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Basiri R, Ziaei Moghaddam A, Rikhtegar A, Jafarian A. Primary Pulmonary Angiosarcoma Found Incidentally in a Complicated Patient: A Rare Case Report. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13818. [PMID: 39107956 PMCID: PMC11303451 DOI: 10.1111/crj.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Primary pulmonary angiosarcoma (PPA) is a highly aggressive and rare malignancy originating from the endothelial cells of blood vessels in the lungs. PPA is an extremely rare subtype, with less than 30 cases reported to date. PPA is not only challenging to diagnose but also has a poor prognosis, often resulting in a high mortality rate within a year of diagnosis, regardless of the treatment approach. METHOD We present the case of a 33-year-old woman with no significant past medical history who presented with abdominal pain and was incidentally found to have a right hilar mass with pleural effusion and empyema. After undergoing surgery for a perforated gastric ulcer, her pulmonary lesions were further worked up. Despite an extensive diagnostic evaluation, including imaging, bronchoscopy, and thoracotomy, establishing a diagnosis was challenging. Ultimately, PPA was diagnosed on surgical lung biopsy, and the patient was started on pazopanib and paclitaxel chemotherapy but expired after 1 month due to multiple complications. CONCLUSION This case highlights the difficulty in diagnosing this rare tumor and its poor prognosis regardless of therapy. Greater awareness of PPA and more research are needed to improve early detection and treatment options for this deadly disease.
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Affiliation(s)
- Reza Basiri
- Lung Disease Research Center, Faculty of MedicineMashhad University of Medicine SciencesMashhadIran
| | | | - Arezoo Rikhtegar
- Department of Internal Medicine, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Amir Hossein Jafarian
- Department of Pathology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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Wang M, Zhang X, Jiang H. A case of primary pulmonary angiosarcoma arising from tuberculous scar with fatal capillary bleeding. Clin Case Rep 2024; 12:e8649. [PMID: 38469127 PMCID: PMC10925814 DOI: 10.1002/ccr3.8649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/26/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024] Open
Abstract
The etiology of primary pulmonary angiosarcoma is still unknown. Here we report a case of primary pulmonary angiosarcoma originated from a tuberculous scar and presented as aggressive deterioration with uncontrolled bleeding from capillaries with angiodysplasia.
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Affiliation(s)
- Minghui Wang
- Department of Pulmonary Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
| | - Xin Zhang
- Department of Pulmonary Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
- Department of Pulmonary Medicine, Taikang Xianlin Drum Tower HospitalMedical School of Nanjing Medical UniversityNanjingChina
| | - Hongni Jiang
- Department of Pulmonary Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
- Department of Pulmonary Medicine, Zhongshan Hospital, Xiamen BranchFudan UniversityXiamenChina
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3
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Yu L, Sun Y, Wang M, Yuan L, Wang Q, Qian X. Primary pulmonary epithelioid angiosarcoma with thyroid tumor history: A case report and literature review. Exp Ther Med 2022; 24:471. [PMID: 35761817 PMCID: PMC9214694 DOI: 10.3892/etm.2022.11398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Primary pulmonary epithelioid angiosarcoma is a rare tumor type without any specific clinical and imaging features. Therefore, it is associated with high rates of misdiagnosis. The present study reports the case of a 54-year-old female patient who was admitted after complaining of cough, expectoration and bloody sputum for >5 months in May 2021. The patient reported a previous history of papillary thyroid carcinoma in 2003 and had undergone treatment through surgery, postoperative chemotherapy and iodine131 therapy. Chest computed tomography (CT) was performed in May 2021, which indicated that the disease had progressed rapidly since February 2021. CT-guided lung biopsy and immunohistochemical staining of the tumor indicated positivity for CD31, CD34 and E26 transformation-specific-related gene markers. The tumor was negative for thyroid cancer-associated antibodies; thus, a diagnosis of primary pulmonary epithelioid angiosarcoma was made. The patient died 3 months after the diagnosis. Primary pulmonary epithelioid angiosarcoma is a rare tumor type with high recurrence and metastasis rates. This tumor has no specific clinical symptoms and signs and is thus easily misdiagnosed. Biopsy is essential for diagnosis of the disease, particularly if patients have a tumor history.
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Affiliation(s)
- Lu Yu
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Yuhui Sun
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Meifang Wang
- Department of 1Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Lingling Yuan
- Department of Pathology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Qiang Wang
- Department of Gastroenterology, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
| | - Xin Qian
- Department of Pulmonary and Critical Care Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, P.R. China
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Tuft C, Maheepala K, Raguparan A, Naeem A, Lodh S, Lindstrom S. Pulmonary artery sarcoma: An important mimic of pulmonary embolism-Case reports and literature review. Respirol Case Rep 2022; 10:e0897. [PMID: 35028154 PMCID: PMC8743422 DOI: 10.1002/rcr2.897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/27/2021] [Accepted: 12/06/2021] [Indexed: 11/10/2022] Open
Abstract
Pulmonary artery intimal sarcoma (PAIS) is a rare malignancy which closely mimics acute or chronic pulmonary thromboembolism. There are clinical and radiological characteristics which may raise suspicion of this important differential diagnosis. These include disproportionately low d-dimer, troponin T or NT-proBNP, as well as characteristic findings on CT pulmonary angiography such as the 'wall eclipsing sign' and an non-dependent position of filling defects in the large arteries. Prompt diagnosis avoids inappropriate anticoagulation and facilitates early surgical management which may improve prognosis. There is emerging evidence of an effective treatment paradigm with surgical resection and adjuvant chemotherapy. We present two cases of PAIS diagnosed at a single centre within a 2-year period. We review the literature and demonstrate the features at presentation in our cases which were suggestive of the diagnosis.
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Affiliation(s)
- Colin Tuft
- Respiratory and Sleep Medicine DepartmentSt George HospitalSydneyNew South WalesAustralia
| | - Krishan Maheepala
- Respiratory and Sleep Medicine DepartmentSt George HospitalSydneyNew South WalesAustralia
| | - Ajantha Raguparan
- Respiratory and Sleep Medicine DepartmentSt George HospitalSydneyNew South WalesAustralia
| | - Anas Naeem
- Intensive Care UnitSt George HospitalSydneyNew South WalesAustralia
| | - Suhrid Lodh
- Radiology DepartmentSt George HospitalSydneyNew South WalesAustralia
| | - Steven Lindstrom
- Respiratory and Sleep Medicine DepartmentSt George HospitalSydneyNew South WalesAustralia
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Tang X, Zhu J, Zhu F, Tu H, Deng A, Lu J, Yang M, Dai L, Huang K, Zhang L. Case Report: Primary Pulmonary Angiosarcoma With Brain Metastasis. Front Bioeng Biotechnol 2022; 9:803868. [PMID: 35071212 PMCID: PMC8776831 DOI: 10.3389/fbioe.2021.803868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
Primary pulmonary angiosarcoma (PPA) is a rare malignant vascular tumor, of which early diagnosis is challenging due to lack of specific clinical manifestations and a low level of suspicion. Here, we report a case of PPA presented with advanced brain metastasis. A 21-year-old patient with 1 week history of headache and mild cough was hospitalized for a head injury. Head MRI showed multiple intracranial lesions with brain edema. Chest CT displayed bilateral pulmonary infiltrates with mediastinal lymph node enlargement. After 2 months of anti-tuberculosis treatment, the patient was readmitted for persistent headache and cough with occasional hemosputum along with worsening pulmonary and intracranial lesions. Despite seizure prophylaxis and control of intracranial pressure and brain edema, his symptoms progressively aggravated, accompanied by cough with bloody sputum, frequent epileptic seizures, and hypotension. He eventually developed coma and died within 3 months of onset of symptoms. An autopsy confirmed PPA with brain metastasis.
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Affiliation(s)
- Xiangjun Tang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fangcheng Zhu
- School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Hanjun Tu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Aiping Deng
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Junti Lu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Minghuan Yang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Longjun Dai
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Kuanming Huang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Li Zhang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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DiGrazia GN, Zinzuwadia S, Aragao AP, Camren GP, Hibbeln JF, Gerena M, Jawahar A. Rare primary pulmonary angiosarcoma with aberrant neuroendocrine differentiation. Clin Imaging 2021; 82:88-93. [PMID: 34798564 DOI: 10.1016/j.clinimag.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/25/2021] [Accepted: 11/02/2021] [Indexed: 11/03/2022]
Abstract
Angiosarcomas are aggressive, malignant endothelial cell tumors derived from the vascular or lymphatic epithelium. Angiosarcomas makes up less than 1% of all soft tissue sarcomas. Primary pulmonary angiosarcoma is a rare tumor that most commonly presents as metastatic disease and carries a grim prognosis. The disease rarity and low index of suspicion make the diagnosis problematic. In this report, we present a case of primary pulmonary angiosarcoma with aberrant neuroendocrine differentiation. The diagnostic images, pathology and management strategy are discussed in this case with overall longer survival. The unique neuroendocrine pathologic subtype may contribute to the overall longer survival, however, there are only a few limited cases published. Further recognition and investigation of primary pulmonary angiosarcoma with aberrant neuroendocrine differentiation is warranted to further characterize diagnostic markers, determine more effective treatment strategies, and establish a possible link to improved survival.
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Affiliation(s)
- Gianna N DiGrazia
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, United States of America.
| | - Shuchi Zinzuwadia
- Loyola University Stritch School of Medicine, 2160 S. 1st Ave., Maywood, IL 60153, United States of America
| | - Alessa P Aragao
- Department of Pathology, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, United States of America
| | - Gerald P Camren
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, United States of America
| | - John F Hibbeln
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, United States of America
| | - Marielia Gerena
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, United States of America
| | - Anugayathri Jawahar
- Department of Radiology, Loyola University Medical Center, 2160 S. 1st Ave., Maywood, IL 60153, United States of America
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Khalid K, Khan A, Lomiguen CM, Chin J. Clinical Detection of Primary Pulmonary Angiosarcoma. Cureus 2021; 13:e17059. [PMID: 34522537 PMCID: PMC8428157 DOI: 10.7759/cureus.17059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 08/10/2021] [Indexed: 12/01/2022] Open
Abstract
Pulmonary angiosarcomas (PAS) are rare malignant vascular tumors that due to their aggressive and metastatic nature, are often diagnosed at a late stage, resulting in a poorer prognosis. Here we present a 53-year-old male who was initially found to have recurring episodes of dyspnea and syncope, with initial workup showing bilateral saddle pulmonary embolisms on computerized tomography, presumed secondary to newly discovered atrial fibrillation with sinus node dysfunction. Further investigation over subsequent months and subsequent biopsy of a potential lung mass ultimately revealed pulmonary angiosarcoma of the spindle cell line. This case emphasizes findings in the current literature, which reveal the time between the onset of symptoms and definitive diagnosis ranges from two to six months, with a median survival time of seven months or two months, with solitary lesions or multiple lesions at the time of diagnosis, respectively. With the limited incidence of PAS, this case suggests benefits in the development of screening and detection criteria for earlier detection and treatment.
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Affiliation(s)
- Kaynat Khalid
- Department of Primary Care, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Anas Khan
- Department of Primary Care, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Christine M Lomiguen
- Department of Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA.,Department of Family Medicine, Millcreek Community Hospital, Erie, USA
| | - Justin Chin
- Department of Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA.,Department of Family Medicine, LifeLong Medical Care, Richmond, USA
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Nguyen QT, Pham AT, Nguyen TT, Nguyen TTT, Van Le K. Role of Immunotherapy in Pulmonary Angiosarcoma: A Case Report. Case Rep Oncol 2021; 14:797-801. [PMID: 34248542 PMCID: PMC8255737 DOI: 10.1159/000516402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 01/03/2023] Open
Abstract
Pulmonary angiosarcoma is a rare clinical entity with a poor prognosis and no established therapeutic strategies. We present the first case to our knowledge of metastatic pulmonary angiosarcoma, treated with checkpoint inhibitor immunotherapy, and have an excellent response. Until now, patient has been treated with immunotherapy for 1 year, and his disease is stable and well-tolerated.
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Affiliation(s)
- Quang Tien Nguyen
- Department of Medical Oncology, National Cancer Hospital, Hanoi, Vietnam
| | - Anh Tuan Pham
- Department of Medical Oncology, National Cancer Hospital, Hanoi, Vietnam
| | - Thuy Thi Nguyen
- Department of Medical Oncology, National Cancer Hospital, Hanoi, Vietnam
| | | | - Ky Van Le
- Department of Pathology, National Cancer Hospital, Hanoi, Vietnam
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Yu M, Huang W, Wang Y, Wang G, Wang L, Tao W, Faiz SA, Ng FH, Li H. Pulmonary angiosarcoma presenting with diffuse alveolar hemorrhage: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:74. [PMID: 33553367 PMCID: PMC7859806 DOI: 10.21037/atm-20-7441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study aimed to analyze the diagnosis and treatment of one case of pulmonary angiosarcoma (PPA) retrospectively. The main manifestation of this female patient was cough, hemoptysis and dyspnea. Computed tomography (CT) of the chest revealed multiple small nodules and ground-glass patches in both lungs suggesting of diffuse alveolar hemorrhage (DAH). Laboratory examination revealed decreased hemoglobin and platelet counting, normal coagulation function. Results of rheumatic markers testing including antinuclear antibody (ANA), anti-extractable nuclear antigen antibody (ENA), vasculitis marker, and antiphospholipid antibody were negative. Tumor markers were negative. Sputum smear, sputum culture, and alveolar lavage fluid culture showed negative results. The bone marrow smear was essentially normal. The patient received methylprednisolone pulse therapy (250 mg daily × 5 days) and immunoglobin (20 d daily × 7 days) treatment, but her hemoptysis persisted. Bilateral pleural effusion drainage found a large amount of bloody effusion, but cytology of the pleural fluid showed negative results. The clinical symptoms, laboratory results, imaging findings, and pathological features of the patient were summarized, and problems in diagnosis and treatment were discussed. A thoracoscopic lung biopsy was performed and the diagnosis of PPA was confirmed by pathology and immunohistochemistry (IHC) staining. This case suggested that the possibility of PPA should be considered in patients with DAH, but with negative findings in routine examinations, lung biopsy is usually required.
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Affiliation(s)
- Min Yu
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Weibin Huang
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Yan Wang
- Department of Pathology, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Guangsuo Wang
- Department of Thoracic Surgery, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Lingwei Wang
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Weihua Tao
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
| | - Saadia A Faiz
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Fung Him Ng
- Department of Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Huiping Li
- Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital & the First Affiliated Hospital of Southern University of Science and Technology & the Second Clinical School of Jinan University & Shenzhen Municipal Institute of Respiratory Medicine, Shenzhen, China
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Primary Intrathoracic Sarcomas: A Review of Cross-sectional Imaging and Pathology. J Comput Assist Tomogr 2020; 44:821-832. [PMID: 33196594 DOI: 10.1097/rct.0000000000001097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most common sarcomas in the thorax are metastasis from an extrathoracic primary malignancy. Primary intrathoracic sarcomas are rare albeit aggressive malignancies that are diagnosed on histopathology. Although a few imaging characteristics have been described that are common to sarcomas, it is still a diagnosis of exclusion as other tumors are much more common. Like elsewhere, primary thoracic sarcomas are also classified according to their histologic features. They are a rare group of tumors that can arise from the mediastinal structures, lung, pleura, or chest wall. On imaging, differentiating these from more common malignancies like lung cancer is difficult and often requires multimodality workup and tissue sampling. A few sarcomas are very specific to their locations, such as angiosarcoma in the right atrium, leiomyosarcoma in the pulmonary artery, where imaging has high accuracy for the diagnosis. Despite being nonspecific in a majority of cases, imaging plays a pivotal role in determining the organ of origin, tumor extent, invasion of adjacent structures, and thus help to assess the surgical resectability. Although sarcomas arising from chest wall are the most common primary sarcomas in the chest, they are excluded from this review to focus only on primary intrathoracic sarcomas. The article provides a comprehensive imaging and pathology review of the rare primary intrathoracic sarcomas, including but not limited to angiosarcoma, Kaposi sarcoma, fibrosarcoma, malignant transformation of fibrous tumor of pleura, sarcomatoid mesothelioma, leiomyosarcoma, and malignant small round blue cell tumors.Key points:Primary intrathoracic sarcomas are rare but clinically important.Imaging helps to determine local extent, invasion, metastases and appropriate site/mode of biopsy.Role of pathology is paramount in diagnosis and guiding treatment based on immunogenetic/molecular typing.
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Aramini B, Masciale V, Bianchi D, Manfredini B, Banchelli F, D'Amico R, Bertolini F, Dominici M, Morandi U, Maiorana A. ALDH Expression in Angiosarcoma of the Lung: A Potential Marker of Aggressiveness? Front Med (Lausanne) 2020; 7:544158. [PMID: 33195295 PMCID: PMC7662079 DOI: 10.3389/fmed.2020.544158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background: Primary angiosarcoma of the lung is a very aggressive rare malignant disease resulting in a severe prognosis (1). This type of cancer represents about 2% of all soft tissue sarcomas and has a high rate of metastasis through the hematogenous route. For the rarity of this malignant vascular tumor it is still challenging to set a diagnosis (1). The diagnostic features that have thus far been considered include primarily clinical and radiological findings. In some cases, immunohistochemical characteristics based on the most common markers used in pathology have been described. The aim of this report is to present two cases of angiosarcoma of the lung in which the aldehyde dehydrogenase (ALDH) marker was analyzed by immunohistochemistry. Methods: We report two cases of angiosarcoma of the lung in patients underwent lung surgery at our Unit. In addition to the standard histopathological analysis for this disease, immunohistochemistry using an ALDH1A1 antibody was performed in both of the cases. For ALDH quantification, a semi-quantitative method based on the positivity of the tumor cells was used: 0 (<5%), 1 (5–25%), 2 (>25–50%), 3 (>50–75%), 4 (>75%). Results: One patient with recurrent lung disease survived, achieving complete remission after chemo- and radiotherapy. The second patient died of recurrent disease within 5 years of diagnosis. ALDH1A1 was evaluated in both of these cases using an immunohistochemistry scoring system based on the positivity for this marker. The scores were consistent with the patients' clinical outcomes, as the lower (score 1) was observed in the patient with the better clinical outcome, while the higher (score 3) was seen in the patient with the worse outcome. Conclusion: Our data suggest that ALDH may be an important clinical marker in angiosarcoma of the lung. Although further studies need to be performed in a larger cohort of patients, we believe that, if the results will be confirmed, ALDH1A1 may be used to stratify patients in terms of prognosis and for targeted therapy.
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Affiliation(s)
- Beatrice Aramini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Masciale
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniel Bianchi
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Beatrice Manfredini
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Banchelli
- Department of Medical and Surgical Sciences, Center of Statistic, University of Modena and Reggio Emilia, Modena, Italy
| | - Roberto D'Amico
- Department of Medical and Surgical Sciences, Center of Statistic, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Bertolini
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Dominici
- Division of Oncology, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Uliano Morandi
- Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Maiorana
- Department of Medical and Surgical Sciences, Institute of Pathology, University of Modena and Reggio Emilia, Modena, Italy
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Aniruna D, Anuj S. Computed Topographic-Guided Core Needle Biopsy of Lung Masses: Our Experience at a Diagnostic Center in Western India. JOURNAL OF MEDICAL SCIENCES AND HEALTH 2020. [DOI: 10.46347/jmsh.2020.v06i01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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13
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Ralki M, Yilmaz A, Vanwing J, Cuppens K. A rare cause of recurrent hemopneumothorax. Acta Clin Belg 2020; 75:235-237. [PMID: 30722765 DOI: 10.1080/17843286.2019.1578030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Angiosarcoma is a rare and aggressive tumor of vascular endothelial origin. Pulmonary metastasis can lead to potential life-threatening complications, such as bleeding and pneumothorax.Methods: We report on a 82-year-old male with major hemoptysis, recurrent hemopneumothorax and cystic lung lesions.Results: Although initial diagnostic findings were misleading, thoracoscopic exploration revealed pulmonary and pleural metastasized angiosarcoma.Conclusion: The presence of hemoptysis or (recurrent) hemopneumothorax associated with cystic lung lesions should alert the clinician of possible pulmonary metastasized angiosarcoma.
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Affiliation(s)
- Mike Ralki
- Department of Pulmonology and Thoracic Oncology, Jessa Hospital, Hasselt, Belgium
| | - Alaaddin Yilmaz
- Department of Cardiothoracic Surgery, Jessa Hospital, Hasselt, Belgium
| | | | - Kristof Cuppens
- Department of Pulmonology and Thoracic Oncology, Jessa Hospital, Hasselt, Belgium
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Xuan Z, Liu B, Ci M, Wang Z, Fan Y. Hemoptysis secondary to pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation: A case report and literature review. J Interv Med 2020; 3:98-100. [PMID: 34805916 PMCID: PMC8562220 DOI: 10.1016/j.jimed.2020.03.008] [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] [Indexed: 11/18/2022] Open
Abstract
Objectives Pulmonary vein stenosis (PVS) is a known complication after radiofrequency ablation of atrial fibrillation (RAAF) and is often misdiagnosed owing to lack of awareness regarding PVS among noncardiologists. Misdiagnosis results in unnecessary treatment; therefore, greater understanding of PVS can improve the management of these patients. Methods We report the case of a 38-year-old man with a history of RAAF who presented with massive hemoptysis. His symptoms persisted despite undergoing transcatheter bronchial artery embolization on two occasions. Results Pulmonary computed tomography angiography revealed a completely occluded left superior pulmonary vein. Considering the patient’s history of RAAF, we diagnosed him with RAAF-induced PVS and performed left superior lobectomy after which hemoptysis did not recur. Conclusions Unexplained massive hemoptysis should alert clinicians regarding the possibility of RAAF-induced PVS. Balloon angioplasty and stent placement are used to treat PVS; however, their efficacy is controversial considering the high recurrence rates associated with these interventions.
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Affiliation(s)
- Zhiming Xuan
- Tianjin Medical University, Tianjin, Guangdong Road 1, Hexi District, 300202, Tianjin, China
| | - Boyu Liu
- Tianjin Medical University, Tianjin, Guangdong Road 1, Hexi District, 300202, Tianjin, China
| | - Minjun Ci
- Tianjin Medical University, Tianjin, Guangdong Road 1, Hexi District, 300202, Tianjin, China
| | - Zhe Wang
- Department of Radiology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, 300052, Tianjin, China
| | - Yong Fan
- Department of Radiology, Tianjin Medical University General Hospital, Anshan Road 154, Heping District, 300052, Tianjin, China
- Corresponding author. Department of Radiology, Tianjin Medical University General Hospital, China.
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15
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Faiek S, Tariq H, Upparapalli D, Bansal A, Sompalli S. Primary Pulmonary Epithelioid Angiosarcoma: A Rare Case Presentation of Bilateral Pneumothoraces. Cureus 2019; 11:e6514. [PMID: 32025433 PMCID: PMC6988729 DOI: 10.7759/cureus.6514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Angiosarcoma is a rare malignant neoplasm with a very poor prognosis that originates from the vascular endothelium and accounts for only 1%-2% of all sarcomatous malignancies. It is most commonly present in the deep soft tissues. Still, a wide range of primary sites, including the adrenals, thyroid, skin, and bone, are encountered. Here, we report a 52-year-old female with a past medical history of hypertension who presented with chest pain. Her chest images showed bilateral pneumothoraces with diffuse cystic lung disease. She underwent bilateral video-assisted thoracoscopy with a tissue biopsy, which was consistent with epithelioid angiosarcoma.
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Affiliation(s)
- Saif Faiek
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Hafsa Tariq
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Deepti Upparapalli
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Aditya Bansal
- Critical Care Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
| | - Sreeja Sompalli
- Internal Medicine, AtlantiCare Regional Medical Center, Atlantic City, USA
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16
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Brandt LP, Albers J, Hejhal T, Pfundstein S, Gonçalves AF, Catalano A, Wild PJ, Frew IJ. Mouse genetic background influences whether HrasG12V expression plus Cdkn2a knockdown causes angiosarcoma or undifferentiated pleomorphic sarcoma. Oncotarget 2018; 9:19753-19766. [PMID: 29731980 PMCID: PMC5929423 DOI: 10.18632/oncotarget.24831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 02/28/2018] [Indexed: 01/09/2023] Open
Abstract
Soft tissue sarcomas are rare mesenchymal tumours accounting for 1% of adult malignancies and are fatal in approximately one third of patients. Two of the most aggressive and lethal forms of soft tissue sarcomas are angiosarcomas and undifferentiated pleomorphic sarcomas (UPS). To examine sarcoma-relevant molecular pathways, we employed a lentiviral gene regulatory system to attempt to generate in vivo models that reflect common molecular alterations of human angiosarcoma and UPS. Mice were intraveneously injected with MuLE lentiviruses expressing combinations of shRNA against Cdkn2a, Trp53, Tsc2 and Pten with or without expression of HrasG12V , PIK3CAH1047R or Myc. The systemic injection of an ecotropic lentivirus expressing oncogenic HrasG12V together with the knockdown of Cdkn2a or Trp53 was sufficient to initiate angiosarcoma and/or UPS development, providing a flexible system to generate autochthonous mouse models of these diseases. Unexpectedly, different mouse strains developed different types of sarcoma in response to identical genetic drivers, implicating genetic background as a contributor to the genesis and spectrum of sarcomas.
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Affiliation(s)
- Laura P. Brandt
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Joachim Albers
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Tomas Hejhal
- Institute of Physiology, University of Zurich, Zurich, Switzerland
| | - Svende Pfundstein
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Zurich Integrative Rodent Physiology, University of Zurich, Zurich, Switzerland
| | | | - Antonella Catalano
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Peter J. Wild
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Ian J. Frew
- Institute of Physiology, University of Zurich, Zurich, Switzerland
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
- BIOSS Centre for Biological Signaling Studies, University of Freiburg, Freiburg, Germany
- Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
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