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Yanar F, Öner G, Yüksel S, Salduz A, Azamat İF, Özçınar B, Bilgic B, Günöz Cömert R, Kozanoğlu E, Kurtoğlu M. Femoral artery aneurysm developed on intimal sarcoma: Case report. Turk J Surg 2022; 38:306-311. [PMID: 36846070 PMCID: PMC9948668 DOI: 10.47717/turkjsurg.2022.4381] [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: 10/11/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022]
Abstract
Intimal angiosarcoma is a rare vascular malignancy, and diagnosis is very difficult due to nonspecific symptoms. There are controversial points regarding the diagnosis, treatment and follow-up of intimal angiosarcomas. The purpose of this case report was to evaluate the diagnosis and treatment process of a patient diagnosed with femoral artery intimal angiosarcoma. Furthermore, in line with previous studies, it was aimed to illuminate controversial points. A 33-year-old male patient, who had been operated on due to ruptured femoral artery aneurysm, was diagnosed with intimal angiosarcoma with the pathology result. Recurrence was observed during clinical follow-up, and the patient was treated with chemotherapy and radiotherapy. Since there was no response to treatment, the patient underwent aggressive surgery including the surrounding tissues. No recurrence or metastasis was observed in the patient's 10th month follow-up. Although intimal angiosarcoma is rare, it should be considered in differential diagnosis when femoral artery aneurysm is detected. The most important step in treatment is aggressive surgery, but adding chemo-radiotherapy to the treatment should be considered.
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Affiliation(s)
- Fatih Yanar
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Gizem Öner
- Multidisciplinary Oncologic Centre (MOCA), Antwerpen University Hospital, Antwerpen, Belgium
| | - Sercan Yüksel
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Ahmet Salduz
- Department of Orthopaedic Surgery and Traumatology, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - İbrahim Fethi Azamat
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Beyza Özçınar
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Bilge Bilgic
- Department of Pathology, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Rana Günöz Cömert
- Department of Radiology, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Erol Kozanoğlu
- Department of Plastic and Reconstructive Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
| | - Mehmet Kurtoğlu
- Department of General Surgery, İstanbul University Faculty of Medicine, İstanbul, Türkiye
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Pucci A, De Martino A, Bortolotti U. Primary Aortic Sarcoma: Rare and with Heterogeneous Presentations. AORTA (STAMFORD, CONN.) 2021; 9:199-200. [PMID: 34879404 PMCID: PMC8654506 DOI: 10.1055/s-0041-1729914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 02/25/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Angela Pucci
- Division of Pathology, University Hospital, Pisa, Italy
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Moyano-Portillo Á, Garrido-Márquez I, Pérez-Naranjo P, Moya-Sánchez E, Martín-Rodríguez JL. Pseudoaneurismas aórticos en cáncer de pulmón: una entidad infrecuente. CIRUGIA CARDIOVASCULAR 2021. [DOI: 10.1016/j.circv.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Conte GA, Alidoost M, Devita MS, Harmon JS, Schuler JW, Brea F, Farooq T, Chinnici AA. Diagnostic Enigma: Spindle Cell Sarcoma of the Aorta Presenting as Pulmonary Embolism and Chronic Anaemia. Eur J Case Rep Intern Med 2020; 7:001832. [PMID: 33312994 PMCID: PMC7727644 DOI: 10.12890/2020_001832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 07/19/2020] [Indexed: 12/12/2022] Open
Abstract
Primary aortic sarcoma is a rare and aggressive malignancy with only approximately 190 cases reported in the literature. While angiosarcoma and intimal sarcomas represent an estimated 67.7% of malignant aortic tumours, spindle cell sarcomas are even more exclusive, consisting of only 0.9% of malignant aortic tumours. Differentiated from other malignant aortic tumours, spindle cell sarcomas are of mesenchymal origin and usually express vimentin and osteopontin. Clinical presentations are variable and nonspecific, ranging from back pain, abdominal pain or elevated blood pressure, misleading to differentials like pulmonary emboli or aortic aneurysms such as in our case here. In this article, we discuss the finding of an extremely rare aortic sarcoma masquerading as a pulmonary embolism. The patient underwent surgical resection; however, the course was complicated by the development of brain metastases and intracranial haemorrhage. The literature is expanding regarding the evolution of adjuvant chemotherapy and radiation therapy in the treatment of these patients. The exact pathogenesis of spindle cell sarcomas is unknown but thought to be related to the MDM2-p53 pathway. The development of spindle cell sarcomas may be related to Li-Fraumeni syndrome, which should be on the differential for these patients. This case highlights the importance of identifying aortic sarcomas in patients who present with signs and symptoms of peripheral embolization as the diagnosis can be easily misconstrued for thrombus or aortic aneurysm, leading to a delay in proper and timely management. We herein emphasize that aortic sarcomas should be included in the clinician’s working differential due to the poor prognosis and outcomes that these aggressive tumours carry.
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Affiliation(s)
- Gabriella A Conte
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Marjan Alidoost
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Mitchel S Devita
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Jonathan S Harmon
- Department of Medicine, Jefferson Health New Jersey, Jefferson University Hospital, Stratford, NJ, USA
| | - Jake W Schuler
- Saint George's University School of Medicine, Grenada, West Indies
| | - Fernando Brea
- University de Santiago de Compostela, Galicia, Spain
| | - Taliya Farooq
- Department of Pathology, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
| | - Angelo A Chinnici
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ, USA
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Shimogawara T, Ono S, Kobayashi K, Sasaki A, Shimizu H, Matsui J. Aortic sarcoma mimicking a mycotic aneurysm in the thoracoabdominal aorta. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:593-596. [PMID: 31872164 PMCID: PMC6909102 DOI: 10.1016/j.jvscit.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/15/2019] [Indexed: 12/29/2022]
Abstract
Aortic sarcoma is a rare primary tumor with dismal prognosis. Here, we report a case involving a 74-year-old female patient with aortic sarcoma masquerading as a mycotic aneurysm in the thoracoabdominal aorta. She underwent aortic resection with Dacron prosthetic graft replacement because of rapid growth. The postoperative pathological findings of the resected specimen confirmed the diagnosis of aortic mural sarcoma, which was an unexpected result based on repeat computed tomography angiography performed within 2 months preoperatively. The preoperative diagnosis of aortic sarcoma is often difficult because of its rarity, and this case demonstrates some of the diagnostic pitfalls.
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Affiliation(s)
- Tatsuya Shimogawara
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Shigeshi Ono
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
| | - Kanako Kobayashi
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Aya Sasaki
- Department of Pathology, Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Junichi Matsui
- Department of Surgery, Tokyo Dental College, Ichikawa General Hospital, Chiba, Japan
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Koshima R, Hashimoto M, Doi H, Mitsube K. Surgical Therapy for Angiosarcoma of the Aorta: A Case Report. Ann Vasc Dis 2019; 12:225-227. [PMID: 31275479 PMCID: PMC6600100 DOI: 10.3400/avd.cr.18-00153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We describe the case of a 71-year-old woman presenting with abdominal angina with an intra-aortic mass at the thoracoabdominal aorta that restricted blood supply to the organs. Initially, the intra-aortic mass was suspected to be a mural thrombus; thus, endarterectomy was performed. However, postoperative histopathological examination revealed an intimal sarcoma, which relapsed locally within a few months. Additional en bloc resection of the aorta with graft interposition was performed. Despite surgical therapy, splenic metastasis was detected a few months after the second surgery; therefore, palliative care was selected for the patient.
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Affiliation(s)
- Ryuji Koshima
- Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Makoto Hashimoto
- Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Hirosato Doi
- Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
| | - Keijiro Mitsube
- Department of Cardiovascular Surgery, Sapporo Cardiovascular Clinic, Sapporo, Hokkaido, Japan
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De Martino A, Ballestracci P, Faggioni L, Pratali S, Morganti R, Pucci A, Bortolotti U. Incidence of Aortitis in Surgical Specimens of the Ascending Aorta Clinical Implications at Follow-Up. Semin Thorac Cardiovasc Surg 2018; 31:751-760. [PMID: 30414447 DOI: 10.1053/j.semtcvs.2018.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/30/2018] [Indexed: 01/01/2023]
Abstract
The objectives of this study are to evaluate the incidence of aortitis on a surgical population, establish any relationship with systemic diseases, verify early and late surgical results and provide clinical and radiological follow-up to determine factors potentially predicting progression of the disease and influencing late outcome. From 2009 to 2017, 237 patients underwent elective operations on the ascending aorta. Segments of the excised tissues were routinely sent for histologic evaluation, providing adequate data in 178 (75%) for a clinical and pathologic correlation. Patients with aortitis (Group 1) (n = 26) were compared with 152 with atherosclerotic or degenerative disease (Group 2). Incidence of aortitis was 15%, being clinically isolated in 73%. In 24 patients (92%), a giant cell aortitis was found. Actuarial survival at 3 years is 88% in Group 1 and 98% in Group 2 and 74% and 98% at 5 years, respectively (P = 0.016). A control angio-computed tomography revealed an increased descending aorta diameter in 2 out of 14 late survivors. A positron emission tomography showed presence of arteritis in other vascular segments in 3 patients. Clinically isolated aortitis is extremely frequent in patients with inflammatory aortic disease. The diagnosis is often difficult and may be supported by routine pathologic evaluation of surgical explants and by multimodality imaging. The latter should be employed to allow adequate patient follow-up and to disclose potential recurrences in untreated aortic segments.
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Affiliation(s)
| | | | | | - Stefano Pratali
- Section of Cardiac Surgery, University Hospital, Pisa, Italy
| | | | - Angela Pucci
- Division of Histopathology, University Hospital, Pisa, Italy
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