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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] [Key Words] [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
- Department of Gastroenterology, 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 Pulmonary 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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2
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Wang X, Lu Z, Luo Y, Cai J, Wei J, Liu A, Zeng Z. Characteristics and outcomes of primary pleural angiosarcoma: A retrospective study of 43 published cases. Medicine (Baltimore) 2022; 101:e28785. [PMID: 35147108 PMCID: PMC8830823 DOI: 10.1097/md.0000000000028785] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/21/2022] [Indexed: 01/04/2023] Open
Abstract
Primary pleural angiosarcoma (PPA) is an extremely rare malignancy for which there is no consensus on treatment. The clinical course of PPA is usually quickly fatal, regardless of the treatment used.We summarized and evaluated a relatively large population of published PPA cases to assess prognostic factors, diagnostic approaches, treatment methods and clinical outcomes. Using the CNKI, Embase, and PubMed databases, literature published in English and Chinese from 1988 through 2020 was searched using the terms "primary pleural angiosarcoma," "pleural angiosarcoma," and "pleuropulmonary angiosarcoma."A total of 43 patients with PPA were identified in retrospective case series and case reports. The median age at diagnosis was 64 years (range 24-87 years), and the median overall survival was 4 months (range 0.1-180 months). Approximately 80% of patients died from PPA within 10 months of diagnosis, and the 2-year survival rate was approximately 4.4%. In univariate analyses, the presence of pleural effusion and hemothorax were significant predictors of decreased survival, with hazard ratios (HRs) of 2.7 (P = .04) and 3.3 (P = .006), respectively. Sixteen patients received no therapy, and their prognosis was worse than patients who did receive therapy (P = .019). Radiation therapy improved survival more than no radiation therapy (P = .007). Patients appeared to derive clinical benefit from chemotherapy (P = .048). However, tumor resection did not seem to provide a survival benefit (P = .051). In multivariate analysis, tumor resection, and radiation were independent, statistically significant, positive predictors of better survival, with HRs of 0.3 (P = .017) and 0.1 (P = .006), respectively. The presence of hemothorax was an independent predictor of worse prognosis (P = .006).Primary angiosarcoma of the pleura is a rare, poorly understood malignancy with a poor prognosis; hence, the clinical spectrum of PPA is not completely defined. By multivariate analysis, this retrospective study showed a survival benefit of tumor resection or radiation therapy, and the presence of hemothorax was a significant prognostic factor for poor outcomes.
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Affiliation(s)
- Xia Wang
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Zhiqin Lu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Yuxi Luo
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Jing Cai
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Jianping Wei
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Anwen Liu
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, China
| | - Zhimin Zeng
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, China
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3
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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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Azzakhmam M, Elktaibi A, El Ochi MR, Allaoui M, Albouzidi A, Oukabli M. Primary epitheloid angiosarcoma of the pleura: an exceptional tumor location. Pan Afr Med J 2019; 33:327. [PMID: 31692820 PMCID: PMC6815478 DOI: 10.11604/pamj.2019.33.327.18145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 07/15/2019] [Indexed: 11/15/2022] Open
Abstract
Primary angiosarcoma of the pleura is an extremely rare tumour arising from arterial or venous pulmonary vessels of various size. It is characterized by an aggressive course and a poor prognosis. The early diagnosis is challenging due to diverse clinical and radiological manifestations. We report a case of a 70 year old male with primary right pleural epitheloid angiosarcoma. The patient had a history of a two week's progressive dyspnea. CT-scan showed a prominent thikening of the right pleura associated with pleural effusion and atelectasis. CT-scan guided by biopsy was performed and histological examination showed a tumor proliferation consisting of sheets of polygonal and epitheloid cells showing rudimentary vascular differentiation. Immunohistochemically, tumor cells were strongly positive for CD31 and Factor VIII-related antigen, negative for CD34, weakly and focally positive for EMA and Cytokeratine. The overall pathological and immunohistochemical features of the pleural specimens supported the diagnosis of epitheloid angiosarcma. The patient died after a week of discharge by pulsless ventricular tachycardia arrest. In addition, we also present a brief litterature review on pleural angiosarcoma. Our experience with this case suggests that comprehensive and sufficient sample collection and meticulous histological examination aided with immunohistochemical stains, particulary the endothelial markers, are required for accurate diagnosis of this rare malignancy.
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Affiliation(s)
| | | | | | - Mohamed Allaoui
- Department of Pathology, Military Hospital of Rabat, Rabat, Morocco
| | | | - Mohamed Oukabli
- Department of Pathology, Military Hospital of Rabat, Rabat, Morocco
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Abstract
RATIONALE Pulmonary artery sarcomas (PAS) are easily misdiagnosed as thromboembolic disease of pulmonary arteries, because of rarity and presenting with nonspecific signs, symptoms, or imaging findings. PATIENT CONCERNS A 26-year-old man was admitted to the department of invasive technology with fever and dyspnea. Blood tests showed inflammatory activity, a slight increase of D-dimer and Fibrin Degradation Product. A chest enhanced computed tomography (CT) scanning revealed multiple filling defects occurred in the main trunk of both pulmonary arteries and branches of the left pulmonary artery DIAGNOSES:: It was initially diagnosed with pulmonary embolism (PE) and deep vein thrombosis (DVT), but was eventually diagnosed with pulmonary artery sarcoma that was confirmed by biopsy. INTERVENTIONS The transcatheter thrombolysis therapy, inferior vena cava filter implantation, and operation were performed. OUTCOMES The Organized mass was removed by the operation and was pathologically diagnosed as pulmonary artery sarcoma, the patient received postoperative chemotherapy according to the recommendation of oncology department. LESSONS Coagulation markers have been reported to differentiate PAS from PE, but this case suggested that PAS can be associated with DVT and abnormal coagulation-fibrinolysis system.
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Affiliation(s)
- Xin Li
- The First Clinical Medical College
| | - Quan Qi
- Cardiac Surgery Department, The First Hospital of Lanzhou University, Lanzhou, China
| | - Fuxiang Liang
- Cardiac Surgery Department, The First Hospital of Lanzhou University, Lanzhou, China
| | | | | | - Bing Song
- Cardiac Surgery Department, The First Hospital of Lanzhou University, Lanzhou, China
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6
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Yang X, Jiang J, Dong X, Liang J, Guan Y. Correlations between computed tomography and positron emission tomography/computed tomography findings and pathology in 6 cases of pulmonary epithelioid angiosarcoma. Medicine (Baltimore) 2018; 97:e12107. [PMID: 30170436 PMCID: PMC6392945 DOI: 10.1097/md.0000000000012107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Previous studies on primary pulmonary epithelioid angiosarcoma (PEA) have been mostly clinical or pathological case reports. We here summarize findings from computed tomography (CT) and positron emission tomography/computed tomography (PET/CT) analyses of PEA to improve the diagnosis and differentiation of this rare tumor.We conducted a retrospective analysis of the clinical findings, radiological imaging, and pathological findings of 6 cases of primary PEA confirmed by surgery, biopsy, and pathology. All cases were evaluated by CT and x-ray prior to surgery, and 2 cases were further examined by PET/CT.CT images indicated maximum tumor diameters of 2.4 to 9.8 cm and inhomogeneous density, with 1 case exhibiting nodular calcification. Contrast-enhanced CT revealed inhomogeneous enhancement with visible necrosis in all 6 cases, while 3 cases had hilar and mediastinal lymph node metastasis. Five cases displayed extensive tumor involvement with extension into the chest wall, mild-to-moderate levels of pleural effusion, and varying degrees of volume loss in the corresponding hemithorax. One case had limited pleural thickening and invasion. Preoperative PET/CT of 1 case revealed abnormal fluorine-18 fluorodeoxyglucose (F-FDG) uptake by the tumor and multiple enlarged right hilar and mediastinal lymph nodes, right diffuse pleural thickening, and systemic multiple bone metastasis. In the other case, PET/CT scan at 7 months after surgery revealed pleural thickening and mediastinal lymph nodes with increased F-FDG uptake on the surgical side. Immunohistochemistry analyses determined that all 6 tumors were positive for CD34, CD31, ERG, and vimentin.CT and PET/CT findings reveal that malignant characteristics, including extensive pleural thickening, invasion and metastasis, and pleural effusion, are common in PEA. Imaging data are only supportive; therefore, the final diagnosis should be based on pathology and immunohistochemistry analyses.
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Affiliation(s)
| | - Juhong Jiang
- Department of Pathology, the First Affiliated Hospital of Guangzhou Medical University
- Guangzhou Institute of Respiratory Health, Guangzhou, China
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Ma J, Zhang W, Huang Y, Wang L, Wang J, Yuan L, Zhang J. Radiologic findings of primary pulmonary angiosarcoma: A case report. Medicine (Baltimore) 2018; 97:e11105. [PMID: 29924006 PMCID: PMC6023840 DOI: 10.1097/md.0000000000011105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
RATIONALE Primary pulmonary angiosarcoma is a rare disease. Here, we report the case of primary pulmonary angiosarcoma diagnosed computed tomographic pulmonary angiography (CTPA) and discuss its specific imaging characteristics. PATIENT CONCERNS A 46-year-old man was admitted for cough and shortness of breath. Thoracic CTPA images demonstrated a high-attenuation lesion surrounding by a halo sign in upper lobe of right lung, and the dilated vessel was also seen in lower lobe of right lung. The sign of "hillside sign" was observed on CTPA. DIAGNOSES It was diagnosed with primary pulmonary angiosarcoma. INTERVENTIONS Right thoracotomy and right upper lobe lobectomy were performed. OUTCOMES Five years later, the patient dead of complete occlusion of the pulmonary artery owing to tumor recurrence. LESSONS Although primary pulmonary angiosarcoma is a rare disease with atypical early clinical symptoms, and it is often misdiagnosed as pulmonary embolism and pulmonary infection. Therefore, it is important to recognize the CTPA imaging characteristics of primary pulmonary angiosarcoma and Surgical resection should be performed to prolong the patients' lifetime.
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Affiliation(s)
- Jianbing Ma
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Jiaxing University, Jiaxing
| | - Weiqiang Zhang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Jiaxing University, Jiaxing
| | - Yijuan Huang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Jiaxing University, Jiaxing
| | - Lizhang Wang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Jiaxing University, Jiaxing
| | - Jia Wang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Jiaxing University, Jiaxing
| | - Linna Yuan
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Jiaxing University, Jiaxing
| | - Jingfeng Zhang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Sheng, China
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8
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Ng FH, Yu SM, Wai OKH, Chan JCS. Primary Epithelioid Angiosarcoma of Lung: Radiologic and Clinicopathologic Correlation. J Clin Imaging Sci 2017; 7:33. [PMID: 28900554 PMCID: PMC5582536 DOI: 10.4103/jcis.jcis_71_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 06/29/2017] [Indexed: 11/04/2022] Open
Abstract
Primary pulmonary angiosarcoma is extremely rare. It is often characterized by a clinically indolent course and delayed diagnosis. To date, there have been <20 cases reported. By far, little article correlates the clinical presentation, the imaging findings with the pathology. The authors present a case of middle-aged gentleman with primary pulmonary epithelioid angiosacroma which we initially thought as tuberculosis (TB) infection. A 60-year-old gentleman, with a history of 6 months on and off blood stained sputum, was admitted for an episode of massive hemoptysis. Urgent computed tomography (CT) bronchial arteriogram excluded any dilated bronchial artery. Patchy consolidation with multiple small centrilobular ground-glass nodules was noted at left upper lobe. The bronchoscopy was negative for malignancy and infection. Autoimmune workup was negative. Despite negative bronchoscopy, fungal, acid-fast bacilli culture and cytology, and anti-TB treatment were empirically given. However, his hemoptysis was unresolved. He was followed up with high-resolution CT after a month showed an enlarging left upper lobe mass surrounding by a ground glass halo. Left thoracotomy and left upper lobe lobectomy were performed. Epithelioid angiosacroma was found in histology. Radiologic and clinical-pathological findings were correlated in this paper.
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Affiliation(s)
- Fung Him Ng
- Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
| | - San Ming Yu
- Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
| | - Ophelia Ka Heng Wai
- Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
| | - James Chi Sang Chan
- Department of Radiology and Organ Imaging, United Christian Hospital, Kowloon, Hong Kong
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Shimabukuro I, Yatera K, Noguchi S, Kawanami Y, Iwanami T, Nishida C, Yamasaki K, Kawanami T, Ishimoto H, So T, Uramoto H, Yoshii C, Tanaka F, Mukae H. Primary Pulmonary Angiosarcoma Presenting with Hemoptysis and Ground-Glass Opacity: A Case Report and Literature Review. TOHOKU J EXP MED 2016; 237:273-8. [PMID: 26582434 DOI: 10.1620/tjem.237.273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Angiosarcoma originates from the vascular endothelium and accounts for only 1-2% of all sarcomatous malignancies. The skin is one of the most common primary sites. However, primary pulmonary angiosarcoma is rare, and only 31 cases of primary pulmonary angiosarcoma have been reported. A 79-year-old Japanese female developed bloody sputum, and chest X-ray and chest computed tomography (CT) showed consolidation with ground-glass opacity (GGO) on the right middle and lower lung fields. The bronchoscopic findings demonstrated bleeding from the right B(4) and B(5), and bronchial arterial embolization was subsequently performed. However, the CT findings demonstrated new pulmonary nodules with GGO in the left lung, and she presented with hemosputum and a progression of anemia. Right hemothorax also occurred, and surgical lung resection was performed to control the bleeding. The pathological analysis of the resected lung revealed the focal growth of atypical alveolar epithelioid-like cells that were positive for CD31 and negative for epithelial membrane antigen, and these atypical cells were replacing the endothelium of the pulmonary artery. Based on these findings, the patient was diagnosed with pulmonary angiosarcoma, which might originate from the endothelium of the pulmonary artery. No abnormal findings were observed except for the pulmonary involvement on systemic CT scanning. However, the patient passed away due to respiratory failure with compression of the brainstem caused by brain metastasis three months after the first visit. Early surgical resection is the important treatment for patients with angiosarcoma. In addition, we review the literature reporting the patients with primary pulmonary angiosarcoma.
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Affiliation(s)
- Ikuko Shimabukuro
- Department of Respiratory Medicine, Wakamatsu Hospital of the University of Occupational and Environmental Health, Japan
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10
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Ren Y, Zhu M, Liu Y, Diao X, Zhang Y. Primary pulmonary angiosarcoma: Three case reports and literature review. Thorac Cancer 2016; 7:607-613. [PMID: 27766785 PMCID: PMC5193014 DOI: 10.1111/1759-7714.12376] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/23/2016] [Indexed: 11/30/2022] Open
Abstract
Primary pulmonary angiosarcoma is a rare type of malignant vascular tumor with a very aggressive clinical course and a grim prognosis. To date, only a handful of cases have been reported in English literature. Its rarity and consequent low index of suspicion makes clinical diagnosis difficult. In this report we present three cases of primary pulmonary angiosarcoma with cough, hemoptysis, and progressive dyspnea to contribute to the sparse literature on this disease. A review is made of previous reports of primary pulmonary angiosarcomas, and the clinical characteristics, diagnosed method, treatment options, and prognosis of pulmonary angiosarcoma are also discussed.
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Affiliation(s)
- Yanhong Ren
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Min Zhu
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Diao
- Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yuhui Zhang
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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11
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Krishnamurthy A, Nayak D, Ramshankar V, Majhi U. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of primary pulmonary angiosarcomas. Indian J Nucl Med 2015; 30:142-4. [PMID: 25829733 PMCID: PMC4379674 DOI: 10.4103/0972-3919.152977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Angiosarcoma is a malignant vascular tumor that originates from the mesenchymal cells which have undergone angioblastic differentiation. Pulmonary angiosarcomas are invariably (>90%) metastatic tumors form primaries of the skin, bone, liver, breast, or heart. Primary pulmonary angiosarcomas are exceedingly rare, with just about 20 cases being reported in the literature. We report an additional case with a brief review of the literature of a primary pulmonary angiosarcoma in a 26-year-old lady who presented with intractable hemoptysis. In addition, we highlight the potential of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography as an important diagnostic tool in the evaluation of this tumor and thus contribute to the existing sparse literature on this fascinating yet devastating disease.
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Affiliation(s)
- Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | - Deepika Nayak
- Department of Surgical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
| | | | - Urmila Majhi
- Department of Pathology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India
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12
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Abstract
We describe a rare case of primary pulmonary epithelioid angiosarcoma detected by F-FDG PET/CT. A 54-year-old female patient with history of non-Hodgkin lymphoma underwent F-FDG PET/CT for follow-up. PET/CT detected an area of increased F-FDG uptake corresponding to a 4-cm mass located in the inferior lobe of the left lung. Based on this PET/CT finding, the patient underwent left inferior pulmonary lobectomy. Histology demonstrated the presence of a pulmonary epithelioid angiosarcoma. Other sites of disease were excluded. In our case, F-FDG PET/CT has been useful in detecting and staging this rare primary pulmonary tumor.
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13
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Primary pleural angiosarcoma in a 63-year-old gentleman. Case Rep Pulmonol 2013; 2013:974567. [PMID: 23844302 PMCID: PMC3697234 DOI: 10.1155/2013/974567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 06/03/2013] [Indexed: 11/25/2022] Open
Abstract
Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature. Herein, we report the case of a 63-year-old gentleman who presented with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. Chest X-ray showed bilateral pleural effusion with partial bibasilar atelectasis. Ultrasound-guided thoracocentesis showed bloody and exudative pleural fluid. Cytologic examination was negative for malignant cells. An abdominal contrast-enhanced computed tomography (CT) scan showed two right diaphragmatic pleural masses. Whole-body positron emission tomography/computed tomography (PET/CT) scan showed two hypermetabolic fluorodeoxyglucose- (FDG-) avid lesions involving the right diaphragmatic pleura. CT-guided needle-core biopsy was performed and histopathological examination showed neoplastic cells growing mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. Immunohistochemical analysis showed strong positivity for vimentin, CD31, CD68, and Fli-1 markers. The overall pathological and immunohistochemical features supported the diagnosis of epithelioid angiosarcoma. The patient was scheduled for surgery in three weeks. Unfortunately, the patient died after one week after discharge secondary to pulseless ventricular tachycardia arrest followed by asystole. Moreover, we also present a brief literature review on pleural angiosarcoma.
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14
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Demirag F, Cakir E, Yazici U, Tastepe I. Pulmonary tumor thrombotic microangiopathy from metastatic epithelioid angiosarcoma. J Thorac Dis 2013; 5:E107-11. [PMID: 23825782 DOI: 10.3978/j.issn.2072-1439.2012.10.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/10/2012] [Indexed: 11/14/2022]
Abstract
The lung is most common site for metastatic disease via hematogenous route. Tumor emboli of the vessels of the lung induces fibrocellular and fibromuscular intimal proliferation. These histopathological changes may cause pulmonary tumor trombotic microangiopaty. Few cases are diagnosed antemortem. We report a 60 year old woman with by metastatic epithelioid angiosarcoma involving the lung. Tumor cells were positive for VEGF and topoisomerase II. VEGF may be involved in the pathogenesis pulmonary tumor trombotic microangioapy and topoisomerase II positivity showed sensitivity against catalytic topoisomerase II inhibitors.
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Affiliation(s)
- Funda Demirag
- Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Pathology, Ankara, Turkey
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