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Rodich S, Garza-Gongora R, So C, Ward R, Zreik R. Epithelioid angiosarcoma of the calf: a case report of an atypical imaging appearance. Skeletal Radiol 2024; 53:989-994. [PMID: 37787920 DOI: 10.1007/s00256-023-04456-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 09/06/2023] [Accepted: 09/13/2023] [Indexed: 10/04/2023]
Abstract
Angiosarcoma is an uncommon cause of soft tissue malignancy, accounting for approximately 2% of all soft tissue sarcomas. Of these, epithelioid angiosarcoma represents a morphologic subtype, where the malignant endothelial cells demonstrate a predominantly or exclusively epithelioid appearance. Overall, epithelioid angiosarcoma shares similar imaging characteristics to conventional angiosarcoma including a T1 hypointense to isointense and T2 hyperintense mass, which demonstrates avid enhancement, serpentine feeding vessels, and overlying skin thickening on MRI. The case herein describes a case of epithelioid angiosarcoma in a 65-year-old female presenting with an enlarging calf mass and lower extremity pain. Initial imaging features, particularly on MRI, were highly unusual for angiosarcoma which was thus not strongly considered in the initial differential diagnosis. However, once diagnosis of epithelioid angiosarcoma was confirmed following resection, pathologic correlates were utilized to account for the unusual imaging findings retrospectively. The goal of this study is to not only describe an atypical presentation of an uncommon diagnosis but also attempt to rationalize the unexpected imaging findings with gross and microscopic correlates. Further, the utility of radiology-pathology correlation demonstrated in this case may be useful to others when evaluating similar lesions with unexpected MRI characteristics.
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Affiliation(s)
- Sean Rodich
- Baylor Scott & White Health, Temple, TX, USA.
| | | | - Connie So
- Baylor Scott & White Health, Temple, TX, USA
| | | | - Riyam Zreik
- Baylor Scott & White Health, Temple, TX, USA
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Navarro Sanchez JM, Oommen T, Lum C, Halford Z, Vierkoetter K. Mediastinal Epithelioid Angiosarcoma, New Insights into an Uncommon Diagnosis: A Case Report and Literature Review. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:208-212. [PMID: 37694219 PMCID: PMC10485769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Angiosarcoma is an uncommon malignant mesenchymal neoplasm, accounting for 1-2% of all sarcomas. More than half are cutaneous, with the remainder arising in the deep soft tissue, breast, bone or viscera, particularly the liver, spleen and heart. Mediastinal angiosarcomas are exceedingly uncommon. While epithelioid morphology is sometimes a minor component in conventional angiosarcoma, tumors with a predominance of epithelioid morphologic features are designated as epithelioid angiosarcoma (EAS). This is a report of a 58-year-old woman presenting with severe chest pain, accompanied by worsening dyspnea and dysphagia. Chest computed tomography (CT) revealed a large pericardial effusion and a bulky mediastinal mass. Biopsy revealed a malignant neoplasm with vascular differentiation consistent with high-grade EAS. By immunohistochemistry, epithelioid angiosarcomas express endothelial cell markers, such as CD31, CD34, ERG and FLI-1. A variable proportion express low molecular weight cytokeratin (CK), epithelial membrane antigen (EMA) and CD30. The use of molecular techniques has proven useful in the diagnosis of this rare neoplasm. Targeted next generation sequencing showed aberrations in multiple genes including NRAS, KRAS, MYC and TP53.
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Affiliation(s)
- Janira M. Navarro Sanchez
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JMNS, CL, KV)
| | - Tiffany Oommen
- Department of Internal Medicine, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (TO)
| | - Christopher Lum
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JMNS, CL, KV)
| | - Zan Halford
- Diagnostic Laboratory Services, Aiea, HI (ZH)
| | - Koah Vierkoetter
- Department of Pathology, John A. Burns School of Medicine, University of Hawai‘i, Honolulu, HI (JMNS, CL, KV)
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Lemus LF, Minervini MH. Epithelioid Angiosarcoma Causing Spinal Cord Compression. Cureus 2021; 13:e14325. [PMID: 33968534 PMCID: PMC8101505 DOI: 10.7759/cureus.14325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Epithelioid angiosarcoma is a rare and very aggressive malignant tumor with high rates of metastasis and recurrence that can present in any part of the body, with the head and neck being the most common regions. Wide-margin surgical resection is the treatment of choice following radiotherapy due to the high rate of recurrence. We present a case of an elderly patient who developed angiosarcoma causing spinal cord compression at the level of C7 vertebrae. We discuss the diagnosis, treatment, histopathology, and outcome.
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Affiliation(s)
- Luis F Lemus
- Department of Surgery, Universidad Dr. José Matías Delgado, San Salvador, SLV
| | - Mario H Minervini
- Radiosurgery, International Cancer Center, Diagnostic Hospital, San Salvador, SLV
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Nguyen Cuong P, Thanh Xuan N, Nhu Huy P, Nhu Tung T, Huu Son N. Histopathological Features of Deep Soft Tissue Epithelioid Angiosarcoma in the Lower Extremity: A Rare Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923933. [PMID: 32712619 PMCID: PMC7414833 DOI: 10.12659/ajcr.923933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Epithelioid angiosarcoma is an extremely rare malignant disease of the endothelial cells. Most of the previous reports about this disease were regarding clinical features and radiological findings, with limited descriptions of pathological diagnosis. This report aimed to present a reference to increase understanding of the timely diagnosis of epithelioid angiosarcoma. CASE REPORT A 65-year-old male was diagnosed with epithelioid angiosarcoma originating from the deep soft tissue of the lower leg. He had a history of 2 months of rapid swelling and painful in the left lower leg, which occurred after a muscle cramp, and was clinically suspicioius for hematoma. Radiological examination revealed a large heterogeneous soft-tissue mass. Histopathology results showed that the mass was malignant, and the differential diagnosis wasa malignant vascular tumor, melanoma, poorly differentiated carcinoma, clear cell sarcoma, epithelioid sarcoma, and anaplastic large-cell lymphoma. Immunohistochemistry findings confirmed that it was an epithelioid angiosarcoma. CONCLUSIONS This case underscores the difficult of diagnosing epithelioid angiosarcoma. It requires careful pathological investigation and immunophenotype labeling.
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Affiliation(s)
| | - Nguyen Thanh Xuan
- Department of Pediatric and Abdominal Emergency Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Pham Nhu Huy
- Emory College of Art and Sciences, Atlanta, GA, USA
| | - Tran Nhu Tung
- Forensic Center, Thua Thien Hue Province, Hue City, Vietnam
| | - Nguyen Huu Son
- Pediatric Center, Hue Central Hospital, Hue City, Vietnam
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Primary angiosarcoma of the femur in a patient with Takayasu arteritis. Rev Bras Ortop 2018; 53:384-388. [PMID: 29892593 PMCID: PMC5993927 DOI: 10.1016/j.rboe.2018.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/02/2017] [Indexed: 11/20/2022] Open
Abstract
Primary osseous angiosarcoma is a rare entity with variable biological behavior and poor prognosis. Little is known about the oncologic treatment and its etiology is still unknown. This study presents a case of lytic lesion in the right femur with dissemination to other bones, such as the vertebral column and skull, and to the lungs and central nervous system. Orthopedic surgery was performed in order to improve quality of life. Surgical specimen confirmed the diagnosis of high-grade malignant osseous angiosarcoma. Despite oncologic and orthopedic treatment, the patient had rapid and aggressive progression with a poor outcome.
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Angiossarcoma primário do fêmur em um paciente com arterite de Takayasu. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Wang J, Zhao M, Huang J, Ang L, Zheng L. Primary epithelioid angiosarcoma of right hip joint: A case report and literature review. Medicine (Baltimore) 2018; 97:e0307. [PMID: 29642158 PMCID: PMC5908628 DOI: 10.1097/md.0000000000010307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Epithelioid angiosarcoma (EA) is a rare, highly invasive tumor. The histopathological features of EA are not distinct and less reported in the literature, and most of the medical records are incomplete. PATIENT CONCERNS A 61-year-old woman who came to the hospital because of pain in her right hip. This patient had had surgery for right hip tuberculosis 30 years ago. DIAGNOSES The present study reports a case of primary EA of bone with aneurysmal bone cyst (ABC) that was diagnosed by 3 experienced pathologists. INTERVENTIONS The patients had undergone 2 surgeries; however, an early recurrence of the tumor was caused the death of the patient. OUTCOMES Ten EA cases from other literature were reviewed in this article; all the symptoms were found in different parts of bone, and the case data were relatively complete. The primary clinical features and nonspecific histopathological morphology of the disease were summarized from the 11 cases mentioned in the literature, and the main immunohistochemistry characteristics and diagnostic traps of EA were reviewed. LESSONS Because the tumor has no characteristic diagnostic index in imaging and laboratory examination, the histopathologic features are not typical, especially in the case of obvious secondary lesions. It is easy to miss and misdiagnose. If possible, the diagnosis should be combined with immunohistochemical results.
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Oc Y, Kilinc BE, Ertugrul R, Sezer HB, Eren OT. Epithelioid Angiosarcoma in Femur: A Case Presentation. World J Oncol 2018; 8:196-198. [PMID: 29317966 PMCID: PMC5755628 DOI: 10.14740/wjon1066e] [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: 10/23/2017] [Accepted: 11/24/2017] [Indexed: 12/02/2022] Open
Abstract
Primary malignant vascular tumors which constitute less than 1% of the primary bone tumors are very rarely encountered. Epithelioid angiosarcoma is a very uncommon subtype of angiosarcomas presenting with an epithelioid phenotype and mimicking carcinomas clinically. These tumors select mostly extra-skeletal locations but rarely bones as their medium. A 31-year-old male patient applied to our clinic with a nonspecific left hip pain. X-ray evaluation revealed a cystic expansile mass in the trochanteric region of the femur extending to the femoral neck. Computed tomography examination proved that the mass was cystic and 7 cm in its greatest width and contained septum. Moreover, magnetic resonance imaging examination was reported as a mass resembling aneurysmal bone cyst. The final diagnosis of epithelioid angiosarcoma was made by histological examination and biopsy of the mass. The excised specimen was examined further to verify the preoperative diagnosis.
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Affiliation(s)
- Yunus Oc
- Orthopaedics and Traumatology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Bekir Eray Kilinc
- Orthopaedics and Traumatology Department, Golhisar State Hospital, Burdur, Turkey
| | - Rodi Ertugrul
- Orthopaedics and Traumatology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hasan Basri Sezer
- Orthopaedics and Traumatology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Osman Tugrul Eren
- Orthopaedics and Traumatology Department, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
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Li Y, Zou X, Chang X, Chang X, Sun S, Zhang B. Right femoral pathological fracture caused by primary bone epithelioid angiosarcoma: Case report. Medicine (Baltimore) 2017; 96:e6951. [PMID: 28682861 PMCID: PMC5502134 DOI: 10.1097/md.0000000000006951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 04/20/2017] [Accepted: 04/20/2017] [Indexed: 01/06/2023] Open
Abstract
RATIONALE Epithelioid angiosarcoma (EAS) is an extremely rare malignant disease, which accounts no more than 1% of all soft tissue sarcomas. In this article, we would report a new case of EAS with multiple bone destruction and right femoral pathological fracture, which was an even rarer manifestation of EAS. PATIENT CONCERNS In this case, a 64-year-old man with right femoral fracture was reported. He had suffered from a progressive low back pain for about 8 months, and the imaging examinations prompted a multiple bone destruction in his vertebra and lower limbs. He then got a right femoral fracture without any obvious traumatic injury, and came to our hospital. INTERVENTIONS He underwent an operation of radical resection, bone cement filling and dynamic condylar screw internal fixation. During the operation, we found that the soft tissue around the fracture had a rotten fish change, which suggested a malignant disease. DIAGNOSES The postoperative pathological diagnosis reported an EAS, which is extremely rare and highly malignant. OUTCOMES The patient died in 83 days after the surgery, and the survival time from the symptoms started to the end was only 11 months, which showed a rapid progress and poor prognosis of EAS. LESSONS EAS is very hard to be diagnosed by clinical manifestation or radiological examinations. As in our case, pathological analysis is the final diagnosis. The images of the patient may offer some tips for the skeletal presentation of EAS, and do more help in future study of this disease.
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Affiliation(s)
| | | | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Beijing
| | | | - Shengfang Sun
- Department of Emergency Surgery, Affiliated Hospital of Binzhou Medical College, Shandong, China
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Primary Left Tibial Epithelioid Hemangioendotheliomas With Multiple Metastases Revealed by FDG PET/CT Imaging. Clin Nucl Med 2016; 41:872-873. [PMID: 27607156 DOI: 10.1097/rlu.0000000000001345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Bone epithelioid angiosarcoma is an extremely rare osseous malignancy with an aggressive and destructive biological behavior. We present FDG PET/CT findings of a 59-year-old woman with left lower limb pain for 1 month. The images revealed abnormal activity in both left fibula and left tibia. In addition, abnormal activity in the sacrum and enlarged retroperitoneal lymph nodes was also noted. Pathological examination demonstrated bone epithelioid angiosarcoma.
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Abstract
Primary angiosarcoma of the bladder is very rare, with approximately 30 cases reported in the literature. Those with epithelioid morphology are even rarer, with only single-case reports published. We describe the histopathologic features and clinical follow-up of 9 patients with epithelioid angiosarcoma (EA) of the bladder retrieved from our Surgical Pathology files from 1998 to 2014. Eight cases were consults. The mean age at presentation was 65 years (range, 39 to 85 y). The M:F ratio was 8:1. The clinical presentation was hematuria and bladder mass in all cases. Six patients had a history of radiotherapy to the pelvis, 5 to treat prostate cancer and 1 to treat uterine cervical cancer. The time from radiotherapy to the diagnosis of EA ranged from 6 to 15 years. The average size of the tumor was 4 cm. (range, 1 to 8 cm.). The submitting diagnoses were poorly differentiated carcinoma (n=5), high-grade invasive urothelial carcinoma (n=3), and atypical vascular proliferation (n=1). Morphologically, the tumors were composed of nests and sheets of highly atypical cells with high nuclear to cytoplasmic ratio, occasional intracytoplasmic lumens, and a hemorrhagic background. None of the cases showed any urothelial carcinoma component. Three patients showed in addition usual angiosarcoma in the resection specimen. By immunohistochemistry, 5/9 cases were positive for cytokeratins, including CK7 (n=3), AE1/AE3 (n=3), and Cam5.2 (n=1). All cases were positive for at least 1 endothelial marker, including CD31 (n=7), CD34 (n=2), FVIII (n=3), and ERG (n=2). Urothelial markers (p63 and GATA3) were consistently negative. Surgical treatment included transurethral resection of the bladder (TURB) only (n=5), TURB followed by cystoprostatectomy (n=2), TURB followed by partial cystectomy (n=1), and cystoprostatectomy only (n=1). The tumor involved the muscularis propria in 5/9 patients, the periureteric adipose tissue in 1 patient, and the prostate and seminal vesicles in 1 patient. Five of 9 patients died of disease, with a median survival of 7 months (range, 6 to 14 mo). Two patients were alive with disease at 3 and 6 months of follow-up. One patient who underwent radical cystoprostatectomy was alive with no evidence of disease 12 months after surgery. EA of the bladder is a rare malignancy that is frequently misdiagnosed as high-grade carcinoma, especially due to positive immunostaining for cytokeratins. This tumor is more frequent in older men with a history of radiotherapy to the pelvis. Morphologic features that should suggest the vascular origin of the tumor include highly atypical nuclei with interspersed erythrocytes, hemorrhagic background, and occasional intracytoplasmic lumens. Patients usually present with muscle invasive disease, and the prognosis is dismal.
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Affiliation(s)
- Andres Matoso
- Departments of *Pathology †Oncology ‡Urology, The Johns Hopkins Hospital, Baltimore, MD
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