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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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2
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Wu ZY, Li YJ. Sarcomatoid renal cell carcinoma mimics thrombus in abdominal aorta. Asian J Surg 2023; 46:5669-5670. [PMID: 37633784 DOI: 10.1016/j.asjsur.2023.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 08/15/2023] [Indexed: 08/28/2023] Open
Affiliation(s)
- Zhi-Yuan Wu
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Sciences, Beijing, PR China
| | - Yong-Jun Li
- Department of Vascular Surgery, Beijing Hospital, National Centre of Gerontology, Institute of Geriatric Medicine, Chines Academy of Medical Sciences, Beijing, PR China.
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3
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Bui THG, Do NS, Pham TT, Ho DT. Aortic sarcoma: a challenging diagnosis. BMJ Case Rep 2023; 16:e256722. [PMID: 37730425 PMCID: PMC10514656 DOI: 10.1136/bcr-2023-256722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Sarcomas of the aorta are rare tumours with various clinical presentations. The most common symptoms are embolic events, constitutional symptoms, claudication, abdominal complaints, aneurysm/pseudoaneurysm, back pain and hypertension. We present a case of a woman in her early 60s having fever, fatigue and cough for 3 months. The chest CT revealed an aneurysm measuring 64.1×65.6 mm. The oncology and thoracic surgical teams were consulted and decided to do an open repair of the aorta and take specimens for histopathological examination, which later confirmed a pleomorphic undifferentiated sarcoma of the aorta. She was temporarily discharged on day 9th after the surgery, followed up by chemotherapy in subsequent admission.
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Affiliation(s)
- Thi Huong Giang Bui
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Ngoc Son Do
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - The Thach Pham
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Duc Trieu Ho
- Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Viet Nam
- Department of Emergency and Critical Care Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
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4
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Bartolomé Sánchez A, Inaraja-Pérez GC, Jiménez Elbaile A, Brito MO, Buisán Bardaji JM. Intimal angiosarcoma of the descending aorta presenting as atheroembolism: case report and description of intravascular biopsy. J Vasc Surg Cases Innov Tech 2023; 9:101230. [PMID: 37799831 PMCID: PMC10547730 DOI: 10.1016/j.jvscit.2023.101230] [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: 03/16/2023] [Accepted: 05/11/2023] [Indexed: 10/07/2023] Open
Abstract
Aortic sarcoma is a rare entity. In most cases, the diagnosis is established late, owing to the course of the disease, with a median survival time of only a few months. We report the case of a 58-year-old patient with ischemic lesions in the lower limb. The lesions after several investigations were diagnosed by imaging studies (eg, magnetic resonance angiography, contrast-enhanced computed tomography [CT], CT angiography, or positron emission tomography-CT with fluorine-18 fluorodeoxyglucose) as possible primary angiosarcoma of the aorta. It was decided to perform endovascular aortic repair and endovascular biopsy of the lesion. This was chosen as a "palliative" treatment to avoid embolic events, given the presence of metastases, instead of open surgery, which would otherwise have been the treatment of choice. Subsequently, histologic examination confirmed aortic intimal angiosarcoma, and adjuvant chemotherapy was initiated. In the present report, we discuss the clinical presentation, diagnosis, and classification of primary aortic sarcomas. We also critically review the diagnostic and therapeutic management of these patients in previous series of studies to improve their treatment in subsequent cases.
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Affiliation(s)
| | - Gabriel-Cristian Inaraja-Pérez
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Alfonso Jiménez Elbaile
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - Manoela Oliveira Brito
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
| | - José Manuel Buisán Bardaji
- Angiología y Cirugía Vascular, Hospital Universitario Lozano Blesa, Zaragoza, Spain
- Grupo de Investigación en Patología Vascular, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain
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5
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Zheng YJ, Ren L, Zhu Y, Yang X, Zhang X, Deng S, Wang ZQ, Chen D, Shao Y, Han PC, Zhang Q. DICER1-associated sarcoma of the aortic arch - a case report and literature review. Cardiovasc Pathol 2022; 60:107451. [PMID: 35835430 DOI: 10.1016/j.carpath.2022.107451] [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: 02/06/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022] Open
Abstract
Primary sarcoma of the aorta is extremely rare. We herein report a case of DICER1-associated sarcoma originating from the aortic arch. A 45-year-old male was admitted to the hospital with a cold left hand and weakened radial artery pulse in the left side. Computed tomography of the chest showed multiple penetrating ulcers with tumor-like ectasia at the aortic arch, diagnosed as a pseudoaneurysm. Histopathological analysis of the mass revealed a biphasic neoplasm composed of epithelial and mesenchymal components and a transition zone between the epithelial and mesenchymal cells, which supports the diagnosis of a biphasic sarcoma rather than carcinosarcoma. The differentiated cells of soft tissue showed strong and diffuse positivity for TLE-1, Bcl-2, and CD99; the nested epithelial cells were focally positive for CK-pan, but negative for EMA, membranous localization of β-catenin. This case showed a unique pattern of SS18-break-apart probe, with loss of the green signal (approximately 33%) by fluorescence in situ hybridization (FISH). Fusion gene profiling using whole transcriptome RNA sequencing (RNA-seq) indicated that this case was negative for common fusion genes including SS18. Next-generation sequencing (NGS) revealed somatic mutations in DICER1 . Taken together, this case was diagnosed as a DICER-associated biphasic sarcoma of the aortic arch. The patient died four months after aorta replacement therapy without radiotherapy and chemotherapy.
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Affiliation(s)
- Yan-Jun Zheng
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Ling Ren
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Yu Zhu
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Xi Yang
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Xiang Zhang
- Third central hospital of Tianjin Medical University, radiology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Shu Deng
- Second Hospital of Tianjin Medical University, stomatology department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Zheng-Qing Wang
- Second Hospital of Tianjin Medical University, stomatology department, Tianjin, China; TEDA international Cardiovascular Hospital of Tianjin University, cardiovascular surgery department, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Dong Chen
- TEDA international Cardiovascular Hospital of Tianjin University, cardiovascular surgery department, Tianjin, China; Affiliated Anzhen Hospital of Capital Medical University, pathology department, Beijing, China; Stomatology colledge, Tianjin Medical University
| | - Yang Shao
- Affiliated Anzhen Hospital of Capital Medical University, pathology department, Beijing, China; Nanjing Geneseeq Technology, Inc, Nanjing, China; School of Public Health, Nanjing Medical University, Nanjing, China; Stomatology colledge, Tianjin Medical University
| | - Peng-Cheng Han
- Department of Pathology, Tianjin Third Central Hospital, Tianjin, China; Stomatology colledge, Tianjin Medical University
| | - Qin Zhang
- TEDA Hospital of Tianjin University, pathology department, Tianjin, China; TEDA international Cardiovascular Hospital of Tianjin University, cardiovascular surgery department, Tianjin, China; Nanjing Geneseeq Technology, Inc, Nanjing, China; School of Public Health, Nanjing Medical University, Nanjing, China; Stomatology colledge, Tianjin Medical University.
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6
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Fan X, Chen X, Yang Z, Zhang T, Liao Y, Fan W, Chen X. Primary aortic intimal sarcoma masquerading as intramural hematoma. Open Med (Wars) 2021; 16:1306-1310. [PMID: 34553076 PMCID: PMC8418191 DOI: 10.1515/med-2021-0337] [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: 03/31/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022] Open
Abstract
Primary aortic intimal sarcoma is a very rare disease and most patients present with features similar to those of atherosclerotic plaque and thrombus; however, primary aortic intimal sarcoma presents with features similar to those of intramural hematoma (IMH) on CT imaging and clinical presentation had never been previously reported. Here we report a case involving a 49-year-old woman with primary aortic intimal sarcoma masquerading as IMH on radiological images and clinical presentation. We also discuss some of the diagnostic pitfalls and hope that these diagnostic pitfalls will be very useful for clinicians.
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Affiliation(s)
- Xiaodong Fan
- Department of Radiology, Meizhou People's Hospital, Meizhou, 514031, China
| | - Xiaofeng Chen
- Department of Radiology, Meizhou People's Hospital, Meizhou, 514031, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, 514031, China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, China
| | - Zhiqi Yang
- Department of Radiology, Meizhou People's Hospital, Meizhou, 514031, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, 514031, China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, China
| | - Tianhui Zhang
- Department of Radiology, Meizhou People's Hospital, Meizhou, 514031, China
| | | | - Weixiong Fan
- Department of Radiology, Meizhou People's Hospital, Meizhou, 514031, China
| | - Xiangguang Chen
- Department of Radiology, Meizhou People's Hospital, Meizhou, 514031, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, 514031, China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, 514031, China
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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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Kaushal V, Amoozgar B, Barua N, Chhetri S, Garsondiya B. Manifestation of Pleomorphic Undifferentiated Aortic Sarcoma with Splenic Infarction: A Case Report. Case Rep Oncol 2020; 13:1002-1005. [PMID: 32999663 PMCID: PMC7506372 DOI: 10.1159/000509240] [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: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 11/19/2022] Open
Abstract
Aortic spindle cell sarcoma is a rare neoplasm with poor prognosis that is often found incidentally due to its adverse effects. CT and MRI with contrast are useful imaging modalities, but a tissue biopsy is the gold standard for diagnosis. Tumor resection is the ultimate treatment followed by chemotherapy. Our case was an adult female who presented mainly for shortness of breath, and further imaging workup demonstrated a soft tumor juxtaposed to a major vein with compressive effect. The patient's tumor was resected, and the pathology result confirmed undifferentiated aortic sarcoma. The patient's condition improved and she was discharged with outpatient oncology follow-up and possible treatment.
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Affiliation(s)
- Varun Kaushal
- Department of Internal Medicine, Jersey Shore University Medical Center, Perth Amboy Division, Perth Amboy, New Jersey, USA
| | - Behzad Amoozgar
- Department of Internal Medicine, Jersey Shore University Medical Center, Perth Amboy Division, Perth Amboy, New Jersey, USA.,University of California, Berkeley, School of Public Health, Berkeley, California, USA
| | - Nabonita Barua
- Department of Internal Medicine, Jersey Shore University Medical Center, Perth Amboy Division, Perth Amboy, New Jersey, USA
| | - Shankar Chhetri
- Department of Internal Medicine, Jersey Shore University Medical Center, Perth Amboy Division, Perth Amboy, New Jersey, USA
| | - Bhaveshkumar Garsondiya
- Department of Internal Medicine, Jersey Shore University Medical Center, Perth Amboy Division, Perth Amboy, New Jersey, USA
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Campana F, Nardin M, Coppini A, Muiesan ML. Case report of a sub-occluding thrombus in thoracic aorta: what is the origin? EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:5532159. [PMID: 31367736 PMCID: PMC6764550 DOI: 10.1093/ehjcr/ytz114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 10/10/2018] [Accepted: 06/21/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Aortic thrombosis represents a consequence of atherosclerotic disease. In few cases, it can be secondary to large vessel or infective vasculitis. More rarely, aortic thrombosis is the manifestation of a primary malignant neoplasm of the aortic wall. Aortic angiosarcoma is a rare tumour, its clinical presentation is often non-specific and associated signs and symptoms may vary greatly. An early diagnosis is difficult to reach and the presence of metastatic disease is not uncommon at the time of diagnosis. The prognosis is poor overall. CASE SUMMARY We report the case of a female patient who presented to her GP because of fatigue, hyporexia, weight-loss, and anaemia. An ultrasound of the abdomen showed two small pancreatic lesions, confirmed and described as benign cystic pancreatic lesions on computed tomography (CT) imaging; an incidental thrombus in the superior mesenteric artery was also found on CT imaging. The thoracic CT identified a large thrombotic lesion in the descending thoracic aorta with significant narrowing of the aortic lumen and confirmed the presence of an osteolytic bone lesion on the VIII right rib, in the absence of atherosclerotic disease. Signs of increased metabolic activity in the aortic lumen and in the VIII posterior right rib were shown at a subsequent positron emission tomography. A CT-guided biopsy of the bone lesion was performed and at histology the diagnosis of metastatic angiosarcoma of the aortic wall was made. DISCUSSION Aortic angiosarcoma is a rare cause of aortic thrombosis, to be taken into consideration in a patient with thrombotic lesions of the aorta in the absence of atherosclerotic disease. The differential diagnosis is difficult because of clinical presentation and radiological features similar to those of inflammatory aortic disease. In our case, the final diagnosis of angiosarcoma was made only by a biopsy of a bone metastatic lesion.
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Affiliation(s)
- Federica Campana
- Department of Clinical & Experimental Sciences, University of Brescia & Postgraduate School of Internal Medicine University of Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Matteo Nardin
- Department of Clinical & Experimental Sciences, University of Brescia & Postgraduate School of Internal Medicine University of Brescia, Piazzale Spedali Civili 1, Brescia, Italy
| | - Anna Coppini
- 2a Medicina Generale ASST Spedali Civili, Piazzale Spedali Civili 1, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical & Experimental Sciences, University of Brescia & Postgraduate School of Internal Medicine University of Brescia, Piazzale Spedali Civili 1, Brescia, Italy
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