Primary Aortic Angiosarcoma: A Review of Two Cases Highlighting Unique Imaging and Clinical Characteristics

Aortic Sarcoma Patients With Bone Metastasis

BACKGROUND

Metastases to the bone of aortic sarcoma include osteolytic and non-osteolytic lesions. This study aims to review the clinical symptoms, the sites and diagnostic methods of bone metastases and to compare the osteolytic and non-osteolytic metastases of patients with aortic sarcoma.

METHODS

A systematic search was conducted in PubMed and scientific journals published from 1972 to 2022. Database included reports of aortic sarcomas with bone metastasis published in english and in french. Characteristics of patients were analyzed with Chi-square test or Fisher's exact test between lytic and sclerotic bone metastases.

RESULTS

In 29 patients with bone destruction, the symptoms of low back pain and claudication were observed in 10 (34.5%), and 9 cases (31%), respectively. Acute ischemia of the legs and arms accounted for 7 cases (24.1%). There were 4 cases with hypertension (13.8%) and 5 cases with chest pain or abdominal pain or epigastric pain (17.2%). Metastases to the vertebrae, pelvis, femur were observed in 14 (48.3%), 12 (41.4%) and 11 cases (37.9%), respectively. Osteolytic lesions were detected at the time of diagnosis in 16/29 (55.2%) cases. In 27 aortic sarcoma patients with sclerotic bone metastases, symptoms of hypertension were observed in 10 (37.0%), of back pain in 7 (25.9 %), of chest pain or abdominal pain in 5 cases (18.5%). Acute ischemia of the leg occurred in 6 cases (22.2%). Metastases to the vertebrae, bone, pelvis, and femur were observed in 10 (37.0%), 9 (33.3%), 7 (25.9%), and 6 cases (22.2%), respectively. The sign of claudication and methods for detected bone destruction by X-rays were the difference between osteolytic and non-osteolytic metastases of aortic sarcoma (p=0,019; p=0,001), respectively.

CONCLUSIONS

Back pain is a common symptom of aortic sarcoma with bone metastasis. The sign of intermittent claudication is the difference between osteolytic and non-osteolytic metastases of aortic sarcoma. Bone destruction occurred in all bones, but mainly in vertebrae, pelvis, femur. Methods for detection of bone destruction mainly by X-rays or CT. Bone destruction was an important sign to detect aortic sarcoma. Sclerotic bone metastases occurred mainly in vertebrae, pelvis, bone and femur. The detection of sclerotic bone metastases based on MRI, PET/CT and autopsy.

Intimal angiosarcoma of the descending aorta presenting as atheroembolism: case report and description of intravascular biopsy

Aortic sarcoma is a rare entity. In most cases, the diagnosis is established late, owing to the course of the disease, with a median survival time of only a few months. We report the case of a 58-year-old patient with ischemic lesions in the lower limb. The lesions after several investigations were diagnosed by imaging studies (eg, magnetic resonance angiography, contrast-enhanced computed tomography [CT], CT angiography, or positron emission tomography-CT with fluorine-18 fluorodeoxyglucose) as possible primary angiosarcoma of the aorta. It was decided to perform endovascular aortic repair and endovascular biopsy of the lesion. This was chosen as a "palliative" treatment to avoid embolic events, given the presence of metastases, instead of open surgery, which would otherwise have been the treatment of choice. Subsequently, histologic examination confirmed aortic intimal angiosarcoma, and adjuvant chemotherapy was initiated. In the present report, we discuss the clinical presentation, diagnosis, and classification of primary aortic sarcomas. We also critically review the diagnostic and therapeutic management of these patients in previous series of studies to improve their treatment in subsequent cases.

Primary Aortic Epithelioid Angiosarcomas With Metastatic Disease Detected by 18F-FDG PET/CT

ABSTRACT

Epithelioid angiosarcoma in the aortic arch with metastatic disease is extremely rare. We report a case of 63-year-old man with suspected bone metastases who underwent 18F-FDG PET/CT for seeking the potential primary tumor. PET/CT demonstrated intense FDG uptake in the aortic arch with multiple FDG-avid lesions involving the lung, lymph nodes, and bones. Finally, the diagnosis of primary aortic epithelioid angiosarcomas with metastatic disease was confirmed.