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Zhou B, Liu H, Feng G, Li X. Well-differentiated primary adrenal angiosarcoma: A case report. Asian J Surg 2024; 47:1035-1037. [PMID: 37925290 DOI: 10.1016/j.asjsur.2023.10.094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 11/06/2023] Open
Affiliation(s)
- Bing Zhou
- Department of Pathology, The Second Affiliated Hospital of Jiujiang University, Jiujiang, 332005, Jiangxi, China
| | - Haoru Liu
- Department of Pathology, Jiujiang No.1 People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Guangui Feng
- Department of Urology, The Second Affiliated Hospital of Jiujiang University, Jiujiang, 332005, Jiangxi, China
| | - Xiaohua Li
- Department of General Surgery, The Second Affiliated Hospital of Jiujiang University, Jiujiang, 332005, Jiangxi, China.
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2
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Alsarraj OM, Alqahtani A, Alswayyed M, Almayouf M, Billa S. Primary Adrenal Angiosarcoma and its Management: A Case Report. Cureus 2023; 15:e48762. [PMID: 38098906 PMCID: PMC10719075 DOI: 10.7759/cureus.48762] [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: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Primary adrenal angiosarcoma is a very rare malignancy. This is a case report of a 54-year-old female, who presented with right-sided abdominal pain. Magnetic resonance imaging of the abdomen and pelvis showed a right adrenal mass with a maximum dimension of 5.7 cm. The patient went for a laparoscopic right adrenalectomy. The postoperative period was uneventful, and she was discharged on postoperative day 2. The patient was free from complaints at outpatient follow-up visits. Pathology confirmed the diagnosis of adrenal angiosarcoma and the metastasis workup was negative. A multidisciplinary approach through the expertise of medical oncology, surgical oncology, and histopathology is essential for the diagnosis and management of such rare diseases.
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Affiliation(s)
- Omar M Alsarraj
- Department of Surgery, Dr. Sulaiman Al-Habib Hospital, Al Takhasussi, SAU
| | | | - Mohammed Alswayyed
- Department of Pathology and Laboratory Medicine, King Saud University, Riyadh, SAU
| | - Mohammad Almayouf
- Department of Surgery, Prince Sattam bin Abdulaziz University, Alkharj, SAU
| | - Srikar Billa
- Department of Surgery, Dr. Sulaiman Al-Habib Hospital, Al Takhasussi, SAU
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3
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Toklu A, Mesa H, Collins K. Incidental adrenal hemangioma clinically suspicious for malignancy: diagnostic considerations and review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2022; 15:444-458. [PMID: 36507066 PMCID: PMC9729942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/15/2022] [Indexed: 12/15/2022]
Abstract
Adrenal hemangiomas are rare lesions often found incidentally during unrelated diagnostic work-up. We report a case of a 67-year-old man with history of hypertension, hyperlipidemia, anemia, arthralgia, joint swelling and unexplained weight loss, which prompted imaging studies. Computed tomography scan revealed a 5.4 cm adrenal mass. The patient had no clinical manifestations of adrenal medullary or cortical hyperfunction. Urine and plasma metanephrines and aldosterone/renin ratio were within normal range. The patient was taking prednisone for hand and ankle swelling, precluding assessment for Cushing syndrome. Given the size of the lesion, the possibility of malignancy was considered, and the patient elected for surgical management. The left adrenalectomy specimen weighed 54 g and revealed a 4.9 cm tan-brown mass with congested cut surface and a thin rim of residual adrenal gland parenchyma. Histologic examination showed thick and thin-walled vessels intermingled with adrenocortical elements at the periphery characteristic of a hemangioma. Surgical resection is the mainstay treatment for large, isolated adrenal masses to exclude malignancy and prevent retroperitoneal hemorrhage. Herein, we report a case of adrenal hemangioma, review a variety of other diagnostic considerations occurring in the adrenal gland, and highlight useful distinguishing features to assist in accurate diagnosis.
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4
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Adrenal angiosarcoma with metastasis: Imaging and histopathology of a rare adrenal cancer. Radiol Case Rep 2020; 15:460-466. [PMID: 32123554 PMCID: PMC7036739 DOI: 10.1016/j.radcr.2020.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 01/15/2023] Open
Abstract
Adrenal angiosarcoma is an extremely rare malignancy with few reported cases in the literature. Patients may be asymptomatic or have nonspecific complaints at presentation. There are no pathognomonic imaging findings, while histopathology can be confounding due to overlap with other disease processes. We present a case of a 38-year-old woman with a long history of cocaine abuse who had metastatic adrenal angiosarcoma at the time of presentation. The adrenal tumor was an incidental finding on imaging. CT demonstrated a heterogeneous mass in the right adrenal gland with central calcification, and MRI identified central necrosis in the mass. Histopathology demonstrated sheets of epithelioid cells, dilated anastomotic vascular spaces, and abundant necrosis, and immunohistochemistry was positive for various vascular markers. The findings were consistent with adrenal angiosarcoma. The patient underwent adrenalectomy and is now receiving adjuvant chemotherapy. Due to the aggressive nature of adrenal angiosarcoma, timely diagnosis and treatment is critical. This case adds to the sparse literature surrounding this disease by highlighting crucial imaging and histopathologic findings that will aid in more efficient diagnosis. Although rare, the disease should be considered in the context of suspicious adrenal lesions. In the future, structured review of all reported cases of adrenal angiosarcoma can help inform diagnosis and therapy for this rare disease.
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5
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Hsu YH, Chuang HC, Lee YH, Lin YF, Chiu YJ, Wang YL, Wu MS, Chiu HW. Induction of Fibrosis and Autophagy in Kidney Cells by Vinyl Chloride. Cells 2019; 8:cells8060601. [PMID: 31212930 PMCID: PMC6627785 DOI: 10.3390/cells8060601] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 02/07/2023] Open
Abstract
Vinyl chloride (VC) is a noninfective occupational risk factor. It is found in industrial chemicals, volatile organic compounds, cigarette smoke ingredients, etc. It is a kind of toxic gas that causes many diseases. VC exposure causes an increased risk of liver fibrosis and can result in angiosarcoma of the liver. Previous studies have shown that high-doses of VC exposure in mice resulted in acute death with marked tubular necrosis of the renal cortex. In this study, we assessed the nephrotoxicity of VC in vitro and in vivo. As a result, we demonstrated that VC induced fibrosis-associated protein expression, such as connective tissue growth factor (CTGF), plasminogen activator inhibitor-1 (PAI-1) and collagen 1, and autophagy-associated protein expression, such as Beclin 1 and LC3-II, in kidney cells. The beclin1 siRNA experiments found that autophagy inhibited VC-induced fibrosis. Blood urea nitrogen (BUN) and creatinine levels were increased after VC treatment. Furthermore, VC caused glomerulosclerosis and tubular injury in mouse kidney tissues. Kidney tissue sections showed that VC induced fibrosis and autophagy in mouse kidney tissues. In summary, the results of VC-induced fibrosis suggest that autophagy plays an important role in kidney damage. VC may cause nephrotoxicity, and the results illustrate the importance of considering the toxicological hazards of VC in kidney cells.
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Affiliation(s)
- Yung-Ho Hsu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yu-Hsuan Lee
- Department of Food Safety/Hygiene &Risk Management, College of Medicine, National Cheng Kung University, Tainan 70430, Taiwan.
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yu-Jhe Chiu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Yung-Li Wang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
| | - Hui-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan.
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6
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Yang F, Yang Y, Yu J, Zheng J, Zhu Y, Shao D, Chen D, Wang S. Primary epithelioid angiosarcoma of the adrenal gland: aggressive histological features and clinical behavior. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:2721-2727. [PMID: 31938388 PMCID: PMC6958267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/22/2018] [Indexed: 06/10/2023]
Abstract
Primary adrenal epithelioid angiosarcoma (PAEA) is an exceedingly rare and high-grade malignant neoplasm with an epithelioid appearance morphologically. To the best of our knowledge, only 35 cases of PAEA have previously been reported in English literature. Here, we present our 7-year experience (2010-2017) with adrenal lesions at our Clinical Pathological Diagnosis Center. Of more than 1,800 adrenal gland specimens, a total of 2 adrenal epithelioid angiosarcoma cases were identified. We reviewed the literature for 13 similar cases. All of the patients appeared to have morphological features of epithelioid cells including vascular endothelium immunophenotype, hemorrhage/necrosis, and anastomosing vascular channels. They underwent adrenalectomy without chemotherapy or radiotherapy. One was still well at 3-year follow up but the other had died at 1-month follow up. One of our cases was first described with accompanying reactive adrenal cortex hyperplasia in a local area. Moreover, the mechanisms of epithelioid angiosarcoma are still uncertain and require further study. Clinical prognosis is poor, therefore early accurate diagnosis and complete resection of this tumor may be very helpful for patients.
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Affiliation(s)
- Fang Yang
- Department of Pathology, Yinzhou Second HospitalNingbo, China
| | - Yusheng Yang
- Department of Pathology, Yinzhou Second HospitalNingbo, China
| | - Jingjing Yu
- Department of Pathology, Yinzhou Second HospitalNingbo, China
| | | | - Yin Zhu
- Department of Pathology, Yinzhou Second HospitalNingbo, China
| | - Dandan Shao
- Department of Pathology, Yinzhou Second HospitalNingbo, China
| | - Dong Chen
- Department of Pathology, Yinzhou Second HospitalNingbo, China
| | - Suying Wang
- Department of Pathology, Clinical Pathological Diagnosis CenterNingbo, China
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7
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Grajales-Cruz A, Baco-Viera F, Rive-Mora E, Ramirez-Tanchez C, Tasso D, Arroyo-Portela N, Calderon E, Padua-Octaviani IJ, Caceres-Perkins W. Primary Adrenal Angiosarcoma: A Rare and Potentially Misdiagnosed Tumor. Cancer Control 2018; 24:198-201. [PMID: 28441375 DOI: 10.1177/107327481702400213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A man aged 69 years presented with acute right flank pain secondary to a hemorrhagic large adrenal tumor. En bloc resection was performed to repair the inferior vena cava. Immunoperoxidase levels in the tumor were positive for factor VIII and CD31 and negative for S100, protein Melan-A, CD34, synaptophysin, chromogranin, desmin, muscle specific actin, ETFA (EMA), KRT20 (CK20), CDX2, TTF1, LNPEP (PLAP), inhibin, ?-fetoprotein, CD30, hepatocyte paraffin, and aberrant expression of cytokeratin 7 and pankeratin. The pathological diagnosis was consistent with adrenal angiosarcoma. Obtaining appropriate immunoperoxidase stains and multidisciplinary evaluation helped make the diagnosis of this rare adrenal tumor and determine its management. The patient had an uneventful postoperative course and completed 4 cycles of adjuvant chemotherapy with doxorubicin/ifosfamide and adequately tolerated the treatment. However, positive surgical margins were found, so he was referred to radiation oncology specialists for possible adjuvant radiotherapy to the surgical bed. Weeks after the first initiation of therapy, the patient presented to the emergency department complaining of shortness of breath, fatigue, and generalized weakness for 3 days. He was admitted and found to have new-onset anemia and a new-onset, large, right pleural effusion. Thoracentesis performed showed sanguinolent fluid that, after microscopic evaluation, was suggestive of recurrent malignancy. Thoracic aortography performed with subselective catheterization to several arteries (right bronchial, right phrenic, and right renal arteries) did not show any active bleeding. However, the right inferior intercostal and adrenal arteries were presumed to be the reason for the bleeding event, so they were embolized until stasis. The patient remained hemodynamically unstable but eventually experienced multiorgan failure. In spite of aggressive measures, he died 10 days after admission to the hospital.
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8
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Cancan G, Teksöz S, Demiryas S, Özcan M, Bükey Y. Adrenal angiosarcoma. Turk J Surg 2018; 34:146-148. [PMID: 30023982 DOI: 10.5152/turkjsurg.2017.3141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/04/2015] [Indexed: 11/22/2022]
Abstract
Adrenal angiosarcoma is an uncommon neoplasm that derives from the vascular endothelium; due to its biological behavior, it should be distinguished from other adrenal tumors. We herein report a case of a 57-year-old woman with diagnosis of an adrenal tumor that was suspected to be malignant. The specimen was histopathologically proved to be an angiosarcoma. The patient was suffering from right upper quadrant pain; after laboratory and radiological workup, a non-functioning right adrenal mass, 14 cm in size, was recognized. A right subcostal incision was made, and adrenalectomy was performed successfully with tumor-free surgical margins. Two months after the operation, a positron emission tomography-computed tomography scan was ordered for follow-up. No tumor tissue or any other metastatic foci remained. The patient had been referred to our medical oncology department and underwent retroperitoneal radiotherapy. However, unfortunately, the patient died due to cardiac insufficiency during the follow-up period.
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Affiliation(s)
- Gülden Cancan
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Serkan Teksöz
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Süleyman Demiryas
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Murat Özcan
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
| | - Yusuf Bükey
- Department of General Surgery, İstanbul University Cerrahpaşa School of Medicine, İstanbul, Turkey
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9
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Li XM, Yang H, Reng J, Zhou P, Cheng ZZ, Li Z, Xu GH. A case report of primary adrenal angiosarcoma as depicted on magnetic resonance imaging. Medicine (Baltimore) 2017; 96:e8551. [PMID: 29137070 PMCID: PMC5690763 DOI: 10.1097/md.0000000000008551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
RATIONALE Angiosarcoma is an extremely rare malignant tumor of endothelial origin. The majority of studies reporting angiosarcoma have been concerned with the clinical and pathological aspects, with limited reporting of their imaging findings. To our knowledge, angiosarcoma of the adrenal gland is very rare. Herein we firstly report a primary adrenal angiosarcoma depicted on magnetic resonance imaging (MRI). PATIENT CONCERNS A 59-year-old man was referred to our hospital for 1 year left-flank pain that exacerbated in recent 4 months. DIAGNOSIS A regular mass with clear boundary was revealed on MRI in the region of left adrenal gland. Its signal intensity was inhomogeneous. It mainly showed isointensity with patchy slight hyperintensity on T1-weighted images and marked hyperintensity with patchy hypointensity on T2-weighted images. On contrast-enhanced images, it demonstrated significantly heterogeneous enhancement, and the peripheral solid component showed delayed enhancement. Bulky blood vessels and hemorrhage were identified in the tumor. INTERVENTIONS The mass was surgically excised under a left laparoscopic adrenalectomy. OUTCOMES Left adrenal angiosarcoma was confirmed by pathological and immunohistochemical examinations. No evidence of recurrence was found 6 months after operation. LESSONS In conclusion, primary adrenal angiosarcoma has some MRI features corresponding to its pathological nature. It should be included in the differential diagnosis when a mass was detected in the adrenal gland.
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Affiliation(s)
- Xue-Ming Li
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Hong Yang
- Department of Pathology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Jing Reng
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Peng Zhou
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Zhu-Zhong Cheng
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
| | - Zhen Li
- Department of Urology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan China
| | - Guo-Hui Xu
- Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China
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10
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A exceptional collision tumor of primary adrenal angiosarcoma and non-functioning adrenocortical adenoma. Pathol Res Pract 2017; 213:702-705. [DOI: 10.1016/j.prp.2017.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/26/2017] [Accepted: 04/14/2017] [Indexed: 12/29/2022]
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11
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Fuletra JG, Ristau BT, Milestone B, Cooper HS, Browne A, Movva S, Galloway TJ, Lee R, Waingankar N, Kutikov A. Angiosarcoma of the Adrenal Gland Treated Using a Multimodal Approach. Urol Case Rep 2016; 10:38-41. [PMID: 27920990 PMCID: PMC5137173 DOI: 10.1016/j.eucr.2016.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/01/2016] [Indexed: 12/29/2022] Open
Abstract
Angiosarcoma of the adrenal gland is an extremely rare malignancy. We report a case of a 59-year-old female who presented with abdominal pain and profound anemia. A 7 cm enhancing, lipid-poor adrenal mass with calcifications that extended posterior to the vena cava was identified on imaging. Patient underwent right adrenalectomy with retroperitoneal lymph node dissection. Pathology demonstrated angiosarcoma of the adrenal gland. Consolidative treatment included adjuvant radiation and chemotherapy. Patient remains disease free 1.5 years following treatment. Prior reported literature on the diagnosis and management of adrenal angiosarcoma is reviewed.
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Affiliation(s)
- Jay G Fuletra
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Benjamin T Ristau
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Barton Milestone
- Department of Radiology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Harry S Cooper
- Department of Pathology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Alysia Browne
- Department of Pathology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Sujana Movva
- Department of Medical Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Thomas J Galloway
- Department of Radiation Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Randall Lee
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Nikhil Waingankar
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
| | - Alexander Kutikov
- Division of Urologic Oncology, Fox Chase Cancer Center-Temple University Health System, Philadelphia, PA, USA
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12
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Cornejo KM, Hutchinson L, Cyr MS, Nose V, McLaughlin PJ, Iafrate AJ, Sadow PM. MYC Analysis by Fluorescent In Situ Hybridization and Immunohistochemistry in Primary Adrenal Angiosarcoma (PAA): a Series of Four Cases. Endocr Pathol 2015. [PMID: 26223194 DOI: 10.1007/s12022-015-9385-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary adrenal angiosarcomas (PAA) are rare with 36 cases reported in the English literature. MYC protein expression and gene amplification have been detected in secondary angiosarcoma (AS), and a subset of primary AS. The aim of this study was to report the clinicopathologic features of PAA and examine these tumors for MYC amplification and protein expression in a small series of four cases (resection, n = 4). Three had available material for ancillary studies and were investigated for MYC gene abnormalities and protein expression using fluorescent in situ hybridization (FISH) and immunohistochemistry (IHC), respectively. Tumors occurred in three females and one male with a mean age of 69 (53-75) years. The sizes ranged from 8.5 to 15 (mean 11.5) cm and were epithelioid in morphology. All tumors had prominent necrosis, and the mitotic count ranged from 4 to 41/10 high-power fields (HPFs) (mean 20/10 HPFs, ×400). Immunohistochemically, the tumor cells were positive for CD31 in 4/4 cases, CD34 in 1/4 cases, and cytokeratin in 4/4 cases. The mean follow-up period was 10.8 (3-19) months, of which three patients died of disease with distant metastases, and one patient was alive with disease. MYC nuclear staining was identified in the three cases tested. Two cases showed polysomy of chromosome 8 without MYC amplification or rearrangement. Two MYC-positive cases by IHC demonstrated copy number gain in chromosome 8, and one MYC-positive case was not associated with a chromosome 8/MYC gene abnormality. In the context of new targeted therapies, MYC positivity in PAA may be clinically valuable in treating patients with these aggressive neoplasms.
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Affiliation(s)
- Kristine M Cornejo
- Department of Pathology, UMass Memorial Healthcare-University of Massachusetts Medical School, One Innovation Drive, Biotech 3, Worcester, MA, 01605, USA.
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Lloyd Hutchinson
- Department of Pathology, UMass Memorial Healthcare-University of Massachusetts Medical School, One Innovation Drive, Biotech 3, Worcester, MA, 01605, USA
| | - Maryann St Cyr
- Department of Pathology, UMass Memorial Healthcare-University of Massachusetts Medical School, One Innovation Drive, Biotech 3, Worcester, MA, 01605, USA
| | - Vania Nose
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick J McLaughlin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - A John Iafrate
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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13
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Hayashi T, Gucer H, Mete O. A mimic of sarcomatoid adrenal cortical carcinoma: epithelioid angiosarcoma occurring in adrenal cortical adenoma. Endocr Pathol 2014; 25:404-9. [PMID: 25246132 DOI: 10.1007/s12022-014-9330-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The adrenal gland is a site of various neoplasms; however, it is rarely involved by sarcomas. We present herein an unusual adrenal neoplasm consisting of epithelioid angiosarcoma and adrenal cortical adenoma. In this report, the authors highlight the diagnostic challenges associated with an epithelioid angiosarcoma occurring in an adrenal cortical neoplasm by providing a comprehensive discussion on the spectrum of vascular proliferations seen in the adrenal gland along with a roadmap for practicing pathologists. The presence of angiosarcoma within an adrenal cortical adenoma may represent a collision tumor; however, one can speculate that the rich vasculature of endocrine lesions can also create a favorable milieu for the occurrence of this phenomenon. While the latter needs to be further clarified, the presented case should be added to the unusual clinical presentations of vascular lesions of the adrenal gland mimicking a sarcomatoid adrenal cortical carcinoma.
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Affiliation(s)
- Toshitetsu Hayashi
- Department of Pathology, University Health Network, 200 Elizabeth Street, 11th floor, Toronto, ON, M5G2C4, Canada
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