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Kawai Y, Koizumi K, Itoh T, Iio M, Shimizu H. Mobile Thrombus in the Ascending Aorta. Ann Vasc Dis 2020; 13:69-71. [PMID: 32273925 PMCID: PMC7140152 DOI: 10.3400/avd.cr.19-00063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 65-year-old male who presented with dizziness, dysarthria, and disability of his left hand was admitted to our hospital. Magnetic resonance imaging of the head revealed cerebral infarction and enhanced computed tomography revealed a suspicious thrombus in the ascending aorta. He did not have a coagulation disorder. We performed ascending aortic replacement and removed the thrombus with the aortic wall in order to avoid any recurrences. Here we report the successful treatment of the case from clinical and pathological points of view with some findings.
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Affiliation(s)
- Yujiro Kawai
- Department of Cardiovascular Surgery, Keio University School of Medicine
| | - Kiyoshi Koizumi
- Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital
| | - Takahito Itoh
- Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital
| | - Minami Iio
- Department of Cardiovascular Surgery, Ashikaga Red Cross Hospital
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine
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2
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Shimogawara T, Ono S, Kobayashi K, Sasaki A, Shimizu H, Matsui J. Aortic sarcoma mimicking a mycotic aneurysm in the thoracoabdominal aorta. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:593-596. [PMID: 31872164 PMCID: PMC6909102 DOI: 10.1016/j.jvscit.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022]
Abstract
Aortic sarcoma is a rare primary tumor with dismal prognosis. Here, we report a case involving a 74-year-old female patient with aortic sarcoma masquerading as a mycotic aneurysm in the thoracoabdominal aorta. She underwent aortic resection with Dacron prosthetic graft replacement because of rapid growth. The postoperative pathological findings of the resected specimen confirmed the diagnosis of aortic mural sarcoma, which was an unexpected result based on repeat computed tomography angiography performed within 2 months preoperatively. The preoperative diagnosis of aortic sarcoma is often difficult because of its rarity, and this case demonstrates some of the diagnostic pitfalls.
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Affiliation(s)
- Tatsuya Shimogawara
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Shigeshi Ono
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Kanako Kobayashi
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Aya Sasaki
- Department of Pathology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Matsui
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
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3
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Iida Y, Yoshitake A, Shimizu H. A Case of Upper Limb Arterial Embolization from Aortic Arch Intimal Sarcoma. Ann Vasc Dis 2018; 11:358-360. [PMID: 30402190 PMCID: PMC6200610 DOI: 10.3400/avd.cr.18-00038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
We report a case with aortic intimal sarcoma who presented with left upper limb arterial embolization from tumor. A 79-year-old female patient presented with paleness and left upper limb paralysis. A transesophageal echocardiogram revealed a mobile and fragile mass attached in the aortic arch. Contrast-enhanced computed tomography showed a massive irregular tumor in the aortic arch with left common carotid and subclavian artery occlusion. Total arch replacement was performed, and tumor was resected en bloc. Although the postoperative course was uneventful, multiple metastasis to the limbs was observed. The patient died 6 months postoperatively.
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Affiliation(s)
- Yasunori Iida
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Yoshitake
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
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4
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Multiple skeletal muscle metastases revealing a cardiac intimal sarcoma. Skeletal Radiol 2018; 47:125-130. [PMID: 28887581 DOI: 10.1007/s00256-017-2768-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/12/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
We report the case of a 59-year-old female with progressive bilateral painful swelling of the thighs. MRI revealed multiple intramuscular necrotic masses with similar morphologic patterns. Whole-body CT and 18-FDG PET-CT scans demonstrated additional hypermetabolic muscular masses and a lobulated lesion within the left atrial cavity. As biopsy of a muscular mass was compatible with a poorly differentiated sarcoma with MDM2 oncogene amplification, two diagnoses were discussed: a dedifferentiated liposarcoma with muscle and heart metastases or a primary cardiac sarcoma, mainly a cardiac intimal sarcoma, with muscular metastases, which was finally confirmed by array-comparative genomic hybridization (aCGH) in a sarcoma reference center. This case emphasizes the potential for intimal sarcoma to disseminate in skeletal muscle prior to any other organ and the need for a genomic approach in addition to classical radiopathologic analyses to distinguish primary from secondary locations facing simultaneous tumors of the heart and skeletal muscles with MDM2 amplification.
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Osio A, Vignon-Pennamen MD, Pedeutour F, Le Maignan C, Koskas F, Lebbé C, Janin A, Battistella M. PDGFRa amplification in multiple skin lesions of undifferentiated pleomorphic sarcoma: A clue for intimal sarcoma metastases. J Cutan Pathol 2017; 44:477-479. [PMID: 28105789 DOI: 10.1111/cup.12907] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/12/2017] [Accepted: 01/16/2017] [Indexed: 12/01/2022]
Abstract
A 62-year-old human immunodeficiency virus-positive man was admitted for multiple cutaneous and subcutaneous nodules on his lower limbs, corresponding to an undifferentiated proliferation of spindle and pleomorphic cells, with irregular nuclei and numerous mitoses. The tumor cells were negative for a large panel of immunohistochemical markers, except CD10. MDM2 immunohistochemical staining was also negative, leading to the diagnosis of Fédération Nationale des Centres de Lutte contre le Cancer grade III undifferentiated pleomorphic sarcoma (UPS). Array-comparative genomic hybridization showed a highly complex karyotype, with amplification of the 4q12 region, an area that contains only the platelet-derived growth factor receptor α (PDGFRa) gene. This amplification of PDFGRa, molecular hallmark of intimal sarcoma (IS), led to the diagnosis of skin IS metastasis. A positron emission tomography showed a hypermetabolic mass protruding in the preaortic area, consistent with the diagnosis of aortic IS. Our study shows that a rare differential diagnosis in peripheral UPS can be IS skin metastasis, and underlines the importance of molecular analyses in UPS.
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Affiliation(s)
- Amélie Osio
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1165, Paris, France.,INSERM, U1165-Paris, Paris, France.,Laboratoire de Pathologie, Hôpital Saint-Louis AP-HP, Paris, France
| | - Marie-Dominique Vignon-Pennamen
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1165, Paris, France.,INSERM, U1165-Paris, Paris, France.,Laboratoire de Pathologie, Hôpital Saint-Louis AP-HP, Paris, France
| | - Florence Pedeutour
- Laboratoire de Biologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | | | - Fabien Koskas
- Service de Chirurgie Vasculaire, Hôpital la Pitié Salpétrière AP-HP, Paris, France
| | - Célèste Lebbé
- Service de Dermatologie, Hôpital Saint-Louis AP-HP, Paris, France
| | - Anne Janin
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1165, Paris, France.,INSERM, U1165-Paris, Paris, France.,Laboratoire de Pathologie, Hôpital Saint-Louis AP-HP, Paris, France
| | - Maxime Battistella
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1165, Paris, France.,INSERM, U1165-Paris, Paris, France.,Laboratoire de Pathologie, Hôpital Saint-Louis AP-HP, Paris, France
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Lin SI, Su MI, Tsai CT. Primary Intimal Sarcoma of Thoracic Aorta Presenting as Hypertensive Crisis. ACTA CARDIOLOGICA SINICA 2016; 31:560-3. [PMID: 27122923 DOI: 10.6515/acs20150119g] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED We report a 45-year-old woman who presented to our facility in a hypertensive crisis. Computed tomography (CT) revealed a thoracic aortic tumor, and tissues obtained via endovascular biopsy revealed undifferentiated sarcoma. A final diagnosis of intimal sarcoma was made by intra-operative pathological examination. Despite undergoing surgical resection followed by adjuvant chemotherapy, the patient died from progressive multiple metastasis and severe sepsis. Although aortic sarcoma is rarely diagnosed, it should be considered a possible etiology of hypertensive crisis. KEY WORDS Aortic tumor; Endovascular biopsy; Hypertension crisis; Intimal sarcoma.
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Affiliation(s)
- Shu-I Lin
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Min-I Su
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Cheng-Ting Tsai
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
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Staats P, Tavora F, Burke AP. Intimal sarcomas of the aorta and iliofemoral arteries: a clinicopathological study of 26 cases. Pathology 2014; 46:596-603. [DOI: 10.1097/pat.0000000000000182] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Rusthoven CG, Liu AK, Bui MM, Schefter TE, Elias AD, Lu X, Gonzalez RJ. Sarcomas of the Aorta: A Systematic Review and Pooled Analysis of Published Reports. Ann Vasc Surg 2014; 28:515-25. [DOI: 10.1016/j.avsg.2013.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 12/19/2022]
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9
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Restrepo CS, Betancourt SL, Martinez-Jimenez S, Gutierrez FR. Aortic Tumors. Semin Ultrasound CT MR 2012; 33:265-72. [DOI: 10.1053/j.sult.2011.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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10
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Bendel EC, Maleszewski JJ, Araoz PA. Imaging sarcomas of the great vessels and heart. Semin Ultrasound CT MR 2012; 32:377-404. [PMID: 21963161 DOI: 10.1053/j.sult.2011.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary sarcomas of the aorta, pulmonary artery, superior vena cava, inferior vena cava, and the heart are rare neoplasms. Aortic sarcomas are broadly categorized as either primarily luminal or primarily mural, with luminal sarcomas more likely to be misdiagnosed as thrombus. Pulmonary artery sarcomas are often mistaken for pulmonary embolism both clinically and at imaging. Vena caval sarcomas appear as intraluminal or extraluminal masses connecting to or filling the veins. The most common are leiomyosarcomas of the inferior vena cava. Primary sarcomas of the heart are rare and usually appear as heterogeneous aggressive masses.
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Affiliation(s)
- Emily C Bendel
- Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester, MN 55905, USA
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Rolf T, Iglesias JF, Tozzi P, von Segesser LK. Acute myocardial infarction caused by coronary embolization of a papillary fibroelastoma of the thoracic ascending aorta. Interact Cardiovasc Thorac Surg 2010; 11:676-7. [PMID: 20739407 DOI: 10.1510/icvts.2010.244772] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Papillary fibroelastomas (PFE) are benign endocardial masses and generally originate from the cardiac valves, while PFE arising from the ascending thoracic aorta are an uncommon clinical finding. We report the case of a 78-year-old female who presented to the emergency department with an acute ST segment elevation myocardial infarction. Urgent coronary angiography showed no significant coronary artery obstructive disease but left ventriculography revealed the presence of a highly mobile mass located in the proximal portion of the ascending thoracic aorta. We postulated that the clinical symptoms were caused by embolization from the aortic mass and surgical excision of the peduncle was performed. Histopathological examination revealed a PFE with thrombotic material. Nowadays, surgical excision of PFE remains, the treatment of choice for symptomatic patients with excellent short- and long-term results but recurrence of PFE following surgical excision has not been reported.
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Affiliation(s)
- Tanina Rolf
- Department of Cardiovascular Surgery, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
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