Postirradiation primary vaginal angiosarcoma with widespread intra-abdominal metastasis

Gynecological radio-induced secondary malignancy after a gynecological primary tumor: a rare entity and a challenge for oncologists

The management of radiation-induced secondary malignancies in the female genital tract after pelvic radiation treatment for a primary gynecological tumor is a challenge for multidisciplinary teams that follow survivors. Considering the lack of data on the incidence of this disease and the absence of guidelines for its management, in this review, the available literature is analyzed to determine the characteristics and the clinical management of gynecological radiation-induced secondary malignancies. Gynecological radiation-induced secondary malignancies were found to be predominantly more aggressive, poorly differentiated, and had rare histologic types compared with sporadic tumors. The management is influenced by previous radiation doses and the localization of the radiation-induced secondary malignancies. Surgery, when feasible, was the cornerstone; re-irradiation was an option when a surgical approach was not feasible and high-dose conformal techniques should be preferred considering the need to spare previously irradiated surrounding normal tissues. Clinical outcomes, when reported, were poor in terms of local control and survival. Given the difficulty in managing these uncommon malignancies, a centralization of care in sites that are connected to research networks actively partaking in international discussions and with higher expertise in complicated surgery or radiotherapy should be considered to improve clinical outcomes.

Infiltration of PD-1-positive cells in combination with tumor site PD-L1 expression is a positive prognostic factor in cutaneous angiosarcoma

Cutaneous angiosarcoma (CAS) is a malignant sarcoma with poor prognosis. Programmed cell death-1 (PD-1)/programmed cell death-1 ligand-1 (PD-L1) expression reflects antitumor immunity, and is associated with patient prognosis in various cancers. The purpose of this study is to investigate the relationship between PD-1/PD-L1 expression and CAS prognosis. CAS cases (n = 106) were immunohistochemically studied for PD-L1 and PD-1 expression, and the correlation with patient prognosis was analyzed. PD-L1 expression was assessed by flow cytometry on three CAS cell lines with or without IFNγ stimulation. A total of 30.2% of patients' samples were positive for PD-L1, and 17.9% showed a high infiltration of PD-1-positive cells. Univariate analysis showed a significant relationship between a high infiltration of PD-1-positive cells with tumor site PD-L1 expression and favorable survival in stage 1 patients (p = 0.014, log-rank test). Multivariable Cox-proportional hazard regression analysis also showed that patients with a high infiltration of PD-1-positive cells with tumor site PD-L1 expression were more likely to have favorable survival, after adjustment with possible confounders (hazard ratio (HR) = 0.38, p = 0.021, 95% confidence interval (CI) 0.16-0.86). Immunofluorescence staining of CAS samples revealed that PD-L1-positive cells were adjacent to PD-1-positive cells and/or tumor stroma with high IFNγ expression. In vitro stimulation with IFNγ increased PD-L1 expression in two out of three established CAS cell lines. Our results suggest that PD-1/PD-L1 expression is related to CAS progression, and the treatment with anti-PD-1 antibodies could be a new therapeutic option for CAS.

Vaginal epithelioid angiosarcoma: a potential pitfall in gynecologic pathology

OBJECTIVE

Epithelioid angiosarcoma of the vagina is a rare variant that can easily be misdiagnosed considering the much higher frequency of epithelial neoplasms at that particular site.

MATERIAL AND METHODS

We report the case of a 41-year-old gravida 2, para 1, aborta 1, with no prior history of irradiation, who consulted after the discovery of 3 lesions at the lower right portion of the vagina.

RESULT

The lesion consisted of epithelioid cells with high-grade nuclei and prominent nucleoli. These cells expressed CD31, CD34, factor VIII, Fli-1, vimentin, smooth muscle actin, and WT-1. Keratin 8/18 was focally positive. They were immunonegative for keratin AE1/AE3, keratin 34βE12, keratin 7, keratin 20, S100, HMB-45, myogenin, desmin, and human herpesvirus type 8. Polymerase chain reaction-based HPV viral search was also negative.

CONCLUSIONS

A broad immunohistochemical panel including antibodies against vascular differentiation markers as well as various cytokeratins allows proper diagnosis of this unusual and aggressive entity.