The Defibrination Syndrome in a Patient with Haemangio-endothelio-sarcoma

Kasabach-Merritt Syndrome Associated to Angiosarcoma of the Breast. A Case Report and Review of the Literature

Introduction

Kasabach-Merritt syndrome is characterized by the association of a consumptive thrombohemorrhagic disorder and angioma occurring usually in children. In the present study, a case of Kasabach-Merritt syndrome associated to an angiosarcoma of the breast is reported.

Clinical History

The tumor together with the thrombohemorrhagic disorder manifested in a 28-year-old woman. The patient underwent mastectomy. The tumor recurred in the same site 2 years later. The patient died of severe anemia 8 years after the first appearance of the angiosarcoma.

Material and Methods

Tissues were formalin fixed and paraffin embedded; in addition, selected sections were immunohistochemically stained.

Results and Conclusions

A well-differentiated angiosarcoma was visible throughout the removed organ. A review of the literature showed that only 6 cases of Kasabach-Merritt syndrome associated to malignant vascular tumors have been previously reported. All these 6 cases occurred in adult patients. On the contrary, Kasabach-Merritt syndrome associated to benign vascular tumors affects children. This is the first case occurring in the breast.

Sacral epithelioid angiosarcoma associated with a bleeding diathesis and spinal epidural hematoma: case report

Epithelioid angiosarcoma of bone is a rare, high-grade lesion that is highly vascular and can be associated with a bleeding diathesis. An association has been reported in angiosarcomas in other locations with coagulopathy from tumor-related disseminated intravascular coagulopathy and fibrinolysis. The authors report the case of a rare occurrence of a primary sacral epithelioid angiosarcoma associated with a large epidural hematoma and a severe bleeding diathesis. A 25-year-old woman presented with weakness, fatigue, neck and low-back pain, and progressive left S-1 radiculopathy. Imaging studies revealed a large ventral epidural hematoma extending from the sacral region rostrally to C-2 and a vascular tumor located in the sacrum. The patient underwent a sacral laminectomy, complicated by postoperative bleeding from the wound, and required massive transfusions. Ultimately, multimodal therapy was required to obtain hemostasis, including the use of endovascular embolization, radiation therapy, and an infusion of epsilon-aminocaproic acid with heparin. This case represents the first report of a primary epithelioid angiosarcoma in the sacrum and emphasizes that the coagulopathy seen in angiosarcoma is also a feature of this epithelioid variant.

Diffuse cavernous hemangioma of the rectosigmoid--CT scan, a new diagnostic modality, and surgical management using sphincter-saving procedures. Report of three cases

Diffuse cavernous hemangioma of the rectosigmoid is a rare lesion. Preoperative recognition has been recorded but, because of lack of awareness and inconsistent diagnoses, inappropriate therapy still persists. Surgical therapy is the hallmark of treatment. Abdominoperineal resection has been advocated. Three cases of diffuse cavernous hemangiomas of the rectosigmoid, recognized preoperatively and treated successfully with sphincter-saving procedures, are reported. Use of the CT scan as a consistent diagnostic tool will be presented for the first time.

Antifibrinolytic therapy in the management of the Kasabach Merritt syndrome

The Kasabach Merritt syndrome consists of thrombocytopenia, microangiopathic hemolytic anemia, and a localized consumption coagulopathy that develops within the abnormal vascular channels of a hemangioma. In general, these patients demonstrate only mild abnormalities of screening clotting tests, but they can potentially develop life-threatening complications. We present a patient who developed a severe anemia that was refractory to erythrocyte transfusions. Treatment with epsilon-aminocaproic acid to inhibit fibrinolysis and cryoprecipitate to replenish his deficient circulating fibrinogen interrupted the cycle of his systemic coagulopathy and enabled us to transfuse him to a normal hematocrit.

Chronic intravascular coagulation associated with chronic myelocytic leukemia. Use of heparin in connection with a surgical procedure

A women with Philadelphia chromosome-positive chronic myelocytic leukemia lived nearly 12 years from the time of diagnosis. During most of this period she received no therapy, and marked cyclic oscillations in the white blood cell count were documented. The last two years of her illness were marked by a hemorrhagic disorder associated with hypofibrinogenemia, thrombocytopenia, increased plasma fibrinopeptide A concentration and markedly elevated serum levels of fibrin degradation products. The coagulation disorder was rapidly reversible on several occasions with heparin therapy. After treatment with heparin and platelet transfusions, the patient underwent successful resection of a large ovarian cyst with excellent hemostasis during the procedure. Postoperatively, the administration of heparin and platelets was discontinued and a large wound hematoma developed. After resumption of therapy with heparin and platelets, the remainder of her postoperative course was uneventful. The literature on the subject is reviewed and tentative guidelines are offered concerning the management of patients with intravascular coagulation who require diagnostic or therapeutic surgical procedures.

Hemangiosarcoma of the spleen: report of a case and review of previously reported cases

Splenic hamangiosarcomas are rare tumors, usually discovered at autopsy. In a few instances the diagnosis was made premortem, at the time of splenectomy for spontaneous rupture. The tumors usually present with abdominal pain, left upper guadrant mass and tenderness, and occasionally with a microangiopathic type of anemia. The histogenesis of the tumor is in dispute. Some authors feel that they are degenerations of hemangiomas. Others feel that they arise de novo in the spleen. There is not proven association of thorotrast administration or vinyl chloride exposure to the development of hemangiosarcomas in the spleen. The prognosis of the tumor is uniformly poor and most of the patients surviving laparotomy have followed a uniformly fatal clinical course. In a few cases treated with chemotherapy there has been no evidence of clinical benefit. The case report in this article presented with essentially all the features enumerated above.

Giant occipital hemangioendothelioma with thrombocytopenia, anemia, and hypofibrinogenemia. Case report

The authors describe the total excision of a huge occipital hemangioendothelioma in an infant with thrombocytopenia, hypofibrinogenemia, and anemia; treatment was followed by normalization of platelet count, blood cell count, and level of fibrinogen. Histological and clincial studies support the concept the disseminated intravascular coagulation was related to the thrombocytopenia and coagulation deficits found in this case.

Ruptured angiomatous spleen presenting as a severe coagulation defect

A case is decribed in which spontaneous rupture of an angiomatous spleen presented with an acute disorder of blood coagulation. Splenectomy was performed after successful correction of the coagulation defect by the administration of blood and blood-products. The presence of amyloidosis associated with myeloma may have increased the liability of the spleen to rupture. Indentation of the right lobe of the liver by the lower ribs produced a misleading appearance of the hepatic scintiscan.