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Muñoz-Casares FC, Martín-Broto J, Cascales-Campos P, Torres-Melero J, López-Rojo I, Gómez-Barbadillo J, González-Bayón L, Sebio A, Serrano C, Carvalhal S, Abreu de Souza J, Souza A, Flores-Ayala G, Palacios Fuenmayor LJ, Lopes-Bras R, González-López JA, Vasques H, Asencio-Pascual JM. Ibero-American Consensus for the Management of Peritoneal Sarcomatosis: Updated Review and Clinical Recommendations. Cancers (Basel) 2024; 16:2646. [PMID: 39123374 PMCID: PMC11311413 DOI: 10.3390/cancers16152646] [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: 06/14/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Peritoneal sarcomatosis is a rare malignant disease with a poor prognosis, secondary to peritoneal dissemination of abdominopelvic soft tissue sarcomas. Its rarity, together with the characteristic histological heterogeneity and the historically poor response to systemic treatments, has prevented the establishment of widely accepted treatment criteria with curative intent. In this sense, radical cytoreductive surgery (CRS) with peritonectomy procedures and hyperthermic intraperitoneal chemotherapy (HIPEC), widely used in peritoneal carcinomatosis with excellent results, have not had the same evolutionary development in patients with peritoneal sarcomatosis. A multidisciplinary working group of experts in sarcomas and peritoneal oncological surgery established a series of recommendations based on current scientific evidence for the management of peritoneal sarcomatosis, taking into account the different histological subgroups of abdominopelvic sarcomas that can cause it depending on their origin: retroperitoneal sarcomas, uterine sarcomas, and visceral/peritoneal sarcomas of GIST (gastrointestinal stromal tumor) and non-GIST origin. This article shows the results of sarcoma experts' voting on the recommendations presented during the I Ibero-American Consensus on the Management of Peritoneal Sarcomatosis, which took place during the recent celebration of the III Hispanic-Portuguese Meeting for Updates on the Treatment of Sarcomas.
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Affiliation(s)
| | - Javier Martín-Broto
- Medical Oncology Department, Jimenez Diaz Foundation University Hospital, 28040 Madrid, Spain
| | - Pedro Cascales-Campos
- Peritoneal and Sarcomas Oncology Surgery Unit, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain
| | - Juan Torres-Melero
- Peritoneal Oncology Surgery Unit, Torrecárdenas University Hospital, 04009 Almeria, Spain
| | - Irene López-Rojo
- Surgery Department, MD Anderson Cancer Center Madrid, 28033 Madrid, Spain
| | - José Gómez-Barbadillo
- Peritoneal Carcinomatosis and Retroperitoneal Sarcomas Unit, San Juan de Dios Hospital, 14012 Córdoba, Spain
| | - Luis González-Bayón
- Peritoneal Carcinomatosis Unit, Gregorio Marañón University Hospital, 28007 Madrid, Spain
| | - Ana Sebio
- Medical Oncology Department, Santa Creu i Sant Pau University Hospital, 08025 Barcelona, Spain
| | - César Serrano
- Medical Oncology Department, Vall D’Hebron University Hospital, 08035 Barcelona, Spain
| | - Sara Carvalhal
- Surgery Department, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
| | | | - Alexandre Souza
- Surgery Department, Portuguese Institute of Oncology of Porto, 4200-072 Porto, Portugal
| | | | | | - Raquel Lopes-Bras
- Medical Oncology Department, Santa María Hospital, Lisboa North University Center, 1649-028 Lisboa, Portugal
| | | | - Hugo Vasques
- Surgery Department, Portuguese Institute of Oncology of Lisbon, 1099-023 Lisbon, Portugal
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Asano Y, Utsunomiya A, Meguro S, Sano M, Inuzuka K, Takeuchi H, Kawasaki H, Kosugi I, Enomoto Y, Fujihiro M, Baba S, Iwashita T. Development of an Undifferentiated Pleomorphic Sarcoma After Aortic Aneurysm Graft Replacement: A Case Report and Literature Review. Cureus 2024; 16:e61530. [PMID: 38827416 PMCID: PMC11144436 DOI: 10.7759/cureus.61530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 06/04/2024] Open
Abstract
Aortic sarcomas are extremely rare. Sarcomas associated with aortic graft replacement are even rarer; only 17 cases have been examined through immunohistochemical staining to date, most of which were either angiosarcomas or intimal sarcomas. Here, we report the case of an 88-year-old man with an undifferentiated pleomorphic sarcoma (UPS) that developed after aortic graft replacement and was diagnosed through postmortem autopsy. To the best of our knowledge, this is the first case of graft-associated sarcoma diagnosed as an undifferentiated pleomorphic type following detailed immunohistochemical staining with sufficient antibodies and fluorescencein situ hybridization (FISH).
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Affiliation(s)
- Yotaro Asano
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Aoi Utsunomiya
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Shiori Meguro
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Masaki Sano
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Kazunori Inuzuka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Hideya Kawasaki
- Institute for NanoSuit Research, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Isao Kosugi
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Yasunori Enomoto
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Mayu Fujihiro
- Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Satoshi Baba
- Department of Diagnostic Pathology, Hamamatsu University Hospital, Hamamatsu, JPN
| | - Toshihide Iwashita
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
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Samargandi R. Etiology, pathogenesis, and management of angiosarcoma associated with implants and foreign body: Clinical cases and research updates. Medicine (Baltimore) 2024; 103:e37932. [PMID: 38701315 PMCID: PMC11062743 DOI: 10.1097/md.0000000000037932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
Angiosarcomas are rare and highly malignant soft tissue sarcomas originating from endothelial cells lining the lymphatic or vascular system. While they predominantly emerge from (sub)cutaneous regions, occurrences have been reported throughout the body. The etiology of angiosarcoma remains elusive in most clinical cases. Nevertheless, several prognosis risk factors play a pivotal role, including chronic lymphedema, therapeutic irradiation, environmental carcinogens, familial syndromes, and the presence of foreign materials like metallic objects and biomedical implants. Despite evidence implicating retained foreign material in angiosarcoma development, understanding its prognosis and pathogenesis remains limited. The pathogenesis of angiosarcoma appears to involve a complex interplay of chronic inflammation, tissue remodeling, and genetic factors that create a conducive microenvironment for malignant transformation. Management of these sarcomas remains challenging due to their infiltrative nature owing to the high chance of metastasis and local recurrence. The primary treatment modalities currently include surgery, radiotherapy, and chemotherapy, but recent advances in targeted immunotherapy and gene therapy hold promise for more effective approaches. This comprehensive review delves into the potential etiological and pathogenic roles of foreign materials, such as metallic objects, biomedical implants, and biomaterials, in the development of angiosarcoma. Further research into the underlying molecular mechanisms could provide valuable insights for tailored management and developing novel targeted therapeutic strategies.
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Affiliation(s)
- Ramy Samargandi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
- Service de Chirurgie Orthopédique et Traumatologique, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, Chambray-les-Tours, France
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Alexiadou D, Panagiotakis S, Kontopodis N, Skiadas C, Nikiforou A, Vouyiouklakis G, Papadakis JA, Kofteridis D. Rapid Progression of Angiosarcoma in a Man with a Left Psoas Muscle Hematoma and a Recent EVAR of Abdominal Aorta. MAEDICA 2023; 18:519-522. [PMID: 38023756 PMCID: PMC10674126 DOI: 10.26574/maedica.2023.18.3.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Angiosarcoma is a rare type of soft tissue cancer with several clinical presentations and a poor prognosis. We present a case of a 75-year-old man who was admitted due to anemia and fatigue. The patient had undergone an endovascular repair (EVAR) of a 9 cm infrarenal aneurysm of the abdominal aorta two months ago. A computed tomography (CT) scan of the abdomen on admission indicated a Type-II endoleak and a large hematoma of the left psoas muscle with multiple sites of intramuscular extravasation. Osseous metastases were found at the head of the left femoral head and at the iliac bones. A CT guided biopsy of the femoral head revealed an angiosarcoma of unknown primary site a few days after the patient had died from intra-alveolar hemorrhage caused by lung metastases.
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Affiliation(s)
- Dimitra Alexiadou
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Symeon Panagiotakis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Nikos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Christos Skiadas
- Department of Radiology, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Antigoni Nikiforou
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - George Vouyiouklakis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - John A Papadakis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
| | - Diamantis Kofteridis
- Internal Medicine Department, Heraklion University Hospital, Heraklion, Crete, Greece
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Arts L, Roesti A, Haller C, Danzer D. Angiosarcoma after popliteal aneurysm exclusion surgery. A systematic review. Ann Vasc Surg 2022; 86:482-489. [PMID: 35820530 DOI: 10.1016/j.avsg.2022.06.012] [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: 03/08/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Expansion after popliteal artery aneurysm exclusion with bypass is a common phenomenon. Popliteal angiosarcoma is seldom reported in literature and in most cases after popliteal artery aneurysm surgery. This paper aims to present the case of a popliteal angiosarcoma, initially diagnosed as late aneurysmal growth after exclusion surgery, to conduct a systematic review of popliteal angiosarcoma and assess any association between angiosarcoma and previous popliteal aneurysm surgery. METHODS We performed a secondary popliteal aneurysmorraphy through posterior approach for symptomatic aneurysm expansion in a 79-year-old woman, 9 years after medial femoropopliteal venous bypass and aneurysm exclusion. The postoperative course was complicated by recurrent hematomas and wound spillages requiring multiple revisions. Pathological analysis identified an angiosarcoma. Staging revealed bone invasion and pulmonary metastasis. Despite transfemoral amputation and adjuvant chemotherapy the patient died eight months later. We performed a systematic review through MEDLINE on 'primary' and 'secondary' (with previous vascular surgery) angiosarcoma in popliteal artery aneurysm. Research was done using the terms '(hem)angiosarcoma', 'aneurysm', 'popliteal aneurysm or artery', 'femoral aneurysm or artery'. Other soft tissue sarcoma or non-popliteal locations were excluded. RESULTS Including this case, only 13 angiosarcomas in popliteal aneurysms are currently described. Two were reported without previous surgery considered a primary angiosarcoma and 11 after popliteal artery aneurysm surgery (secondary angiosarcoma). Patient age ranges from 8 months to 83 years with a male predominance (10/3). Nine of the 11 patients with secondary angiosarcoma were initially diagnosed as popliteal aneurysm expansion after previous bypass surgery, the two other secondary cases presented respectively with pain and inflammatory syndrome without expansion. All prior surgical exclusion were carried out by a medial approach. Interval with the index operation ranges from 3 months to 15 years. Death was reported in 8 of the 13 cases within the first year of diagnosis. CONCLUSION Although seldom reported, popliteal angiosarcomas are mainly described after popliteal artery aneurysm exclusion surgery, raising suspicion on a potential association, yet causality cannot be demonstrated. Angiosarcoma should be included in the differential diagnosis of popliteal aneurysm growth or unexpected outcome after exclusion bypass surgery. Systematic imaging and pathological studies should be undertaken to allow early diagnosis and treatment. Routine use of a posterior approach, with aneurysm resection, when feasible as initial popliteal artery aneurysm treatment, might reduce the risk of late sarcomatous transformation.
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Affiliation(s)
- Laure Arts
- Department of vascular surgery, Centre Hospitalier du Valais Romand, Switzerland.
| | - Aurore Roesti
- Department of vascular surgery, Centre Hospitalier du Valais Romand, Switzerland
| | - Claude Haller
- Department of vascular surgery, Centre Hospitalier du Valais Romand, Switzerland
| | - Daniel Danzer
- Department of vascular surgery, Centre Hospitalier du Valais Romand, Switzerland
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May Lee M, Pierobon E, Riva G, Germi L, Feliciani C, Naldi L. Angiosarcoma and Vascular Surgery A Case Report and Review of the Literature to Focus on a Possible Risk Factor. Vasc Endovascular Surg 2022; 56:762-766. [PMID: 35694959 DOI: 10.1177/15385744221108248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Angiosarcomas (AS) are rare and aggressive neoplasms originating from the endothelium: they represent less than 2% of all soft tissue sarcomas and usually have a poor prognosis. Although more often primary, different risk factors have been described and some cases are associated with vascular surgery. Materials and Methods: We present the case of an 84-year-old man who developed an AS on his thigh 3 years after a popliteal bypass with autologous saphenous vein. We performed a thorough review of the literature describing the main characteristics of the 25 cases (including ours) of AS associated with vascular surgery reported from 1981 to 2022. Results: Most of the patients were males (21 men vs 4 women) with a range age of 50-84 years. Most of AS are associated with Dacron grafts (12 cases), the overall mean time to onset is 7.8 years after surgery. The most common presenting symptoms are pain (20 cases) and weight loss (10 cases), while cutaneous presentation is uncommon; indeed, violaceous and painful papules, plaques, nodules, and skin ulceration have been found in 3 cases only. Due to unspecific symptoms, differential diagnosis is often difficult and a biopsy for histological confirmation is mandatory. Conclusion: Even if it seems to be a very rare complication, AS should always be considered in patients with compatible symptoms and who have undergone vascular surgery in the past.
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Affiliation(s)
- Marco May Lee
- Department of Medicine and Surgery, Section of Dermatology, 9370University of Parma, Parma, Italy
| | - Elena Pierobon
- Department of Medicine and Surgery, Section of Dermatology, 9370University of Parma, Parma, Italy
| | - Giulio Riva
- Pathology Unit and Health and Risk Management, 198202Ospedale San Bortolo, Vicenza, Italy
| | - Lerica Germi
- Dermatology Unit, 198202Ospedale San Bortolo, Vicenza, Italy
| | - Claudio Feliciani
- Department of Medicine and Surgery, Section of Dermatology, 9370University of Parma, Parma, Italy
| | - Luigi Naldi
- Dermatology Unit, 198202Ospedale San Bortolo, Vicenza, Italy
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Pecceu S, Van Herzeele I, Deolet E, Van Dorpe J, Moreels N, Desender L, Vermassen F, Randon C. Angiosarcoma after endovascular aneurysm repair: case report and literature review. Acta Chir Belg 2022; 123:317-324. [PMID: 34937527 DOI: 10.1080/00015458.2021.2021718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Epithelioid angiosarcoma is a rare soft tissue sarcoma with a poor prognosis. We report two cases of patients who presented with a history of lower back pain, inflammatory signs and weight loss 5 and 6 years after endovascular aortic repair (EVAR) of an elective infrarenal abdominal aortic aneurysm (AAA). Imaging suggested graft infection but tissue samples revealed an epithelioid angiosarcoma. The objective is to report the clinical presentation, investigative modalities and immunohistochemical findings of an angiosarcoma after EVAR. PATIENTS AND METHODS Two cases are described of an angiosarcoma of the aorta after EVAR. A literature search using PubMed, Embase and Web of Science was performed in English about angiosarcoma after EVAR published between 2007 and 2021. Relevant reports were selected and analysed. RESULTS Fifteen case reports were identified, including the current two cases. Time to tumour detection after EVAR ranged from 6 to 120 months with a mean interval of 68 months. Most patients underwent endovascular repair of an AAA (13/15). Males (13 male/2 female patients) were predominant with a median age of 72 years (IQR 68-78 years). Over half of the patients had metastases at the time of diagnosis (9/15), most frequently in bones and liver. CONCLUSION Diagnosis of angiosarcoma after EVAR remains challenging due to indistinctive clinical and radiological findings mimicking graft infection or endoleak. Angiosarcoma should be included in the differential diagnosis in patients previously treated with EVAR presenting with unintended weight loss, abdominal back pain and contrast enhancement of the aortic wall.AbbreviationsAAAabdominal aortic aneurysmCTAcomputed tomography angiographyCRPc-reactive proteinEVARendovascular aortic repairESRerythrocyte sedimentation rateFDGfluoro-deoxyglucoseMRImagnetic resonance imagingMeSHmedical subject headings.
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Affiliation(s)
- Stefanie Pecceu
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ellen Deolet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Moreels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Caren Randon
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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