Immunohistochemical and ultrastructural studies of a primary aortic intimal sarcoma

Aortic Angiosarcoma Presenting as Distal Arterial Embolization

Aortic angiosarcoma is a rare, malignant neoplasm of the vasculature, with 24 case reports in the literature. Patients usually present with either aneurysmal or occlusive disease. Treatment consists of en bloc resection of the vessel and contiguous structures with postoperative chemoradiation therapy. Despite surgery and adjunctive measures, prognosis remains dismal as a result of early metastasis and late diagnosis. We report a case of aortic angiosarcoma that presented with distal thromboembolic phenomenon.

Angiosarcoma of the aorta: report of a case and review of the literature

Primary malignant tumors of the thoracic and abdominal aortas are extremely rare. In most cases, a diagnosis is established either postmortem or after an emergency operation for embolic complications. We present the case of a thoracic aortic angiosarcoma in a 71-year-old man who initially was seen with peripheral embolization. The management of these tumors and the world literature are reviewed.

Primary aortic intimal sarcoma of the endothelial cell type with long-term survival

Primary tumors of the aorta are rare and are difficult to diagnose preoperatively. These tumors are malignant and ultimately fatal. A patient had initial evidence of aortoiliac obstructive disease. Aortic endarterectomy produced an excellent postoperative clinical result until the pathology report from the endarterectomy specimen revealed aortic sarcoma. The patient refused a second operation for en bloc aortic resection. One year later with recurrent symptoms, the patient underwent en bloc resection of the aorta and common iliac vessels until clear margins were obtained. The tumor was found to be intimal aortic sarcoma of endothelial cell origin. The only metastasis was to bone, and it was controlled with radiation and chemotherapy. The patient lived a total of 8 years from the time of initial diagnosis. Abdominal aortic intimal sarcoma of the endothelial cell type is a rare variety of aortic sarcoma that can be managed successfully if diagnosed early. This specific type of tumor has a longer survival period and better prognosis than other types of aortic sarcoma when managed with aggressive surgical resection, radiation, and chemotherapy.

Metastasizing sarcoma of the aorta. A case report

Sarcomas of the great vessels are rats. We report a case of a metastasizing sarcoma of the aorta. The patient was an 82-year-old male who presented with a subcutaneous tumour, which was initially classified as a malignant fibrous histiocytoma. Autopsy revealed a polypoid sarcoma of the luminal aspect of the aortic arch with metastases to several organs. By means of immunohistochemical staining, the aortic neoplasm was classified as an undifferentiated intimal sarcoma. The morphology of intimal sarcomas is very heterogeneous, and, when metastatic deposits are present, there may be considerable problems in differential diagnosis.

Aortic intimal sarcoma with acute myocardial infarction

An autopsy case of aortic sarcoma who died of acute myocardial infarction caused by coronary involvement is reported. The patient was a 54 year old woman who was admitted because of an undiagnosed fever and general fatigue of 6 months duration. Magnetic resonance imaging (MRI) showed a tumor in the aortic arch. Total aortic arch replacement was performed. It was diagnosed as a malignant mesenchymal tumor of the aorta. The patient died of acute myocardial infarction 10 months after the operation. At autopsy, the tumor had invaded the luminal surface and intima of the proximal anastomosis (the remnant ascending aorta and the graft), the aortic valves, the distal anastomosis (surgical line of the thoracic aorta plus the graft), and the coronary arteries. The left main coronary artery showed complete obstruction by fibrin thrombus with tumor invasion in the intima, which was responsible for acute myocardial infarction. Primitive and bizarre tumor cells proliferated with many slit-like tissue spaces. Most of the tumor except for its luminal surface showed necrosis. Ultrastructurally, there were spaces between tumor cells, suggesting lumen formation, and some of them had microvilli. This sarcoma was considered to be the so-called aortic intimal sarcoma.

Sarcomas of the great vessels. A clinicopathologic study

BACKGROUND

There are few reports comparing the clinicopathologic features of sarcomas of the aorta (SA), sarcomas of the inferior vena cava (SIVC), and sarcomas of the pulmonary artery (SPA).

METHODS

The authors retrospectively reviewed 11 SA, 16 SIVC, and 16 SPA, and compared clinical, pathologic, and immunohistochemical findings.

RESULTS

The mean age at presentation for SA was 62.3 +/- 17.3 years versus 41.3 +/- 17.1 for SPA; mean age for SIVC was 49.9 +/- 18.8. Nine of 11 SA and 14 of 16 SPA were grossly confined to the lumen, compared with only two SIVC. Luminal sarcomas were classified as poorly differentiated (intimal), angiosarcoma or leiomyosarcoma. Eight SA, 13 SPA, and one SIVC were of the intimal type and were composed of fibroblastic or myofibroblastic cells; five had "storiform" areas typical of malignant fibrous histiocytoma, and all had areas of necrosis. Intimal SPA were more likely myxoid than SA, and osteosarcomatous differentiation was present only in SPA (three cases). Intimal sarcomas were negative for desmin, Factor VIII-related antigen, S-100 protein, and CD34/QBend; all were positive for vimentin and most showed positive cells for smooth muscle actin. One luminal SA and one luminal SPA were histologically typical of angiosarcoma. Two SPA, 2 SA, and 14 SIVC were predominantly mural, most of which were leiomyosarcomas. The mean survival of intimal SA was poor (5 months), compared with 37 months for SIVC and 23 months for intimal SPA.

CONCLUSION

SA, SPA, and SIVC differ in their clinical presentation and survival. Most SA and SPA sarcomas are aggressive, probably derived from intimal cells that show myofibroblastic differentiation. SIVC are usually derived from medial smooth muscle and are relatively well differentiated leiomyosarcomas.

Characterization of myxoid substance of human aortic sarcoma

An autopsy case of aortic sarcoma which was located in the intima of the abdominal aorta and characterized by abundant extracellular myxoid substances was examined. Histological, immunohistochemical and ultrastructural studies revealed no characteristics suggestive of endothelial, leiomyogenic or histiocytic differentiation. Histochemical and biochemical analyses revealed that the myxoid substances were glycosaminoglycans (GAGs) consisting of hyaluronic acid (85% of the total GAG) and chondroitin sulfate proteoglycan (15% of the total GAG). Neither heparan sulfate proteoglycan nor dermatan sulfate proteoglycan was detected. In the aorta, GAGs are synthesized mainly by arterial smooth muscle cells and endothelial cells. Among these cells, the arterial smooth muscle cell is the principal cell type that synthesizes aortic GAGs, predominantly chondroitin sulfate proteoglycan, whereas the endothelial cell synthesizes small amounts of GAGs, predominantly heparan sulfate proteoglycan. Therefore, the results of this study suggest that the tumor cells of the present case have a property similar to arterial smooth muscle cells in terms of GAG synthesis, and that the tumor originated most probably from arterial smooth muscle cells.