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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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Wang X, Wei J, Zeng Z, Cai J, Lu Z, Liu A. Primary pleural epithelioid angiosarcoma treated successfully with anti-PD-1 therapy: A rare case report. Medicine (Baltimore) 2021; 100:e27132. [PMID: 34477160 PMCID: PMC8415961 DOI: 10.1097/md.0000000000027132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/29/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE 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. PATIENT CONCERNS We describe the rare case of a 52-year-old man who presented initially with hemoptysis and received emergency surgery for the primary. DIAGNOSES He received a confirmed diagnosis of primary pleural angiosarcoma (PPA) by postoperative pathology and was subsequently treated with radiotherapy and chemotherapy, but had failed and was intolerant to chemotherapy. INTERVENTIONS The patient had 5% tumor PD-L1 positivity with 22C3 pharmDx and received pembrolizumab (200 mg every 21 days) for 13 cycles. OUTCOMES The disease remained well controlled according to the RECIST 1.1. criteria. He is currently under observation and waiting to start the next cycle of immunotherapy. LESSON Our case report suggests that the use of anti-PD-1 therapy does show efficacy in the treatment of PPA and may provide a viable treatment option for patients.
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Affiliation(s)
- Xia Wang
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Jianping Wei
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Zhimin Zeng
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
- Jiangxi Key Laboratory of Clinical Translational Cancer Research, China
| | - Jing Cai
- Department of Oncology, The Second Affiliated Hospital of Nanchang University, China
| | - Zhiqin Lu
- 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
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Woo JJ, Kim Y, An JK, Lee H. Primary pleural epithelioid angiosarcoma manifesting as a loculated hemothorax: A case report and literature review focusing on CT findings. Radiol Case Rep 2021; 16:3072-3075. [PMID: 34429805 PMCID: PMC8365445 DOI: 10.1016/j.radcr.2021.07.048] [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] [Received: 07/13/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022] Open
Abstract
Primary pleural angiosarcoma (PPA) is an extremely rare and clinically aggressive tumor. We report the case of a 66-year-old man having PPA with chest computed tomography (CT) scan showing a large oval-shaped, nonenhancing high attenuation cystic mass in the left hemithorax. Morphological and immunohistochemical findings supported the diagnosis of epithelioid angiosarcoma. Pleural angiosarcoma should be considered in the differential diagnosis of spontaneous hemothorax manifesting as high attenuation loculated pleural fluid on CT.
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Affiliation(s)
- Jeong Joo Woo
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Yongsang Kim
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Jin Kyung An
- Department of Radiology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
| | - Hojung Lee
- Department of Pathology, Nowon Eulji Medical Center, Eulji University, Seoul, Korea
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Sedhai YR, Basnyat S, Golamari R, Koirala A, Yuan M. Primary pleural angiosarcoma: Case report and literature review. SAGE Open Med Case Rep 2020; 8:2050313X20904595. [PMID: 32095244 PMCID: PMC7011321 DOI: 10.1177/2050313x20904595] [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: 05/03/2019] [Accepted: 01/06/2020] [Indexed: 12/12/2022] Open
Abstract
Primary pleural angiosarcoma is an exceptionally rare malignancy of pleura
originating from the vascular endothelial cells. Here, we present a 70-year-old
African-American female who presented with 1-month history of dyspnea on
exertion, loss of appetite, and loss of weight along with left-sided pleuritic
chest pain. Evaluation revealed hemorrhagic pleural effusion in the left pleural
cavity. Computed tomography of the chest performed after therapeutic
thoracocentesis revealed left upper lobe lung mass along with multiple nodules
in right lung. Mass was biopsied at video-assisted thoracoscopy. Histopathology
was consistent with high-grade angiosarcoma. Endothelial origin of the tumor
cells was confirmed with positive immunohistochemical staining with CD31
antibodies. Our patient was diagnosed with primary pleural angiosarcoma
metastatic to the lung. She opted for palliative care and had a rapidly
declining clinical course and expired within 5 weeks of the diagnosis. Here, we
present a case report and review the relevant literature.
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Matsuda K, Yamaryo T, Akazawa Y, Kawakami K, Nakashima M. Primary pleural angiosarcoma associated with pneumoconiosis: An autopsy case. Pathol Int 2015; 65:603-7. [PMID: 26314557 DOI: 10.1111/pin.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 08/04/2015] [Indexed: 11/29/2022]
Abstract
We report a case of pleural angiosarcoma in an adult male patient confirmed by autopsy and possibly associated with pneumoconiosis. The lesion was characterized by thickened pleura of both lungs with nodular tumors. Histologically, the tumor was composed of spindle-to-polygonal epithelioid cells that were positive for CD31, CD34, vimentin, and cytokeratin on immunohistochemical staining but were negative for calretinin. Further examination revealed mix-dust pathological findings consistent with the existence of pneumoconiosis; dystrophic ossification, anthracosis, and fractal small dust particles were observed in the lung parenchyma and a hilar lymph node. The current case suggests that pneumoconiosis-associated pathologies may be risk factors for the development of angiosarcoma in the pleura.
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Affiliation(s)
- Katsuya Matsuda
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Hospital, Nagasaki, Japan
| | - Takeshi Yamaryo
- Nagasaki Kawatana Medical Center, Surgery, National Hospital Organization, Nagasaki, Japan
| | - Yuko Akazawa
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Hospital, Nagasaki, Japan.,Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan
| | - Kenji Kawakami
- Nagasaki Kawatana Medical Center, Surgery, National Hospital Organization, Nagasaki, Japan
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University Hospital, Nagasaki, Japan
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Zhang S, Zheng Y, Liu W, Yu X. Primary epithelioid angiosarcoma of the pleura: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:2153-2158. [PMID: 25973118 PMCID: PMC4396223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 01/28/2015] [Indexed: 06/04/2023]
Abstract
Primary angiosarcoma of the pleura is an extremely rare malignancy. Herein, we report the case of an elderly Chinese patient with primary left pleural epithelioid angiosarcoma. The 76-year-old man presented with a 4-month history of a cough with sputum expectoration and weight loss of 4 kg within one month. A chest scan showed a massive oval-shaped mass in the left pleural cavity. We then performed a left thoracotomy for tumor resection and surgical exploration. Histological examination of the resected specimen showed few viable tumor cells with significant atypia; tumor cells had large nuclei and prominent nucleoli and were arranged in a crack-like, sheeted pattern. Moreover, there was a significant amount of fibrinous exudates, hemorrhage, degeneration, and necrosis. With immunohistochemical analysis, tumor cells had strong expression of CD31, CD34, FLI-1, vimentin. Morphological and immunohistochemical findings supported the diagnosis of epithelioid angiosarcoma.
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Affiliation(s)
- Shuhong Zhang
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China
| | - Yuanyuan Zheng
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China
| | - Weihua Liu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China
| | - Xiaomeng Yu
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University Beijing, China
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Bruixola G, Díaz-Beveridge R, Jiménez E, Caballero J, Salavert M, Escoin C, Aparicio J. Pleuropulmonary angiosarcoma involving the liver, the jejunum and the spine, developed from chronic tuberculosis pyothorax: Multidisciplinary approach and review of literature. Lung Cancer 2014; 86:105-11. [PMID: 25097031 DOI: 10.1016/j.lungcan.2014.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/04/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023]
Abstract
Pleuropulmonary angiosarcomas are very rare, with less than fifty cases reported in the literature. In most cases, the etiology is unknown but the presence of a chronic tuberculous pyothorax has been reported in several Asian case reports as a possible risk factor. We report the case of a Caucasian 68-year old man who presented with a pleuropulmonary angiosarcoma that arose from a chronic tuberculous pyothorax and which involved the ribs and the vertebrae, the psoas muscle, and the jejunum. The patient received adapted anti-tuberculosis treatment, embolization of the mass in the small bowel, palliative external beam radiotherapy on the spine and systemic chemotherapy with liposomal non-pegylated doxorubicin and ifosfamide. With this multidisciplinary approach the patient's symptoms were well controlled and he achieved a complete metabolic response after six cycles of chemotherapy. Unfortunately, the patient died after eight months from the beginning of chemotherapy due to an acute lung injury secondary to extensive bilateral interstitial infiltrates. Opportunistic pathogens or drug-induced lung toxicity were the most probable causes. Treatment with liposomal non-pegylated doxorubicin and ifosfamide could be a reasonable option in pleuropulmonary angiosarcoma but it should be validated in clinical trials. Chronic pyothorax seems to be a predisposing factor for the development of pleural angiosarcoma but further investigations are required to assess a causal association.
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Affiliation(s)
- Gema Bruixola
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | | | - Enrique Jiménez
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Caballero
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit, Internal Medicine Department, University Hospital La Fe, Valencia, Spain
| | - Corina Escoin
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
| | - Jorge Aparicio
- Medical Oncology Department, University Hospital La Fe, Valencia, Spain
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Lorentziadis M, Sourlas A. Primary De Novo Angiosarcoma of the Pleura. Ann Thorac Surg 2012; 93:996-8. [PMID: 22365000 DOI: 10.1016/j.athoracsur.2011.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 07/04/2011] [Accepted: 07/12/2011] [Indexed: 11/26/2022]
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9
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Kao YC, Chow JM, Wang KM, Fang CL, Chu JS, Chen CL. Primary pleural angiosarcoma as a mimicker of mesothelioma: a case report **VS**. Diagn Pathol 2011; 6:130. [PMID: 22208720 PMCID: PMC3260116 DOI: 10.1186/1746-1596-6-130] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Accepted: 12/30/2011] [Indexed: 11/24/2022] Open
Abstract
Primary pleural angiosarcoma is a rare and clinically aggressive tumor. Patients usually present with chest pain, dyspnea, hemoptysis and/or cough. Radiologic studies reveal diffuse pleural thickening and pleural effusion with or without mass lesion. The clinical and radiological features both resemble those of mesothelioma, and its definite diagnosis requires careful histologic examination. However, frequent epithelioid feature and immunoreactivity to cytokeratin in primary pleural angiosarcoma further complicate the pathologic diagnosis. The use of proper immunohistochemical stains is often needed to support endothelial differentiation in the tumor cells and to exclude metastatic carcinoma and mesothelioma. We report the case of a 49-year-old male patient with primary pleural angiosarcoma, who presented with initial hemothorax, followed by a rapid progress to an inoperable status.
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Affiliation(s)
- Yu-Chien Kao
- Department of Pathology, Wan Fang Hospital, Taipei Medical University, Taiwan
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10
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Baisi A, Raveglia F, De Simone M, Cioffi U. Primary multifocal angiosarcoma of the pleura. Interact Cardiovasc Thorac Surg 2011; 12:1069-70. [PMID: 21429871 DOI: 10.1510/icvts.2011.267708] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Alessandro Baisi
- Thoracic Surgery Unit, University of Milan, Ospedale San Paolo, 20142 Milan, Italy.
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Dainese E, Pozzi B, Milani M, Rossi G, Grazia Pezzotta M, Vertemati G, Tricomi P, Sessa F. Primary pleural epithelioid angiosarcoma. A case report and review of the literature. Pathol Res Pract 2010; 206:415-9. [PMID: 20089367 DOI: 10.1016/j.prp.2009.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 09/14/2009] [Accepted: 11/24/2009] [Indexed: 10/19/2022]
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