NA, Thway K, Patel P, See LM, Mahmood A. A rare cause of small bowel bleeding. JRSM SHORT REPORTS 2013; 3:79. [PMID: 23323197 PMCID: PMC3545331 DOI: 10.1258/shorts.2012.012059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Natalie A Watson
- Department of Gastroenterology, Epsom & St Helier University Hospitals , Carshalton, Surrey SM5 1AA , UK
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