|
1
|
Misiak J, Sokołowski B, Skrobisz N, Matczak M, Braun M. Pancytopenia Related to Splenic Angiosarcoma: A Case Report and Literature Review. Hematol Rep 2024; 16:648-655. [PMID: 39449306 PMCID: PMC11503393 DOI: 10.3390/hematolrep16040063] [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: 08/01/2024] [Revised: 10/14/2024] [Accepted: 10/15/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Angiosarcomas are highly aggressive malignancies with endothelial differentiation, presenting considerable challenges in oncology, especially when arising in rare locations such as the spleen. These tumors predominantly affect adults and are commonly found in the skin, breast, liver, or soft tissues, with more unusual occurrences in other organs. Angiosarcomas have a high propensity for metastasis, typically spreading to the liver, lungs, lymph nodes, and gastrointestinal tract. Splenic angiosarcoma, with fewer than 300 documented cases, is an especially rare and complex form of this malignancy. CASE PRESENTATION This report details a case of splenic angiosarcoma in a 45-year-old male, where bone marrow metastases were the first clinical presentation, initially mimicking myelodysplastic syndrome (MDS) due to persistent pancytopenia. CONCLUSIONS The eventual identification of the splenic origin underscores the diagnostic difficulties and clinical challenges inherent in managing such atypical and rare presentations.
Collapse
Affiliation(s)
| | | | | | | | - Marcin Braun
- Department of Pathology, Chair of Oncology, Medical University of Lodz, 92-213 Lodz, Poland; (J.M.); (B.S.); (N.S.); (M.M.)
| |
Collapse
|
|
2
|
Dicovitsky RH, Schappa JT, Schulte AJ, Lang HP, Kuerbitz E, Roberts S, DePauw TA, Lewellen M, Winter AL, Stuebner K, Buettner M, Reid K, Bergsrud K, Pracht S, Chehadeh A, Feiock C, O’Sullivan MG, Carlson T, Armstrong AR, Meritet D, Henson MS, Weigel BJ, Modiano JF, Borgatti A, Vallera DA. Toxicity Profile of eBAT, a Bispecific Ligand-Targeted Toxin Directed to EGFR and uPAR, in Mice and a Clinical Dog Model. Toxins (Basel) 2024; 16:376. [PMID: 39330834 PMCID: PMC11436214 DOI: 10.3390/toxins16090376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/15/2024] [Accepted: 08/20/2024] [Indexed: 09/28/2024] Open
Abstract
EGFR-targeted therapies are efficacious, but toxicity is common and can be severe. Urokinase type plasminogen activator receptor (uPAR)-targeted drugs are only emerging, so neither their efficacy nor toxicity is fully established. Recombinant eBAT was created by combining cytokines EGF and uPA on the same single-chain molecule with truncated Pseudomonas toxin. Its purpose was to simultaneously target tumors and their vasculature in the tumor microenvironment. In prior studies on mice and dogs, the drug proved efficacious. Here, we report the safety of eBAT in normal wildtype, uPAR knockout, and immunoreplete and immunodeficient tumor-bearing mice, as well as in dogs with spontaneous sarcoma that more closely mirror human cancer onset. In immunocompetent mice, tumor-bearing mice, uPAR knockout mice, and mice receiving species-optimized eBAT, toxicities were mild and self-limiting. Likewise, in dogs with life-threatening sarcoma given dosages found to be biologically active, eBAT was well tolerated. In mice receiving higher doses, eBAT was associated with dose-dependent evidence of liver injury, including portal biliary hyperplasia, oval cell proliferation, lymphoplasmacytic inflammation, periportal hepatocellular microvesicular change, hemorrhage, necrosis, and apoptosis. The results support continuing the clinical development of eBAT as a therapeutic agent for individuals with sarcoma and other cancers.
Collapse
Affiliation(s)
- Rose H. Dicovitsky
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
| | - Jill T. Schappa
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Experimental Surgical Services, Department of Surgery, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| | - Ashley J. Schulte
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Haeree P. Lang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Comparative Molecular Biosciences Graduate Program and DVM-PhD Dual Degree Program, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - Ellen Kuerbitz
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
| | - Sarah Roberts
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
| | - Taylor A. DePauw
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Microbiology, Immunology, and Cancer Biology Graduate Program, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| | - Mitzi Lewellen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Amber L. Winter
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - Kathy Stuebner
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - Michelle Buettner
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - Kelly Reid
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - Kelly Bergsrud
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - Sara Pracht
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - Andrea Chehadeh
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - Caitlin Feiock
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
| | - M. Gerard O’Sullivan
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA;
| | - Tim Carlson
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA;
| | - Alexandra R. Armstrong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
| | - Danielle Meritet
- Department of Population Health and Pathobiology, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27607, USA
| | - Michael S. Henson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
| | - Brenda J. Weigel
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jaime F. Modiano
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Laboratory Medicine and Pathology, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
- Center for Immunology, University of Minnesota, Minneapolis, MN 55455, USA
- Stem Cell Institute, University of Minnesota, Minneapolis, MN 55455, USA
- Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Antonella Borgatti
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA; (R.H.D.); (J.T.S.); (A.J.S.); (H.P.L.); (E.K.); (S.R.); (T.A.D.); (M.L.); (C.F.); (A.R.A.); (M.S.H.); (J.F.M.); (A.B.)
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Clinical Investigation Center, College of Veterinary Medicine, University of Minnesota, St. Paul, MN 55108, USA
- Center for Immunology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Daniel A. Vallera
- Animal Cancer Care and Research Program, University of Minnesota, St. Paul, MN 55108, USA; (A.L.W.); (K.S.); (M.B.); (K.R.); (K.B.); (S.P.); (A.C.); (M.G.O.); (B.J.W.)
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Radiation Oncology, Medical School, University of Minnesota, Minneapolis, MN 55455, USA
| |
Collapse
|
|
3
|
Damouny M, Mansour S, Khuri S. Primary Angiosarcoma of the Spleen: An Aggressive Neoplasm. World J Oncol 2022; 13:337-342. [PMID: 36660212 PMCID: PMC9822683 DOI: 10.14740/wjon1542] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 12/25/2022] Open
Abstract
Primary tumors of the spleen are rare, with an incidence rate of about 0.1%. These tumors could be benign, usually asymptomatic, or malignant which are usually symptomatic with abdominal pain being the most common symptom. Lymphoid neoplasms are the most common primary splenic tumors. Primary angiosarcoma is one of the extremely rare malignant vascular neoplasms of the spleen, which carries a dismal prognosis. It constitutes almost 7.4% of all primary malignant splenic neoplasms and is well known as an aggressive tumor with high local recurrence and distant metastasis rates. Overall survival is up to 12 months following diagnosis, regardless of management strategy. Due to the broad differential diagnosis of splenic tumors, this tumor is often forgotten, and is very challenging to diagnose early. Less than 300 cases of primary splenic angiosarcoma have been reported in the English literature. The main issue of this article is to review the current English literature to figure out the characteristic demographic features, clinical presentation, imaging findings and management of such tumors, in order to increase awareness of the treating physicians to improve diagnosis, management, as well as overall survival.
Collapse
Affiliation(s)
- Mira Damouny
- General Surgery Department, Rambam Medical Center, Haifa, Israel
| | - Subhi Mansour
- General Surgery Department, Rambam Medical Center, Haifa, Israel
| | - Safi Khuri
- General Surgery Department, Rambam Medical Center, Haifa, Israel,HPB and Surgical Oncology Unit, Rambam Medical Center, Haifa, Israel,Corresponding Author: Safi Khuri, HepatoPancreatoBiliary Surgical Unit, General Surgery Department, Rambam Medical Care Center, Haa’leya Hashniya, Haifa 31096, Israel.
| |
Collapse
|
|
4
|
Sudden and unexpected deaths due to non-traumatic abdominal disorders: A forensic perspective. J Forensic Leg Med 2022; 89:102355. [DOI: 10.1016/j.jflm.2022.102355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/08/2022] [Accepted: 04/23/2022] [Indexed: 12/22/2022]
|
|
5
|
Pan D, Li TP, Xiong JH, Wang SB, Chen YX, Li JF, Xiao Q. Treatment with sorafenib plus camrelizumab after splenectomy for primary splenic angiosarcoma with liver metastasis: A case report and literature review. World J Clin Cases 2022; 10:2818-2828. [PMID: 35434106 PMCID: PMC8968800 DOI: 10.12998/wjcc.v10.i9.2818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/04/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary splenic angiosarcoma (PSA) is an extremely rare and aggressive mesenchymal malignancy with high metastatic potential and a poor prognosis. There are no established treatment guidelines for PSA, even for adjuvant therapy. This rare case may provide a reliable therapeutic regime for a better prognosis.
CASE SUMMARY A 49-year-old female who complained of right-upper quadrant abdominal pain was diagnosed as having PSA with splenic rupture and liver metastasis. After splenectomy and liver tumor resection, she received sorafenib and camrelizumab therapy. After 15 mo of follow-up, she is in good condition, without recurrence or any identified metastasis.
CONCLUSION Immunotherapy combined with targeted therapy could be a potential option for the adjuvant therapy of PSA.
Collapse
Affiliation(s)
- Dan Pan
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Tai-Ping Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Jian-Hui Xiong
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Shu-Bo Wang
- The Medical Department, 3D Medicines Inc., Shanghai 201114, Shanghai Province, China
| | - Yao-Xu Chen
- The Medical Department, 3D Medicines Inc., Shanghai 201114, Shanghai Province, China
| | - Jian-Feng Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Qi Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| |
Collapse
|
|
6
|
Abstract
Introduction: Spleen angiosarcoma (SA) is a rare malignant neoplasm that arises from the splenic vascular endothelium, with only around 300 cases reported to date. Due to a limited number of reported cases, there is a paucity of data and a lack of understanding of its presentation, diagnosis, and management. In this study, we aim to provide a comprehensive review of SA.Areas covered: On 27 February 2021, a literature search was done in PubMed and Embase database. The search yielded 122 articles involving 205 patients. The focus was on patient demographics, risk factors, clinical presentations, investigation results, preliminary diagnoses, therapies provided, and patient outcomes. These factors were analyzed to identify possible risk factors, diagnostic modalities, and therapeutic principles that were not mentioned before.Expert opinion: The clinical presentation or investigation results of patients with SA are often nonspecific. Hence, they may not be sufficient to clinch the diagnosis of SA if used alone. The authors recommend a triple assessment of clinical examination, imaging findings, and pathology to diagnose SA with high accuracy. Splenectomy should be the mainstay of management, with chemotherapy and radiotherapy considered as adjuncts, especially in the presence of metastases.
Collapse
|
|
7
|
Takehara M, Miyamoto H, Fujino Y, Tomonari T, Taniguchi T, Kitamura S, Okamoto K, Sogabe M, Sato Y, Muguruma N, Bando Y, Takayama T. Long-Term Survival due to Chemotherapy including Paclitaxel in a Patient with Metastatic Primary Splenic Angiosarcoma. Case Rep Gastroenterol 2021; 15:910-918. [PMID: 34720843 PMCID: PMC8543300 DOI: 10.1159/000519211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/20/2021] [Indexed: 11/19/2022] Open
Abstract
A primary splenic angiosarcoma is a rare type of soft tissue sarcoma and is associated with an extremely poor prognosis. In this study, we describe the case of a patient who was diagnosed with metastatic primary splenic angiosarcoma and survived for about 2 years. A 62-year-old female was referred to us for the treatment of splenic angiosarcoma with disseminated intravascular coagulation (DIC) and multiple liver and bone metastases. Paclitaxel therapy resulted in recovery from DIC and enabled her to continue sequential treatment through to sixth-line chemotherapy. We reviewed all splenic angiosarcoma case reports which were described as stage IV to date and compared with our case. From these data, we found that the median overall survival was 105 days, and the prognosis of splenic angiosarcoma of stage IV was worse than conventional case series. Splenectomy was performed in more patients than chemotherapy as a treatment. Moreover, various chemotherapeutic regimens were used. These data suggest that administering chemotherapy including paclitaxel to patients with splenic angiosarcoma might improve their prognosis.
Collapse
Affiliation(s)
- Masanori Takehara
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hiroshi Miyamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuteru Fujino
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsu Tomonari
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tatsuya Taniguchi
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shinji Kitamura
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Koichi Okamoto
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masahiro Sogabe
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasushi Sato
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Naoki Muguruma
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshimi Bando
- Department of Pathology, Tokushima University Hospital, Tokushima, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| |
Collapse
|
|
8
|
Wheelwright M, Spartz EJ, Skubitz K, Yousaf H, Murugan P, Harmon JV. Primary angiosarcoma of the spleen, a rare indication for splenectomy: a case report. Int J Surg Case Rep 2021; 82:105929. [PMID: 33957408 PMCID: PMC8113851 DOI: 10.1016/j.ijscr.2021.105929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary angiosarcoma of the spleen is a rare condition with a nonspecific clinical presentation and is associated with a poor prognosis. We describe two patients with primary splenic angiosarcoma successfully treated with splenectomy and adjuvant chemotherapy. CASE PRESENTATIONS Case 1: A 50-year-old female presented with fatigue and left-sided rib, shoulder, and abdominal pain. A CT scan demonstrated a large splenic mass, and biopsy was diagnostic of angiosarcoma. An open en bloc resection of the spleen was performed, and pathologic examination confirmed high-grade angiosarcoma; the surgical margins were negative. The patient received pegylated liposomal doxorubicin (PLD) and ifosfamide; she demonstrated no evidence of recurrence with four years of follow-up. Case 2: A 70-year-old male presented with acute back pain. A CT scan demonstrated a splenic mass; biopsy was diagnostic of angiosarcoma. The patient underwent open splenectomy, and pathology revealed high-grade angiosarcoma; the surgical margins were positive. The patient received PLD and ifosfamide but presented three years later with metastatic tumor to the spine. The patient had a favorable tumor response to pembrolizumab. The patient's tumor burden remains stable at 5 years following splenectomy. CLINICAL DISCUSSION Angiosarcoma of the spleen is a rare clinical entity and is often challenging to diagnose early. Moratality is high, especially in the case of metastasis or spontaneous rupture. CONCLUSION Due to the rare nature of this tumor, optimal treatment is not known. Here, we show excellent response in two patients to surgery combined with adjuvant therapy.
Collapse
Affiliation(s)
- Matthew Wheelwright
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN 55414, United States of America.
| | - Ellen J Spartz
- University of Minnesota Medical School, Minneapolis, MN 55414, United States of America
| | - Keith Skubitz
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical School, Minneapolis, MN 55414, United States of America
| | - Hira Yousaf
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN 55414, United States of America
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN 55414, United States of America
| | - James V Harmon
- Department of Surgery, University of Minnesota Medical School, Minneapolis, MN 55414, United States of America
| |
Collapse
|
|
9
|
Zhao S, Zhu L, Tong F, Tinzin L, Huang F, Zhou Y. Unexpected death due to spontaneous splenic rupture: A rare case in splenic angiosarcoma. Leg Med (Tokyo) 2020; 47:101785. [PMID: 32977197 DOI: 10.1016/j.legalmed.2020.101785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 12/27/2022]
Abstract
Splenic angiosarcoma (SA) is a rare disease that can cause spontaneous splenic rupture leading to unexpected death. The rare incidence and non-specific clinical presentations made the early correct diagnosis of SA impossible in clinical practice. Even with medical intervention, 80% of patients died within 6 months after diagnosis. Here, we report a man who had complained of abdominal distension for 2 weeks and succumbed to the disease nine hours after admission. Diagnosis of hepatic and splenic angiosarcomas was based on post-mortem histopathological examination and immunohistochemistry, and the cause of death was hemorrhagic shock caused by spontaneous splenic rupture secondary to SA. This present case was the first forensic autopsy of spontaneous splenic rupture secondary to SA, which can highlight the diagnosis of rare diseases in forensic practice, and forensic pathologists should bear in mind these rare diseases even in routine practice.
Collapse
Affiliation(s)
- Shuquan Zhao
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Longlong Zhu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Fang Tong
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Lopsong Tinzin
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Fang Huang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China
| | - Yiwu Zhou
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, No. 13 Hangkong Road, Wuhan 430030, PR China.
| |
Collapse
|
|
10
|
Bergas A, Escrihuela-Vidal F, Fernández Calvo D, Capdevila Pons O, Corbella X. Relapsing Haemothorax as an Unusual Presentation of Primary Angiosarcoma of the Spleen. Eur J Case Rep Intern Med 2020; 7:001944. [PMID: 33457353 DOI: 10.12890/2020_001944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 08/25/2020] [Indexed: 01/25/2023] Open
Abstract
Spontaneous haemothorax (SH) is a rare subcategory of haemothorax that involves the accumulation of blood within the pleural space in the absence of trauma. SH especially occurs in middle-aged or elderly patients, but data are usually limited to case reports and case series. Coagulopathy, aneurysm or aortic dissection, Rendu-Osler-Weber syndrome and malignancy have to be considered among the causes of SH. Aim We describe a case of primary angiosarcoma of the spleen presenting as relapsing haemothorax. Results An 81-year-old woman was referred to our hospital because of a 2-month history of relapsing haemothorax after the performance of urgent splenectomy due to active bleeding from large spleen cysts. No evidence of neoplasm was seen after pathological examination of the spleen. On admission, left haemothorax and 2 new cystic masses in the thoracic wall were documented, both in close relation to the scars of previous surgery and chest tubes. After excision of 1 mass, histological examination revealed angiosarcoma, and a final diagnosis of primary angiosarcoma of the spleen with postsurgical metastatic dissemination to the thorax and pleura was made. Conclusion Primary angiosarcoma should be included in the differential diagnosis of haemorrhagic spleen cysts. Clinical diagnosis and management usually requires splenectomy, but it should be carefully planned in order to avoid local metastatic dissemination or haematogenous spread of the tumour. LEARNING POINTS The differential diagnosis of spleen cysts must include malignant conditions.Despite its absolute rarity, angiosarcoma is considered the most common primary non-haematolymphoid splenic malignancy and has a poor prognosis.Splenectomy is usually required for a prompt diagnosis of primary angiosarcoma of the spleen, but it needs to be performed with extreme caution to avoid metastatic dissemination.
Collapse
Affiliation(s)
- Alba Bergas
- Department of Internal Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Francesc Escrihuela-Vidal
- Department of Internal Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Davinia Fernández Calvo
- Department of Pathology, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Olga Capdevila Pons
- Department of Internal Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Xavier Corbella
- Department of Internal Medicine, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Spain.,School of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| |
Collapse
|
|
11
|
Shono K, Hashimoto Y, Shono T. Emergent laparoscopic dome resection and omental suturing to the splenic parenchymal edge for a spontaneously ruptured non-parasitic large splenic cyst in a pediatric patient: a case report. Surg Case Rep 2019; 5:201. [PMID: 31853667 PMCID: PMC6920282 DOI: 10.1186/s40792-019-0750-2] [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] [Received: 08/20/2019] [Accepted: 11/19/2019] [Indexed: 11/21/2022] Open
Abstract
Background Spontaneously ruptured large splenic cyst is a rare in children, and traditionally total or partial splenectomy has been performed for treating an emergent case. We herein present a first case with spontaneously ruptured pediatric splenic cyst treated with emergent laparoscopic dome resection with omental suturing to the parenchymal edge of the spleen. Case presentation A 12-year-old girl with a spontaneously ruptured large non-parasitic splenic cyst (SC) was successfully treated by emergent laparoscopic dome resection with omental suturing to the edge of the splenic parenchyma. The patient presented with acute abdominal pain and was diagnosed with a ruptured non-parasitic SC and peritonitis by contrast-enhanced computed tomography (CT). Emergent laparoscopic dome resection of the SC and omental suturing to the splenic parenchymal edge were then performed. The protruding part of the cyst wall was completely resected using an ultrasonically activated device (USAD), and the greater omentum was then sutured to the anterior edge of the splenic parenchyma under a laparoscopic view. No complications were observed during the operation. A histological examination revealed a congenital splenic cyst lined by epithelial cells. The postoperative course was uneventful, and an ultrasound scan showed no evidence of cyst recurrence at 3 years after the operation. Conclusions This minimally invasive laparoscopic procedure was feasible and effective for treating a ruptured large splenic cyst in an emergent pediatric patient.
Collapse
Affiliation(s)
- Kumiko Shono
- Department of Pediatric Surgery, National Hospital Organization, Kokura Medical Center, Kitakyushu, 803-8533, Japan.
| | - Yoshiko Hashimoto
- Department of Pediatric Surgery, National Hospital Organization, Kokura Medical Center, Kitakyushu, 803-8533, Japan
| | - Takeshi Shono
- Department of Pediatric Surgery, National Hospital Organization, Kokura Medical Center, Kitakyushu, 803-8533, Japan
| |
Collapse
|
|
12
|
Fiorentino MD, Monteiro JMC, de Siqueira REB, Kim EIM, Curi AP, Ferrreira CR, Nardo M, de Campos FPF. Primary splenic angiosarcoma: a rare entity often associated with rupture and hemoperitoneum. AUTOPSY AND CASE REPORTS 2019; 9:e2019100. [PMID: 31372360 PMCID: PMC6629266 DOI: 10.4322/acr.2019.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 06/06/2019] [Indexed: 12/16/2022] Open
Abstract
Primary splenic angiosarcoma (PSA) is a rare neoplasm of vascular origin associated with aggressive behavior and poor prognosis. The clinical presentation is usually non-specific and is mostly characterized by a wasting disease with anemia and splenomegaly, mimicking a wide range of entities. The authors present the case of an 80-year-old woman with cardiovascular comorbidities with a 6-month history of weight loss, fatigue, weakness, pallor, and abdominal pain. The physical examination showed massive splenomegaly and pallor. After a thorough evaluation that ruled out lymphoproliferative diseases, the working diagnosis was a myelodysplastic disorder. A few days after discharge, she returned to the emergency room with severe abdominal pain, worsening fatigue, and a remarkable pallor. Point-of-care ultrasound showed free intraperitoneal fluid. Spleen rupture was confirmed by abdominal computed tomography (CT) scan, and an emergency laparotomy with splenectomy was performed. The postoperative period was uneventful, and the patient recovered in a few days. The histopathology confirmed the diagnosis of PSA and the patient was referred to an oncological center. Two months later staging CT demonstrated liver and peritoneal metastases, and despite the chemotherapy she died 6 months after the diagnosis.
Collapse
Affiliation(s)
- Matheus Dalben Fiorentino
- Universidade de São Paulo (USP), School of Medicine, Internal Medicine Department. São Paulo, SP, Brazil
| | | | | | - Elizabeth Im Myung Kim
- Universidade de São Paulo (USP), Hospital Universitário, Internal Medicine Department. São Paulo, SP, Brazil
| | - Ana Paula Curi
- Universidade de São Paulo (USP), Hospital Universitário, Internal Medicine Department. São Paulo, SP, Brazil
| | - Cristiane Rubia Ferrreira
- Universidade de São Paulo (USP), Hospital Universitário, Internal Medicine Department. São Paulo, SP, Brazil.,Hospital AC Camargo, Unidade Antonio Prudente, Department of Pathology. São Paulo, SP, Brazil
| | - Mirella Nardo
- Instituto do Câncer do Estado de São Paulo, Oncology Department. São Paulo, SP, Brazil
| | | |
Collapse
|
|
13
|
Cao L, Hong J, Wang Y, Yu J, Ma R, Li J, Wu J, Zheng S. A primary splenic angiosarcoma hepatic metastasis after splenectomy and its genomic alteration profile. Medicine (Baltimore) 2019; 98:e16245. [PMID: 31305404 PMCID: PMC6641855 DOI: 10.1097/md.0000000000016245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Primary splenic angiosarcoma (PSA) is a rare mesenchymal malignancy of the splenic vascular origin often with a dismal prognosis. Genomic profile may provide evidence for the solution of therapy. PATIENT CONCERNS We reported a case of a 51-year-old woman with splenectomy 4 years ago and the postoperative histopathology diagnosis revealed "splenic hemangioma" with spontaneous rupture. Two years after the operation, the patient's rechecked abdominal computed tomography (CT) showed multiple hepatic occupations. DIAGNOSES Pathological test suggested PSA hepatic metastasis. INTERVENTIONS The patient was treated with trans-catheter arterial chemoembolization (TACE) and a pathological diagnosis of PSA was highly suspected in the hepatic biopsy. Four somatic alterations, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), Fos proto-oncogene, AP-1 transcription factor subunit (FOS), MCL1 apoptosis regulator (MCL1), and phosphoinositide-3-kinase regulatory subunit 1 (PIK3R1) were detected in the tumor tissue using a Next generation sequencing (NGS) technology. The results prompted that the patient may get clinical benefit from using some agents for targeted therapy, Everolimus, Temsirolimus, or Copanlisib. OUTCOMES The patient refused targeted therapy. As a result, the patient passed away within 51 months after splenectomy. LESSONS PSA is an aggressive disease that often presented with a high propensity for metastasis and rupture hemorrhage. Some of these mutations were first discovered in PSA and these findings added new contents to the genomic mutation profile of PSA.
Collapse
Affiliation(s)
- Linping Cao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| | - Jiawei Hong
- Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health
| | - Yacong Wang
- Department of Gerontology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Jun Yu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| | | | - Jia Li
- OrigiMed, Shanghai, China
| | - Jian Wu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery
| |
Collapse
|
|
14
|
Özcan B, Çevener M, Kargı AO, Dikici H, Yıldız A, Özdoğan M, Gürkan A. Primary splenic angiosarcoma diagnosed after splenectomy for spontaneous rupture. Turk J Surg 2018; 34:68-70. [PMID: 29756113 DOI: 10.5152/turkjsurg.2017.3207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/19/2015] [Indexed: 11/22/2022]
Abstract
Primary splenic angiosarcoma is a rare abnormality and has a bad prognosis. It has unknown pathogenesis. This abnormality is usually presented by splenic rupture. Surgery is the most promising treatm Surgery is the most accepted and accurate method for diagnosis and treatment. Surgery before rupture increases the life expectancy. A 65-year-old woman who presented to the emergency room with abdominal pain, abdominal distension, and anemia was found to have a splenic mass and massive ascites. After getting a hemorrhagic sample from the abdomen, the patient was operated with splenic rupture prediagnosis. The spleen material was reported as splenic angiosarcoma. The staging 18F-FDG-Positron Emission Tomography-Computed Tomography did not show any metastasis. Five months later, paclitaxel treatment was initiated upon liver and bone metastasis, and the treatment still continues. Splenic angiosarcoma has a place among splenic parenchymal lesions. The splenectomy material names the diagnosis. Pathologic examination of splenectomy material is revealed certain diagnosis.
Collapse
Affiliation(s)
- Barış Özcan
- Department of General Surgery, Medstar Antalya Hospital, Antalya, Turkey
| | - Metin Çevener
- Department of Radiology, Medstar Antalya Hospital, Antalya, Turkey
| | | | - Hilmi Dikici
- Department of Gastroenterology, Medstar Antalya Hospital, Antalya, Turkey
| | - Akın Yıldız
- Department of Nuclear Medicine, Medstar Antalya Hospital, Antalya, Turkey
| | - Mustafa Özdoğan
- Department of Medical Oncology, Medstar Antalya Hospital, Antalya, Turkey
| | - Alihan Gürkan
- Department of General Surgery, Memorial Antalya Hospital, Antalya, Turkey
| |
Collapse
|
|
15
|
Gao L, Xu W, Li T, Luo H, Gai S, Xing R, Chen G, Chen Y. A rare case of angiosarcoma with skull masses and erythropenia and thrombocytopenia: A case report and review of literature. Medicine (Baltimore) 2017; 96:e8787. [PMID: 29245237 PMCID: PMC5728852 DOI: 10.1097/md.0000000000008787] [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: 12/30/2022] Open
Abstract
RATIONALE Primary splenic angiosarcoma (PSA) is a rare, fatal neoplasm originating from sinusoidal vascular endothelial cells, and usually metastasizes and almost always has a poor prognosis. Surgical excision is the main treatment of this highly malignant disease. PATIENT CONCERNS We reported a special case of a 68-year-old female who had a 6-month history of scalp masses. DIAGNOSIS The patient was found to have 2 skull masses on computed tomography (CT). Laboratory findings revealed erythropenia and thrombocytopenia. Enhanced abdomen magnetic resonance imaging (MRI) showed multiple masses in liver and spleen. The pathological result of the skull masses was revealed to be metastatic angiosarcoma. INTERVENTIONS The patient underwent surgical excision of skull masses, and no subsequent radiotherapy or chemotherapy was done. OUTCOMES The patient died due to dyscrasia at August 12, 2015, with a survival of nearly 1 month. LESSONS We highlight the importance for clinicians to be aware of this rare neoplasm, and to consider it in the differential diagnosis when encountering a skull mass. Early confirmation and treatment may improve the prognosis.
Collapse
Affiliation(s)
- Liansheng Gao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
- Department of Neurosurgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Weilin Xu
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Tao Li
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Huali Luo
- Department of Pathology, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, Zhejiang, China
| | - Shiying Gai
- Department of Neurosurgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Ruxin Xing
- Department of Neurosurgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| | - Gao Chen
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yili Chen
- Department of Neurosurgery, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu
| |
Collapse
|
|
16
|
Demanding Diagnosis of Splenic Angiosarcoma as Cause of Delayed Treatment of Spontaneous Splenic Rupture: A Case Report and Literature Review. Case Rep Surg 2017; 2017:6256102. [PMID: 28261515 PMCID: PMC5312503 DOI: 10.1155/2017/6256102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/22/2016] [Indexed: 01/31/2023] Open
Abstract
Background. Primary splenic angiosarcoma is a very rare mesenchymal malignant tumor associated with a poor prognosis due to its high metastatic potential. This disease can be easily neglected and spontaneous splenic rupture is a frequent manifestation at the time of diagnosis leading to a poor outcome because of peritoneal dissemination. Case Presentation. We describe the case of a 49-year-old man who presented with asthenia, left upper quadrant abdominal pain, and anemia. Computerized tomography scan showed an enlarged spleen with no nodules and a nontraumatic rupture of the splenic capsule. Splenectomy was performed on account of the severe anemia and histopathology examination showed a primary angiosarcoma. Conclusions. Splenic angiosarcoma should be considered as one of the differential diagnoses in patients with nontraumatic spleen rupture and a specific previous medical history. Regrettably, splenectomy allows for a definitive diagnosis but not a curative treatment.
Collapse
|
|
17
|
Primary Angiosarcoma of the Spleen: Rare Diagnosis with Atypical Clinical Course. Case Rep Oncol Med 2016; 2016:4905726. [PMID: 27867672 PMCID: PMC5102718 DOI: 10.1155/2016/4905726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/12/2016] [Indexed: 01/26/2023] Open
Abstract
Primary angiosarcoma of the spleen is a rare diagnosis with poor prognosis. Morphologically, it demonstrates conventional blood vessel differentiation. We present a case of 65-year-old female who underwent radical splenectomy for primary angiosarcoma of the spleen. After three-year disease-free interval, she was diagnosed with bone-only metastatic disease. Palliative radiotherapy and bisphosphonates kept her disease reasonably stable for another four years. After development of lung metastases, six cycles of single agent doxorubicin kept her progression-free for six years. Upon further progression in lungs, thirteen years after original diagnosis, lung biopsy confirmed metastatic splenic angiosarcoma in the lungs. She started weekly paclitaxel chemotherapy. Although splenic angiosarcoma generally carries grave prognosis, some patients may enjoy prolonged periods of disease stabilization. Durable benefit can be achieved in some patients with multimodality management. We review the literature focusing on systemic treatment for this rare tumor.
Collapse
|
|
18
|
Primary Splenic Angiosarcoma Presenting as Idiopathic Thrombocytopenic Purpura: A Case Report and Review of the Literature. Case Rep Surg 2016; 2016:4173060. [PMID: 27651973 PMCID: PMC5019921 DOI: 10.1155/2016/4173060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022] Open
Abstract
Angiosarcoma of the spleen is a rare malignancy that arises from vascular endothelial origin. This neoplasm is highly malignant and diagnosis is often delayed due to the vague presentation of clinical symptoms. A case report and concise review of the current diagnostic criteria and surgical treatment are provided to aid in the detection and treatment of this malignancy. We present a case of a 56-year-old female who presented with massive splenomegaly secondary to angiosarcoma of the spleen. The patient suffered from longstanding symptomatic anemia and thrombocytopenia. Diagnosis of a splenic angiosarcoma can be difficult due to the vague presentation and lack of concrete risk factors. Early identification and splenectomy are paramount. However, it is an aggressive malignancy with poor prognosis. We reviewed the literature of the current diagnostic and surgical treatment of primary splenic angiosarcoma.
Collapse
|
|
19
|
Chen F, Jin HF, Fan YH, Cai LJ, Zhang ZY, Lv B. Case report of primary splenic angiosarcoma with hepatic metastases. World J Gastroenterol 2015; 21:11199-11204. [PMID: 26494974 PMCID: PMC4607917 DOI: 10.3748/wjg.v21.i39.11199] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/29/2015] [Accepted: 08/31/2015] [Indexed: 02/06/2023] Open
Abstract
Primary splenic angiosarcoma (PSA) is the most unusual type of malignancy with early multifocal metastasis through hematogenous spread. PSA is generally believed to originate from splenic sinusoidal vascular endothelium with a high rate of metastasis and to have a poor prognosis. Its etiology and pathogenetic mechanisms have not yet been clearly described. Thus far, only approximately 200 cases have been reported. PSA has variable symptomatology with the potential to present with life-threatening complications. The diagnosis of PSA is challenging; and often late. PSA should be considered in the differential diagnosis of patients with splenomegaly and anemia of unknown etiology. Surgical treatment with splenectomy is considered the only curative intervention for potential long-term disease-free survival. Early diagnosis and treatment are very important. It is important that clinical doctors improve the understanding of PSA. Herein, we report one rare case of PSA with hepatic metastases, along with a review of the current literature.
Collapse
|
|
20
|
Xu B, Xie X, Zhou X, Zhai M, Yang W. Spontaneous rupture of primary splenic angiosarcoma: A case report. Oncol Lett 2015; 10:3271-3273. [PMID: 26722324 DOI: 10.3892/ol.2015.3714] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 07/30/2015] [Indexed: 12/18/2022] Open
Abstract
Primary angiosarcoma of the spleen is an extremely rare malignant neoplasm of vascular origin that often has a poor prognosis. The majority of cases presents with splenic rupture and hemorrhage. The present study retrospectively analyzed the case of 77-year-old female who presented with diffuse abdominal pain and distension. During laparotomy, a huge actively bleeding spleen was identified and a splenectomy was performed. Since an accurate diagnosis could not be achieved by abdominal computed tomography, a pathological examination was performed. The patient and the family refused post-operative adjuvant chemotherapy and radiation therapy. The patient succumbed to uncontrolled hemorrhagic shock and lung metastases at 2 weeks post-surgery.
Collapse
Affiliation(s)
- Botao Xu
- Division of General Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China ; Department of General Surgery, Zhuji City People's Hospital of Zhejiang Province, Zhuji, Zhejiang, P.R. China
| | - Xiaona Xie
- Pulmonary Division, Wenzhou Traditional Chinese Medicine Hospital, Wenzhou, Zhejiang, P.R. China
| | - Xiong Zhou
- Division of General Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Menghe Zhai
- Division of General Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| | - Wenjun Yang
- Division of General Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China
| |
Collapse
|
|
21
|
Kornmann V, van Rijn P, Mulder D, Reijnders K. Delayed diagnosis of angiosarcoma of the spleen: clinically presenting as recurrent haemoperitoneum following embolisation. BMJ Case Rep 2015; 2015:bcr-2014-208956. [PMID: 25858933 DOI: 10.1136/bcr-2014-208956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Angiosarcoma is a highly aggressive and extremely rare neoplasm of the spleen, with a limited number of reported cases worldwide. We report a case of a 69-year-old man who presented with progressive symptoms of fatigue, abdominal and back pain, anaemia and haemoperitoneum 1 year following embolisation of the spleen for splenic rupture. Additional imaging and colonoscopy with biopsy revealed intra-abdominal fluid and a colonic adenocarcinoma. Diagnostic laparoscopy demonstrated a haemoperitoneum and colon carcinoma, after which splenectomy via laparotomy was performed. Pathology report revealed an angiosarcoma of the spleen with peritoneal tumour deposits. Rupturing of a spleen may be due to an underlying disease. Therefore, the differential diagnosis of splenic rupture should include the possibility of a splenic tumour. The definitive diagnosis and treatment of a splenic angiosarcoma may require splenectomy, although prognosis is poor.
Collapse
Affiliation(s)
- Verena Kornmann
- Department of Surgery, Slingeland Hospital Doetinchem, Doetinchem, The Netherlands
| | - Philip van Rijn
- Department of Radiology, Slingeland Hospital, Doetinchem, The Netherlands
| | - Dries Mulder
- Department of Pathology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Koen Reijnders
- Department of Surgery, Slingeland Hospital Doetinchem, Doetinchem, The Netherlands
| |
Collapse
|
|
22
|
Primary angiosarcoma of the spleen: an oncological enigma. Case Rep Oncol Med 2014; 2014:193036. [PMID: 25105042 PMCID: PMC4101939 DOI: 10.1155/2014/193036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/08/2014] [Accepted: 06/15/2014] [Indexed: 02/07/2023] Open
Abstract
Introduction. Primary splenic angiosarcoma is an extremely unusual neoplasm originating from sinusoidal vascular endothelium. Surgical extirpation is the mainstay of treatment of this highly malignant disease. Case Presentation. An 82-year-old woman was admitted with left pleural effusion and a palpable left upper quadrant abdominal mass, secondary to splenomegaly by two large splenic tumors. Classic open splenectomy was performed and angiosarcoma of the spleen was the final histopathological diagnosis, which was primary since no other disease site was revealed. Discussion. The incidence of the disease is 0.14-0.23 cases per million, with slight male predominance. Etiology is not established and clinical presentation may confuse even experienced physicians. Imaging modalities cannot differentiate the lesion from other vascular splenic neoplasms and the correct diagnosis is mainly set after histopathological examination of the resected spleen. As with other sarcomas, surgery is the only curative approach, while chemo- and radiotherapy have poor results. Prognosis remains dismal.
Collapse
|