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Randhawa TS, Aggarwal A, Chatterjee D, Gharat MG, Singla R, Ahuja C. Pediatric primary intracranial angiosarcoma with epithelioid differentiation: a surgeon's dilemma. Childs Nerv Syst 2024; 40:267-271. [PMID: 37563363 DOI: 10.1007/s00381-023-06114-9] [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: 05/05/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
Angiosarcoma is a rare form of soft tissue sarcoma originating from endothelial tissue, accounting for < 1% of all sarcomas. Primary epithelioid angiosarcomas of the central nervous system (CNS) are even more elusive, with only four reports described in the literature. In this article, we describe the first case in pediatric population, with a brief literature review regarding this entity. A 13-year-old girl presented to emergency services with raised intracranial pressure. MRI demonstrated a heterogenous lesion in the temporal lobe. She underwent emergency craniotomy and subtotal excision of the tumor. Eventually the patient developed multiple infarcts and succumbed post operatively. Pre-operative diagnosis on radiology is difficult considering the rarity of this entity and heterogeneity in radiological appearance. One needs to have a high degree of suspicion to consider angiosarcoma as a radiological differential. Overall prognosis remains poor. Early adjuvant treatment may improve overall survival.
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Affiliation(s)
- Tejasvi Singh Randhawa
- Deparment of Neurosurgery, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Ashish Aggarwal
- Deparment of Neurosurgery, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Debyajyoti Chatterjee
- Department of Pathology, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Mayur Gopichand Gharat
- Deparment of Neurosurgery, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Raghav Singla
- Deparment of Neurosurgery, Post Graduate Institute of Medical Sciences, Chandigarh, India.
| | - Chirag Ahuja
- Deparment of Neuroradiology, Post Graduate Institute of Medical Sciences, Chandigarh, India
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2
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Cao J, Fang J, Jiang X, Di G, Shen J. Case report: a case of primary intracranial parasagittal meningeal angiosarcoma. Diagn Pathol 2023; 18:104. [PMID: 37717004 PMCID: PMC10504741 DOI: 10.1186/s13000-023-01389-7] [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] [Received: 12/07/2022] [Accepted: 09/03/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Angiosarcoma, also known as malignant hemangioendothelioma, is a rare vasogenic malignant tumor, commonly found on the skin of the head and neck, rarely occurring in the intracranial region. As for intracranial meningeal angiosarcoma, only 8 cases have been reported before and there is no clinical study with large sample size. We report here a case of parasagittal meningeal angiosarcoma. CASE DESCRIPTION A 48-year-old Chinese male patient was admitted to our hospital due to headache accompanied by bilateral lower limb weakness. On admission, CT showed a high-density mass on both sides of the sagittal sinus at the top of the frontal lobe. We performed exploratory surgical resection of the tumor. During the operation, it was found that the tumor originated from the dura mater and extensively invaded the surrounding brain tissue and skull, and the surrounding hemosiderin deposition was observed. Postoperative pathology suggested angiosarcoma. CONCLUSIONS Intracranial meningeal angiosarcoma is difficult to accurately diagnose before surgery, so radiologists and neurosurgeons need to strengthen their understanding of this disease. The presence of extensive superficial hemosiderin deposition during operation may contribute to the diagnosis, and immunohistochemistry is very important for the diagnosis of intracranial angiosarcoma.
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Affiliation(s)
- Jun Cao
- Department of Neurosurgery, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
| | - Jincheng Fang
- Department of Neurosurgery, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
| | - Xiaochun Jiang
- Department of Neurosurgery, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China.
| | - Guangfu Di
- Department of Neurosurgery, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
| | - Jun Shen
- Department of Neurosurgery, the First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Wuhu, 241001, People's Republic of China
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3
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Zuo P, Wang Y, Mai Y, Zhang B, Wu Z, Zhang J, Zou W, Zhang L. Clinical characteristics and surgical outcomes of primary intracranial angiosarcomas. J Neurooncol 2023; 164:397-404. [PMID: 37650954 DOI: 10.1007/s11060-023-04437-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/26/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE Primary intracranial angiosarcomas (PIAs) are exceedingly uncommon, with the literature predominantly comprising case reports. The clinical characteristics and prognosis of this condition remain elusive. Our objective is to describe the clinical characteristics and surgical prognosis of this rare disease while offering insights into the most effective contemporary treatment strategy. METHODS The authors of this article incorporated a cohort of 28 cases of PIAs, consisting of 3 from our institution and 25 from previously documented literature sources. Subsequently, we conducted both Cox univariate and multivariate analyses to assess the potential risk factors influencing overall survival (OS). RESULTS The cohort include 19 males and 9 females with a mean age of 39.6 ± 23.5 years (range: 0.03-73 years). Radiologically, 24 cases were located at supratentorial area, while only 4 cases were located at infratentorial area. 17 cases underwent gross total resection (GTR), and 11 cases underwent Non-GTR. Postoperative radiotherapy was administered to 17 cases, and postoperative chemotherapy was administered to 6 cases. After a mean follow-up time of 21.5 ± 26.4 months, 19 (67.9%) patients died. The 1-year, 2-year, 5-year OS is 55.3%, 50.7% and 24.6%, respectively. Univariate and multivariate Cox regression analysis showed that Non-GTR was the sole factor predicting a shorter OS (p = 0.004). CONCLUSION In this study, we found that PIAs have a higher incidence in males than in females, and most cases show evidence of old hemorrhage on preoperative MRI. Through our statistical analysis, GTR plays a crucial role in for treating this rare disease. Further clinical data are needed to validate our conclusions.
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Affiliation(s)
- Pengcheng Zuo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yujin Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yiying Mai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Bochao Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Junting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Wanjing Zou
- Department of Neuropathology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Liwei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
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4
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Valera-Melé M, Darriba Allés JV, Ruiz Juretschke F, Sola Vendrell E, Hernández Poveda JM, Montalvo Afonso A, Casitas Hernando V, García Leal R. Primary central nervous system angiosarcoma with recurrent acute subdural hematoma. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:199-203. [PMID: 35725222 DOI: 10.1016/j.neucie.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
Angiosarcoma is an infrequent tumor among sarcomas, especially presenting as a primary tumor within the central nervous system, which can lead to a rapid neurological deterioration and death in few months. We present a 41-year old man with a right frontal enhancing hemorrhagic lesion. Surgery was performed with histopathological findings suggesting a primary central nervous system angiosarcoma. He was discharged uneventfully and received adjuvant chemotherapy and radiotherapy. At 5 months, the follow-up MRI showed two lesions with an acute subdural hematoma, suggesting a relapse. Surgery was again conducted finding tumoral membranes attached to the internal layer of the duramater around the right hemisphere. The patient died a few days later due to the recurrence of the subdural hematoma. This case report illustrates a rare and lethal complication of an unusual tumor. The literature reviewed shows that gross-total resection with adjuvant radiotherapy seems to be the best treatment of choice.
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Affiliation(s)
- Marc Valera-Melé
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain.
| | - Juan Vicente Darriba Allés
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Fernando Ruiz Juretschke
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Emma Sola Vendrell
- Department of Neuropathology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - José Manuel Hernández Poveda
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Antonio Montalvo Afonso
- Department of Neurosurgery, Hospital Universitario de Burgos, Avenida Islas Baleares 3, 09006 Burgos, Spain
| | - Vicente Casitas Hernando
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Roberto García Leal
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
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5
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Valera-Melé M, Darriba Allés JV, Ruiz Juretschke F, Sola Vendrell E, Hernández Poveda JM, Montalvo Afonso A, Casitas Hernando V, García Leal R. Primary central nervous system angiosarcoma with recurrent acute subdural hematoma. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00027-0. [PMID: 33766476 DOI: 10.1016/j.neucir.2021.02.002] [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: 12/23/2020] [Accepted: 02/04/2021] [Indexed: 11/18/2022]
Abstract
Angiosarcoma is an infrequent tumor among sarcomas, especially presenting as a primary tumor within the central nervous system, which can lead to a rapid neurological deterioration and death in few months. We present a 41-year old man with a right frontal enhancing hemorrhagic lesion. Surgery was performed with histopathological findings suggesting a primary central nervous system angiosarcoma. He was discharged uneventfully and received adjuvant chemotherapy and radiotherapy. At 5 months, the follow-up MRI showed two lesions with an acute subdural hematoma, suggesting a relapse. Surgery was again conducted finding tumoral membranes attached to the internal layer of the duramater around the right hemisphere. The patient died a few days later due to the recurrence of the subdural hematoma. This case report illustrates a rare and lethal complication of an unusual tumor. The literature reviewed shows that gross-total resection with adjuvant radiotherapy seems to be the best treatment of choice.
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Affiliation(s)
- Marc Valera-Melé
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain.
| | - Juan Vicente Darriba Allés
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Fernando Ruiz Juretschke
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Emma Sola Vendrell
- Department of Neuropathology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - José Manuel Hernández Poveda
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Antonio Montalvo Afonso
- Department of Neurosurgery, Hospital Universitario de Burgos, Avenida Islas Baleares 3, 09006 Burgos, Spain
| | - Vicente Casitas Hernando
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
| | - Roberto García Leal
- Department of Neurosurgery, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 28007 Madrid, Spain
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6
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Radiation-associated angiosarcoma of the brain with repeated intracerebral hemorrhage: A case report. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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7
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Melguizo-Gavilanes I, Snipes G, Rodríguez-Márquez I, Duarte-Jurado L, Jaramillo-Jiménez E. Therapeutic options for primary meningeal angiosarcoma: A case report. Surg Neurol Int 2020; 11:204. [PMID: 32874707 PMCID: PMC7451178 DOI: 10.25259/sni_533_2019] [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: 10/24/2019] [Accepted: 06/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background Primary angiosarcoma (AS) of the central nervous system (PACNS) is an extremely rare malignancy. The meninges represent an uncommon site of origin of PACNS. This report describes a recurrent meningeal PACNS treated with surgery, radiotherapy, stereotactic radiosurgery, and paclitaxel at different stages of the disease. Case Description A 36-year-old Asian male presented to our facility with a 4-month history of worsening headaches and complete right homonymous hemianopia. Neuroimaging revealed a left occipital lobe hematome with an underlying left tentorial tumor. After subtotal resection, neuropathological examination revealed features of a malignant endothelial cell AS. He received a course of adjuvant radiation therapy but experienced disease progression. He subsequently received additional stereotactic radiosurgery followed by weekly paclitaxel. Magnetic resonance imaging during the course of treatment revealed stable disease until patient died following another progression of his tumor. Conclusion This case of a meningeal PACNS highlights the importance of considering this entity in the face of a malignant lesion presenting with intracranial hemorrhagic activity. Our observations suggest that the use of paclitaxel provided a modest clinical response in PACNS, highlighting the need to consider a combined approach structured mainly on surgery and radiotherapy. Stereotactic radiosurgery appears to be a promising treatment option.
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Affiliation(s)
| | - George Snipes
- Department of Pathology, Baylor University Medical Center, Dallas, Texas, United States
| | - Iader Rodríguez-Márquez
- Department of Neurology, Neuro-Oncology Unit, Instituto Neurológico de Colombia/Universidad CES, Medellín, Antioquia, Colombia
| | - Laura Duarte-Jurado
- Department of Neurology, Neuro-Oncology Unit, Instituto Neurológico de Colombia/Universidad CES, Medellín, Antioquia, Colombia
| | - Esteban Jaramillo-Jiménez
- Department of Neurology, Neuro-Oncology Unit, Instituto Neurológico de Colombia/Universidad CES, Medellín, Antioquia, Colombia
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8
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Unique Case Report of a Meningeal Sarcoma Arising during Ongoing Treatment for Progressing Intraparenchymal Glioma. Case Rep Oncol Med 2019; 2019:7950782. [PMID: 31885975 PMCID: PMC6900946 DOI: 10.1155/2019/7950782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/10/2019] [Indexed: 11/21/2022] Open
Abstract
Radiation-induced sarcomas in the brain are extremely rare, usually occur with an average latency of 9 years, and are associated with poor outcomes. Latency periods shorter than 1 year may indicate a genetic predisposition such as Li-Fraumeni syndrome. A 34-year-old man underwent initial tumor resection and radiation therapy for a World Health Organization (WHO) Grade II Astrocytoma. Within 6 months, the tumor recurred as WHO Grade III and was treated with temozolomide and then bevacizumab. Despite the patient's apparent improving condition, MRI revealed new dural-based lesions 10 months after radiation therapy and identified as high-grade sarcoma. The patient resumed bevacizumab, began NovoTTF treatment for progressing glioma, and ifosfamide/doxorubicin for the sarcoma. Genetic testing revealed no pathogenic mutation in the TP53 gene. Ultimately, treatment was unsuccessful and the patient succumbed to glioma and sarcoma within 2 years of initial diagnosis. This case was unique due to the rapidly progressing glioma and sudden appearance of a high-grade sarcoma. It is unusual to have two separate intracranial primary cancers with each requiring a different chemotherapy regimen. We discuss the difficulty of simultaneously treating with separate chemotherapy regimens. It remains unclear whether the sarcoma was induced by the radiation treatment or a genetic predisposition.
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9
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Giakoumettis D, Nikas I, Stefanaki K, Kattamis A, Sfakianos G, Themistocleous MS. Giant intracranial congenital hemangiopericytoma/solitary fibrous tumor: A case report and literature review. Surg Neurol Int 2019; 10:75. [PMID: 31528413 PMCID: PMC6744783 DOI: 10.25259/sni-85-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/08/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hemangiopericytoma and solitary fibrous tumor (HPC/SFT) are considered to be one category according to the WHO 2016 classification of central nervous system tumors. HPC/SFT are subdivided into infantile (congenital) and adult type. Both are extremely rare entities, with little knowledge about etiology, prognosis, and optimal therapeutic strategy. CASE DESCRIPTION A 10-day-old girl was referred to our neurosurgical department due to hypotonia, palsy of the right oculomotor nerve, and prominent frontal fontanel. Imaging studies revealed a large occupying mass in the right middle cerebral fossa and the suprasellar cisterns. Only a subtotal resection of the tumor was possible, and postoperatively, she underwent chemotherapy (CHx). After a 3-year follow-up, the girl has minimum neurologic signs and receives no medications, and she can walk when she is supported. CONCLUSION Congenital HPC/SFT is considered to have a benign behavior with a good prognosis. Treatment with gross total resection, when it is feasible, is the key to a good prognosis and low rates of recurrence. However, there is no consensus on the therapeutic strategy of a HPC/SFT, which is difficult to be completely resected. Literature lacks a therapeutic algorithm for these tumors, and thus, more clinical studies are needed to reach a consensus.
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Affiliation(s)
- Dimitrios Giakoumettis
- Department of Neurosurgery, University of Athens Medical School, “Evangelismos” General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Nikas
- Department of Imaging, National and Kapodistrian University of Athens, Athens, Greece
| | - Kalliopi Stefanaki
- Department of Pathology, Children’s Hospital “Aghia Sofia”, Athens, Greece
| | - Antonis Kattamis
- Department of First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - George Sfakianos
- Department of Neurosurgery, Children’s Hospital “Aghia Sophia”, Athens, Greece
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10
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Jerjir N, Lambert J, Vanwalleghem L, Casselman J. Primary Angiosarcoma of the Central Nervous System: Case Report and Review of the Imaging Features. J Belg Soc Radiol 2016; 100:82. [PMID: 30151480 PMCID: PMC6100495 DOI: 10.5334/jbr-btr.1087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Primary angiosarcoma of the central nervous system is a rare malignant tumor with only 28 reported cases so far. Imaging findings have only been reported in a few cases. We report a case of intracranial angiosarcoma in a Caucasian male and present a review of the imaging features in the recent literature. The tumor mostly presents as a well-demarcated, heterogeneous, moderately to strongly enhancing lesion with signs of intratumoral bleeding and surrounding vasogenic edema. The differential imaging features of common hemorrhagic intracranial tumors are discussed.
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11
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Hoshiai S, Masumoto T, Matsuda M, Sugii N, Sakamoto N, Minami M. Radiation-induced angiosarcoma of the brain. BJR Case Rep 2016; 2:20150374. [PMID: 30363634 PMCID: PMC6180856 DOI: 10.1259/bjrcr.20150374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/02/2015] [Accepted: 11/10/2015] [Indexed: 11/21/2022] Open
Abstract
Primary angiosarcoma of the central nervous systemis unusual.We encountered a case of radiation-induced angiosarcoma of the brain. A 65-year-old male was referred to our hospital with drowsiness for the last 6 months. He had undergone radiation therapy for pituitary adenoma 43 years ago. An MRI revealed a right temporal lobe tumour that consisted of a well-demarcated haemorrhagic lesion and an avid contrast enhancement, with significant vasogenic oedema. Surgical resection was performed and a post-operative pathological diagnosis of an angiosarcoma was made. A Thorotrast-associated angiosarcoma has been, hitherto, the only reported case of radiation-induced angiosarcoma of the brain. We present an extremely rare case of primary angiosarcoma of the brain, occurring after external beam radiotherapy.
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12
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La Corte E, Acerbi F, Schiariti M, Broggi M, Maderna E, Pollo B, Nunziata R, Maccagnano E, Ferroli P. Primary central nervous system angiosarcoma: a case report and literature review. Neuropathology 2014; 35:184-91. [PMID: 25388456 DOI: 10.1111/neup.12178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/25/2014] [Indexed: 12/01/2022]
Abstract
Angiosarcoma is a rare vascular malignant neoplasm that mainly occurs in skin and soft tissues. Intracranial localization is very rare and only a few cases have been reported. This report intends to present the clinical, radiological and pathological pictures of a primary central nervous system angiosarcoma along with a review of the literature. A 35-year-old woman presented at our institution with weakness and sensory disturbances of her right hand. Neuroimaging revealed a roughly round, hemorrhagic and moderately enhancing lesion in the left frontal posterior region. The tumor was totally removed under awake anesthesia and continuous monitoring of motor and language functions. Histopathology revealed an epithelioid angiosarcoma. Radical removal, followed by adjuvant radiotherapy and chemotherapy, is able to completely control the disease for a relatively long period.
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Affiliation(s)
- Emanuele La Corte
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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13
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Mahore A, Ramdasi RV, Pauranik A, Epari S. Tumour bleed manifesting as spontaneous extradural haematoma in posterior fossa. BMJ Case Rep 2014; 2014:bcr-2014-205175. [PMID: 25008340 DOI: 10.1136/bcr-2014-205175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a unique case of primary extradural angiosarcoma of posterior fossa manifesting as extradural haematoma in a 12-year-old boy who presented with acute onset headache, vomiting, nuchal rigidity and altered sensorium. The patient underwent a retromastoid suboccipital craniotomy on emergency basis, and the lesion was excised completely. Histopathology and immunohistochemistry revealed an angiosarcoma, following which radiation therapy was given. The patient showed complete clinical and neurological improvement. At a follow-up of 2 years he is in good health without any sign of regrowth.
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Affiliation(s)
- Amit Mahore
- Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | | | - Anvita Pauranik
- Department of Radiology, Seth G.S. Medical College & KEM Hospital, Mumbai, Maharashtra, India
| | - Shridhar Epari
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
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14
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Epithelioid angiosarcoma of the septum pellucidum. Case Rep Pathol 2013; 2013:603671. [PMID: 24171128 PMCID: PMC3792530 DOI: 10.1155/2013/603671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/29/2013] [Indexed: 11/18/2022] Open
Abstract
Primary cerebral intra-axial epithelioid angiosarcoma is an extremely rare malignancy. To the best of our knowledge we describe the first case of epithelioid angiosarcoma arisen in the septum pellucidum of a 54-years-old man. Albeit extremely rare, this neoplasia is a potential source of misdiagnosis for other aggressive malignant tumors, and it should be taken into consideration.
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15
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Hackney JR, Palmer CA, Riley KO, Cure JK, Fathallah-Shaykh HM, Nabors LB. Primary central nervous system angiosarcoma: two case reports. J Med Case Rep 2012; 6:251. [PMID: 22909122 PMCID: PMC3459733 DOI: 10.1186/1752-1947-6-251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 03/02/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction Primary angiosarcoma of the brain is extremely rare; only 15 cases have been reported in adults over the last 25 years. Case presentations We describe two cases of primary angiosarcoma of the brain that are well characterized by imaging, histopathology, and immunohistochemistry. Case 1: our first patient was a 35-year-old woman who developed exophthalmos. Subtotal resection of a left extra-axial retro-orbital mass was performed. Case 2: our second patient was a 47-year-old man who presented to our facility with acute visual loss, word-finding difficulty and subtle memory loss. A heterogeneously-enhancing left sphenoid wing mass was removed. We also review the literature aiming at developing a rational approach to diagnosis and treatment, given the rarity of this entity. Conclusions Gross total resection is the standard of care for primary angiosarcoma of the brain. Adjuvant radiation and chemotherapy are playing increasingly recognized roles in the therapy of these rare tumors.
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Affiliation(s)
- James R Hackney
- Division of Neuropathology, University of Alabama at Birmingham, PD6A 175, Birmingham, AL, 35294, USA.
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16
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Jung SH, Jung TY, Joo SP, Kim HS. Rapid clinical course of cerebral metastatic angiosarcoma from the heart. J Korean Neurosurg Soc 2012; 51:47-50. [PMID: 22396844 PMCID: PMC3291707 DOI: 10.3340/jkns.2012.51.1.47] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Revised: 06/02/2011] [Accepted: 01/11/2012] [Indexed: 11/27/2022] Open
Abstract
We report here one case of rapid and aggressive course of cerebral metastatic angiosarcoma from the heart. A 36-year-old man presented with 10-days history of headache. Magnetic resonance imaging demonstrated subacute hemorrhage with a small region of enhancement in right parietal region and the pathological diagnosis was angiosarcoma. Transthoracic echocardiography demonstrated 3.2×3 cm sized mass on right atrial wall. Newly developed lesion was reoperated, three and four weeks later respectively, and whole brain radiotherapy of total 30 Gy was done. With the interval of two months, gamma knife surgery was done for new lesions two times, which were well controlled. Newly developed lesions rapidly happened even in the adjuvant treatment. He died 9 months after the diagnosis because of the aggravation of primary cancer. The cerebral metastatic angiosarcoma from the heart showed the rapid aggressive behavior and the closed follow-up could be needed for the adjuvant treatment.
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Affiliation(s)
- Seung-Hoon Jung
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Medical School, Hwasun Hospital, Hwasun, Korea
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17
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Liu ZH, Lee ST, Jung SM, Tu PH. Primary spinal angiosarcoma. J Clin Neurosci 2010; 17:387-9. [DOI: 10.1016/j.jocn.2009.03.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Revised: 03/21/2009] [Accepted: 03/24/2009] [Indexed: 11/15/2022]
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18
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Dea N, Pelmus M, Mathieu D, Belzile F, Bergeron D, Gosselin S, Tsanaclis AM. 64-year-old man with multiple cerebral lesions. Brain Pathol 2009; 19:535-8. [PMID: 19563547 DOI: 10.1111/j.1750-3639.2009.00302.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Guode Z, Qi P, Hua G, Shangchen X, Hanbin W. Primary cerebellopontine angle angiosarcoma. J Clin Neurosci 2008; 15:942-6. [DOI: 10.1016/j.jocn.2006.11.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 10/30/2006] [Accepted: 11/01/2006] [Indexed: 11/25/2022]
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20
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Abstract
We describe a pediatric case of primary angiosarcoma of the brain displaying striking intravascular papillary pattern, consistent with the "Dabska tumor," often in continuity with a massive, multifocal intravascular papillary endothelial hyperplasia. The tumor contained small hemangioma and obliterated dysplastic arteries as well as very large thin-walled veins. The surrounding brain tissue showed scattered telangiectasias, conglomerates of calcified dysplastic arteries, old hemorrhages and gliosis. Colocalization of these lesions suggests the development of a papillary angiosarcoma in the pre-existing vascular malformation. Although never reported, the possibility of a malignant transformation of endothelial papillary hyperplasia also should be considered in this case.
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Affiliation(s)
- Boleslaw Lach
- Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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21
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Kurian KM, Tagkalakis P, Erridge SC, Ironside JW, Whittle IR. Primary intracranial angiosarcoma of the Pineal gland: an unusual cause of recurrent intraventricular haemorrhage and superficial haemosiderosis. Neuropathol Appl Neurobiol 2006; 32:557-61. [PMID: 16972889 DOI: 10.1111/j.1365-2990.2006.00762.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Sobel G, Halász J, Bogdányi K, Szabó I, Borka K, Molnár P, Schaff Z, Paulin F, Bánhidy F. Prenatal diagnosis of a giant congenital primary cerebral hemangiopericytoma. Pathol Oncol Res 2006; 12:46-9. [PMID: 16554916 DOI: 10.1007/bf02893431] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Accepted: 11/20/2005] [Indexed: 11/25/2022]
Abstract
Congenital primary intracranial hemangiopericytomas are exceptionally rare tumors. We present a case of a fetus, with the prenatal sonogram at 33 weeks of gestation revealing a large cerebral tumor. Because of the enlarged head, a cesarean section was performed. The tumor was confirmed by postnatal ultrasound, magnetic resonance imaging (MRI) and biopsy. Elevated intracranial pressure and hemorrhage led to death on the 11th day. Autopsy revealed a 10x9 cm large inhomogeneous tumor located centrally, mainly in the posterior fossa. Histology showed a hypercellular and hypervascular tumor with extended necrosis and high mitotic rate. The tumor cells were positive for vimentin and CD34 antigens and negative for several neurological markers, desmin and CD31. The diagnosis of a congenital primary cerebral hemangiopericytoma was confirmed.
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Affiliation(s)
- Gábor Sobel
- 2nd Department of Obstetrics and Gynecology, Semmelweis University, Budapest, Hungary
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23
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Scholsem M, Raket D, Flandroy P, Sciot R, Deprez M. Primary temporal bone angiosarcoma: a case report. J Neurooncol 2006; 75:121-5. [PMID: 16132518 DOI: 10.1007/s11060-005-0375-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present a rare case of temporal bone angiosarcoma diagnosed in a 26-year-old female patient at 36 week of pregnancy. The patient was referred with a 2 months history of left otalgia and tinnitus with a tender swelling above the mastoid. Cranial imaging studies showed a 7 x 5 x 4 cm hypervascularized mass located in the left middle fossa with lysis of the temporal bone and extension to the subcutis. After the baby was delivered by caesarean section, the patient entered the oncology protocol. Selective embolization of the feeding vessels was followed by gross total surgical resection using a combined supra- and infra-tentorial approach. Pathological findings were those of a poorly differentiated, highly malignant sarcoma with a large epitheloid component and immunohistochemical evidence of endothelial differentiation (CD31, Factor VIII related antigen, CD34), consistent with an angiosarcoma with epitheloid features. No extra-cranial tumor was found after extensive staging. The patient received adjuvant radiotherapy followed by a course of chemotherapy consisting of 6 cycles of paclitaxel. At 15 months follow-up, she developed multiple distant metastasis to a left postauricular lymph node and to the lungs and ribs. The patient was given a second line chemotherapy using doxorubicine and ifosfamide. Despite an initial good response, she died with metastatic disease 26 months after diagnosis. We present a rare case of primary temporal bone angiosarcoma and report our experience with a multimode therapeutic approach combining surgery, radiotherapy and chemotherapy.
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Affiliation(s)
- Martin Scholsem
- Department of Neurosurgery, University Hospital of Liège, B-35, Sart-Tilman, 4000 Liège, Belgium.
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24
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Matsuno A, Nagashima T, Tajima Y, Sugano I. A diagnostic pitfall: Angiosarcoma of the brain mimicking cavernous angioma. J Clin Neurosci 2005; 12:688-91. [PMID: 16023347 DOI: 10.1016/j.jocn.2004.08.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Accepted: 08/10/2004] [Indexed: 11/16/2022]
Abstract
Primary or secondary angiosarcoma in the central nervous system is rarely reported. We present a rare case of cerebral angiosarcoma, which comprised both poorly-differentiated solid areas and well-differentiated areas that led to the misdiagnosis of cavernous angioma. A 79-year old woman presented with an intracerebral hematoma in the left frontal lobe that was misdiagnosed as a hemorrhage from a cavernous angioma at initial operation. At a second surgery, the lesion was diagnosed as angiosarcoma involving the cerebellum, heart, femur, sacro-iliac bones and other locations. An autopsy suggested that the angiosarcoma of the heart was the primary lesion, which was occult at the time of the initial operation. Angiosarcoma may have areas with different degrees of differentiation and when a cavernous angioma is suspected histopathologically, the specimen should also be carefully explored for poorly-differentiated areas and the diagnosis of primary or secondary angiosarcoma considered.
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Affiliation(s)
- Akira Matsuno
- Department of Neurosurgery, Teikyo University Ichihara Hospital, Ichihara City, Chiba, Japan
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Akutsu H, Tsuboi K, Sakamoto N, Nose T, Honma S, Jikuya T. Cerebral metastasis from angiosarcoma of the aortic wall: case report. ACTA ACUST UNITED AC 2004; 61:68-71. [PMID: 14706384 DOI: 10.1016/s0090-3019(03)00297-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Primary or metastatic cerebral angiosarcoma is extremely rare, and only limited cases have been reported. The authors here describe a case of angiosarcoma, which was initially identified and diagnosed by the cerebral metastatic lesion; later examinations suggested that the primary site was the abdominal aorta. CASE DESCRIPTION A 53-year-old man, who had suffered an abdominal aortic aneurysm 2 months earlier, experienced a sudden onset of left-sided hemifacial convulsion and dysarthric speech. Computed tomography (CT) showed a hemorrhagic mass lesion with perifocal edema in the right frontal lobe. Magnetic resonance imaging (MRI) showed a regionally marked hypointensity in the mass lesion on both T1- and T2-weighted images, which might suggest hemosiderin deposition. The tumor was removed in its entirety. Pathologic examination revealed an old hematoma with a hemosiderin deposit containing markedly atypical tumor cells, and angiosarcoma was diagnosed. Resection of the abdominal aortic aneurysm and iliac bone biopsy were performed and angiosarcoma was recognized in each surgical specimen. Based on clinical and pathologic findings, the primary site was considered to be the abdominal aorta. CONCLUSIONS Clinicians should be aware of this rare histologic type of tumor. Unique MRI findings such as those obtained in our case might be useful for differentiating this condition from other intracranial neoplasms.
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Affiliation(s)
- Hiroyoshi Akutsu
- Departments of Neurosurgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan
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26
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Liassides C, Katsamaga M, Deretzi G, Koutsimanis V, Zacharakis G. Cerebral Metastasis from Heart Angiosarcoma Presenting as Multiple Hematomas. J Neuroimaging 2004. [DOI: 10.1111/j.1552-6569.2004.tb00220.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mühlau M, Schlegel J, Von Einsiedel HG, Conrad B, Sander D. Multiple progressive intracerebral hemorrhages due to an angiosarcoma: a case report. Eur J Neurol 2003; 10:741-2. [PMID: 14641524 DOI: 10.1046/j.1468-1331.2003.00680.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Identification of intracerebral hemorrhage (ICH) and the underlying cause is a common clinical problem. Rare causes of ICH can be particularly difficult to diagnose. We describe a man on oral anticoagulation with multiple progressive ICHs, who initially showed no signs of a malignant disease. After normalisation of all coagulation tests, the ICHs continued to spread. Autopsy examination revealed an angiosarcoma. Multiple progressive ICHs caused by an angiosarcoma that mainly affects the brain have not yet been described. In the presence of normal coagulation tests, further progression of ICH should raise questions about common causes of ICH such as oral anticoagulation in our case.
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Affiliation(s)
- M Mühlau
- Department of Neurology, Technical University of Munich, Munich, Germany.
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Kurtkaya-Yapícíer O, Scheithauer BW, Dedrick DJ, Wascher TM. Primary epithelioid sarcoma of the dura: case report. Neurosurgery 2002; 50:198-202; discussion 202-3. [PMID: 11852861 DOI: 10.1097/00006123-200201000-00030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Epithelioid sarcomas are rare mesenchymal neoplasms that occur most often in the extremities of young adults. Despite isolated reports of epithelioid sarcomas arising in the head and neck region, these lesions have not been described previously, to our knowledge, in the central nervous system. CLINICAL PRESENTATION We present the case of an 18-year-old woman with a unique dural sarcoma that arose in the right frontotemporal region. As visualized on magnetic resonance imaging studies, the 4.5-cm tumor focally traversed the cranium to penetrate the galea, the temporal muscle, and subcutaneous tissue. No brain invasion was noted. INTERVENTION Despite gross total removal and postoperative radiotherapy (59 Gy), a large recurrence was noted 5 months after surgery. Histologically, the partly necrotic tumor consisted of epithelioid and spindle cells showing widespread vimentin and variable cytokeratin as well as epithelial membrane antigen immunoreactivity. Ultrastructurally, the cohesive cells featured various organelles, intermediate filaments, junctions, and filopodia-containing intercellular spaces. CONCLUSION With the inclusion of epithelioid sarcoma, the spectrum of central nervous system sarcomas continues to expand.
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Affiliation(s)
- Ozlem Kurtkaya-Yapícíer
- Department of Pathology, Institute of Neurological Sciences, Marmara University, Istanbul, Turkey
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30
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Kurtkaya-Yapcer Ö, Scheithauer BW, Dedrick DJ, Wascher TM. Primary Epithelioid Sarcoma of the Dura: Case Report. Neurosurgery 2002. [DOI: 10.1227/00006123-200201000-00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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31
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Gallo P, Dini LI, Saraiva GA, Sonda I, Isolan G. Hemorrhage in cerebral metastasis from angiosarcoma of the heart: case report. ARQUIVOS DE NEURO-PSIQUIATRIA 2001; 59:793-6. [PMID: 11593285 DOI: 10.1590/s0004-282x2001000500026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The purpose of this article is to describe the clinical and pathological features of metastatic angiosarcoma in the central nervous system. Only a few cases of cerebral metastasis from angiosarcoma of the heart have been recorded in the literature; particularly related to intracerebral hemorrhage. A case of secondary cerebral angiosarcoma of the heart in a 33 years old man is presented. The initial symptoms were headache, vomiting, lethargy and aphasia. There was a mass in the left temporal lobe with hemorrhage and edema on the computerized tomography (CT). After 24 hours the neurological status worsened and another CT scan showed rebleeding on the tumor area. He underwent an emergency craniotomy but died two days after. Considering the longer survival of sarcoma patients with new modalities of treatment, the incidence of brain metastasis may increase, demanding a better preventive and more aggressive approach. Besides, due to the hemorrhagic nature of such lesions, we suggest the immediate surgery to prevent a fast and lethal evolution because rebleeding.
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Affiliation(s)
- P Gallo
- Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre, RS, Brazil
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32
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Iuliano BA, Nguyen TT, Fuller BG, Schrager JA, Oldfield EH. Cerebrospinal fluid rhinorrhea caused by metastatic angiosarcoma. Case illustration. J Neurosurg 2001; 95:143. [PMID: 11453386 DOI: 10.3171/jns.2001.95.1.0143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- B A Iuliano
- Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland 20892, USA
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33
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Suzuki Y, Yoshida YK, Shirane R, Yoshimoto T, Watanabe M, Moriya T. Congenital primary cerebral angiosarcoma. Case report. J Neurosurg 2000; 92:466-8. [PMID: 10701536 DOI: 10.3171/jns.2000.92.3.0466] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Reports of angiosarcoma arising in the central nervous system are rare. The authors present the case of a 30-day-old infant with clinical manifestations of projectile vomiting and tense anterior fontanelle resulting from a left frontotemporal tumor. Total excision of this highly vascular, well-circumscribed tumor was performed without incident, and histopathological examination revealed a malignant angiosarcoma. Immunohistochemical reaction of the neoplastic cells was diffusely positive for endothelium-specific antigens including factor VIII-related antigen, CD31, and CD34. The final diagnosis of congenital primary cerebral angiosarcoma was thus confirmed. The patient's postoperative course was uneventful, and he was discharged 2 weeks after the operation. He was in good condition with no sign of recurrence after 11 months; follow-up computerized tomography, magnetic resonance (MR) imaging, and abdominal ultrasonography studies demonstrated no tumor regrowth. The characteristic findings for this tumor on MR imaging, the immunohistochemical findings, and surgical outcome are discussed.
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Affiliation(s)
- Y Suzuki
- Department of Neurosurgery, Tohoku University School of Medicine, Sendai, Japan.
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Avellino AM, Grant GA, Harris AB, Wallace SK, Shaw CM. Recurrent intracranial Masson's vegetant intravascular hemangioendothelioma. Case report and review of the literature. J Neurosurg 1999; 91:308-12. [PMID: 10433320 DOI: 10.3171/jns.1999.91.2.0308] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In the central nervous system, recurrence of intracranial Masson's vegetant intravascular hemangioendothelioma (MVIH) is rare. To the authors' knowledge, only three recurrent intracranial cases have been reported. The authors report the case of a 75-year-old woman with a recurrent left-sided cerebellopontine angle and middle cranial fossa MVIH. When the patient was 62 years of age, she underwent preoperative embolization and subtotal resection of the intracranial lesion followed by postoperative radiotherapy. She was well and free from disease until 9 years postoperatively when she became symptomatic. At 71 years of age, the patient again underwent preoperative embolization and near-gross-total resection of the lesion. Follow-up imaging performed 15 months later revealed tumor recurrence, and she underwent stereotactic gamma knife radiosurgery. At a 2.75-year follow-up review, the patient's imaging studies revealed stable residual tumor. This case report is unique in that it documents the clinical and pathological features, surgical and postoperative treatment, and long-term follow-up review of a patient with recurrent intracranial MVIH and suggests that this unusual vascular lesion is a slow-growing benign tumor rather than a reactive process. Because the pathological composition of the lesion may resemble an angiosarcoma, understanding this benign vascular neoplasm is crucial so that an erroneous diagnosis of malignancy is not made and unnecessary adjuvant therapy is not given.
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Affiliation(s)
- A M Avellino
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle 98195, USA
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35
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Shintaku M, Miyaji K, Adachi Y. Gliosarcoma with angiosarcomatous features: a case report. Brain Tumor Pathol 1999; 15:101-5. [PMID: 10328547 DOI: 10.1007/bf02478891] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A surgical case of gliosarcoma in which the mesenchymal component showed angiosarcomatous features is reported. The neoplasm was extirpated from the right cerebral hemisphere of a 76-year-old man who presented with left hemiparesis and headache, and it was composed of both anaplastic astrocytomatous and sarcomatous elements. The sarcomatous element was composed of a proliferation of atypical endothelial cells that had pleomorphic, mitotically active nuclei and formed vascular lumina of irregular shapes or solid cellular sheets, and was accompanied by the deposition of collagenous matrix. The cytoplasm of some of the atypical endothelial cells was immunohistochemically positive for vimentin, factor VIII-related antigen, CD 34, and thrombomodulin. The MIB-1 labeling index of the sarcomatous component was higher than that of the astrocytomatous component.
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Affiliation(s)
- M Shintaku
- Department of Pathology, Osaka Red Cross Hospital, Tennoji, Japan
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36
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Lopes M, Duffau H, Fleuridas G. Primary spheno-orbital angiosarcoma: case report and review of the literature. Neurosurgery 1999; 44:405-7; discussion 407-8. [PMID: 9932897 DOI: 10.1097/00006123-199902000-00102] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Angiosarcoma is a rare neoplasm that uncommonly involves the cranium. We report the second case in the literature of a primary right spheno-orbital malignant angiosarcoma. CLINICAL PRESENTATION This 43-year-old man experienced a 3-month history of rapid growing temporal mass. The results of his neurological examination were normal. Neuroimaging revealed an intensively enhanced right spheno-orbital lesion, with destruction of the greater wing of the sphenoid bone and extension into the orbit, the infratemporal fossa, and the temporal fossa with infiltration of the dura mater but without parenchymal abnormality. INTERVENTION The tumor was first biopsied and then totally removed, with exenteration of the right eye. The histological features were typical of angiosarcoma with immunohistochemical evidence of Factor VIII-related antigen produced by tumor cells. Neither radiotherapy nor chemotherapy was performed. The patient remained well during 16 months of follow-up, without evidence of recurrence on magnetic resonance images. CONCLUSION We emphasize the benefit of wide surgical resection without systematic complementary treatment (radiotherapy and/or chemotherapy) in a case of primary angiosarcoma of the cranium. The literature is reviewed.
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Affiliation(s)
- M Lopes
- Department of Neurosurgery, Hôpital de la Salpêtrière, Paris, France
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37
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Chen TC, Gonzalez-Gomez I, Gilles FH, McComb JG. Pediatric intracranial hemangioendotheliomas: case report. Neurosurgery 1997; 40:410-4. [PMID: 9007881 DOI: 10.1097/00006123-199702000-00042] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Intracranial hemangioendotheliomas are rare lesions, especially in the pediatric age group. Recognizing hemangioendotheliomas as a differential in intracranial tumors of vascular origin is important; complete excision results in a cure, and medical therapy for those lesions that are not resectable produces long-term survival. CLINICAL PRESENTATION We report two patients, a 7-year-old female patient with a lesion in the right gasserian ganglion and a 3-month-old male patient with a cervicomedullary junction tumor. INTERVENTION The 7-year-old underwent a gross total removal with no recurrence. The 3-month-old underwent a partial resection followed by treatment with interferon alpha-2a, with a decrease in the size of the residual tumor. Both patients have been followed for more than 4 years without a recurrence or progression of the tumor. CONCLUSION Hemangioendotheliomas are fairly indolent tumors and may be treated with complete surgical resection, resulting in a cure. In cases in which complete tumor removal is not possible, adjunctive therapy with interferon alpha-2a may control residual tumor growth.
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Affiliation(s)
- T C Chen
- Division of Neurosurgery, Children's Hospital of Los Angeles, California, USA
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38
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Abstract
Epithelioid hemangioendothelioma is an uncommon form of endothelial neoplasm, one of intermediate-grade malignancy and relatively favorable prognosis. Herein we report the third and fourth cases described in the central nervous system and compare their clinical and pathologic properties with those arising at systemic sites. Both patients presented with signs and symptoms of a mass lesion with seizures present in both cases. Imaging studies revealed well-demarcated mass lesions with surrounding edema. Gross total removal was accomplished surgically in both cases One case was partially cystic and nodular; the other was firm, focally gritty, and cartilaginous in appearance. Histologically they were identical to hemangioendotheliomas of other locales: multinodular neoplasms with regional variation in cellularity, cords and clusters of epithelioid cells with variable attempts at lumen formation, and spindled cells associated with a fibromyxoid matrix. Immunohistochemical stains confirmed the endothelial natures of the cells. These cases and those previously reported were treated with surgical excision. The few patients described have ranged in age from infants to older adults. Some patients have had residual neurologic defects, but no deaths due to tumor have been reported.
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Affiliation(s)
- F E Nora
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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39
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Abstract
BACKGROUND Angiosarcomas (AS) are rare, aggressive tumors. Optimal treatment has not been well defined. The authors undertook a retrospective review of patients seen at their institution with the intent of identifying prognostic factors and optimal treatment strategies. METHODS Between 1955 and 1990, 67 patients with AS were seen at the University of California, at Los Angeles Medical Center. Follow-up ranged from 1 to 173 months with a median of 30 months. RESULTS The overall prognosis was poor. The actuarial 2- and 5-year disease free survivals (DFS) were 44% and 24%, respectively. Of 52 recurrences after primary treatment, 81% (42 of 52) had a component of local failure. Twenty-eight patients had developed distant metastases at last follow-up. Of patients who received surgery (S) and radiation therapy (RT), with or without chemotherapy (CT), 5-year actuarial DFS was 43%, compared with 17% for patients who underwent S +/- CT as initial treatment (P = 0.03). Only 9% of patients (1 of 11) treated with RT +/- CT were rendered free of disease. CONCLUSIONS Patients with AS usually present with high grade histology, and with multifocal disease. There is a propensity for both local recurrence and distant metastases. Our results and a review of the literature, suggest that S plus RT offers the best chance for long term control of this aggressive tumor. The role of CT remains undefined.
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Affiliation(s)
- R J Mark
- Department of Radiation Oncology, Good Samaritan Hospital, Los Angeles, California, USA
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40
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Antoniadis C, Selviaridis P, Zaramboukas T, Fountzilas G. Primary Angiosarcoma of the Brain: Case Report. Neurosurgery 1996. [DOI: 10.1227/00006123-199603000-00033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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41
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Antoniadis C, Selviaridis P, Zaramboukas T, Fountzilas G. Primary angiosarcoma of the brain: case report. Neurosurgery 1996; 38:583-5; discussion 585-6. [PMID: 8837814 DOI: 10.1097/00006123-199603000-00033] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
A 41-year-old patient with a primary angiosarcoma of the brain is reported. The tumor was located in the left parietal lobe and was radically removed. The diagnosis of angiosarcoma was established by immunohistochemistry. The patient was postoperatively treated with adjuvant chemotherapy and then radiation therapy. After 41 months, she was in excellent clinical and neurological condition without any sign of recurrence.
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Affiliation(s)
- C Antoniadis
- Department of Neurosurgery, Saint Lucas Clinic, Thessaloniki, Macedonia, Greece
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Lach B, Duncan E, Rippstein P, Benoit BG. Primary intracranial pleomorphic angioleiomyoma--a new morphologic variant. An immunohistochemical and electron microscopic study. Cancer 1994; 74:1915-20. [PMID: 8082097 DOI: 10.1002/1097-0142(19941001)74:7<1915::aid-cncr2820740715>3.0.co;2-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Angioleiomyomas usually are benign subcutaneous neoplasms that occur most often in extremities of middle-aged individuals. Very few cases have been described in other locations; none along the neuroaxis. An intracranial example of angioleiomyoma displaying unusual morphologic features not seen in the typical peripheral variants of this tumor is described. METHODS The tumor was studied with conventional histology, immunohistochemistry with morphometric calculation of proliferation index, immunoelectron microscopy, and DNA flow cytometry. RESULTS The tumor was composed of large epithelioid and pleomorphic cells filled with intermediate filaments positive for desmin and vimentin. Scattered cells also expressed myosin and muscle-specific actin. Smooth muscle cell differentiation was confirmed by ultrastructural demonstration of subplasmalemmal dense bodies, attachment plaques, and discontinuous basal lamina. The proliferation index with proliferating cell nuclear antigen (PCNA) monoclonal antibody was 75.78%, whereas it was only 4.22% with Ki67 monoclonal antibodies adopted to paraffin material (MIB-1). CONCLUSION The tumor represents a unique morphologic variant of a pleomorphic angioleiomyoma. Cellular pleomorphism and a strong reaction for PCNA in numerous cells suggested that the lesion was malignant. However, the absence of mitotic figures, a small number of Ki-67-positive cells, a diploic DNA pattern, and a low proliferation index in flow cytometry all supported the concept that this neoplasm represented an unusual histologic variant of benign angiogenic leiomyoma. Encapsulation and demarcation of the surgical specimen and the survival of the patient for more than 4 years without recurrence after resection support this interpretation.
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Affiliation(s)
- B Lach
- Department of Laboratory Medicine, Ottawa Civic Hospital, Canada
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43
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Abstract
Angiosarcoma involving the lung is a rare disorder and its clinical features are not well known. We conducted a retrospective analysis of 15 patients seen at our institution from 1950 to 1990 in an attempt to better characterize the spectrum of clinical and radiographic findings of angiosarcoma in the lung. No documented case of primary angiosarcoma of the lung was seen. The diagnosis of metastatic angiosarcoma to the lung was made antemortem in 12 of 15 cases, either by lung biopsy specimen (5 patients), biopsy evidence of metastatic disease elsewhere with abnormal chest radiograph (4 patients), or a compatible clinical picture in a patient with previously documented angiosarcoma arising in an extrapulmonary site (3 patients). The median age at the time of diagnosis was 45 years with the most common presenting symptom being hemoptysis (7 of 15 patients). Other presenting complaints included weight loss (6 of 15), cough (4 of 15), and chest pain (4 of 15) occurring 6 weeks to 1 year prior to diagnosis. Chest radiographs frequently disclosed multiple pulmonary nodules (11 of 15). Primary origins of the angiosarcoma most commonly included the heart and breast. Metastatic sites other than the lung included the pericardium, liver, spleen, kidney, adrenal gland, bone, and brain. The prognosis is generally poor, with our study population surviving an average of 9 months after diagnosis.
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Affiliation(s)
- A M Patel
- Mayo Clinic, Division of Thoracic Diseases and Internal Medicine, Rochester, Minn 55905
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Vinores SA, Herman MM, Perentes E, Nakagawa Y, Thomas CB, Innes DJ, Rubinstein LJ. The growth of two murine hemangioendotheliomas intracranially, subcutaneously, and in culture, and their comparison with human cerebellar hemangioblastomas: morphological and immunohistochemical studies. Acta Neuropathol 1992; 84:67-77. [PMID: 1502883 DOI: 10.1007/bf00427217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Two thorium dioxide-induced murine hemangioendotheliomas, 42021 TCT and 44347 TST, were grown subcutaneously (for up to 22 and 15 passages respectively) or intracranially (single passage) and were adapted to culture as a monolayer and, in a limited fashion, in an organ culture system or in rotary suspension. They remained viable and malignant following 20-21 years of storage in liquid nitrogen, and had ultrastructural similarities to human hemangioblastomas. The murine tumors were positive for Griffonia (Bandeiraea) simplicifolia isolectin B4 binding, establishing their endothelial nature; however, unlike human hemangioblastic tumors, they did not cross-react with antisera to human factor VIII or fibronectin and they did not demonstrate Ulex europaeus type I lectin (UEA I) binding (as is also the case for non-neoplastic murine vascular endothelial cells). A variety of morphological cell types in cultures derived from the tumors were also positive for Griffonia (Bandeiraea) simplicifolia isolectin B4 binding. Both murine hemangioendotheliomas, when implanted in the cerebrum, were potent inducers of reactive gliosis, but there was no evidence of uptake of glial fibrillary acidic protein. Unlike the human cerebellar hemangioblastomas, murine tumors were malignant and invasive and did not contain stromal cells, nor did they demonstrate Weibel-Palade bodies or extensive pinocytotic activity. Thus, the murine tumors appear to more closely resemble angiosarcomas or epitheloid hemangioblastomas than the cerebellar hemangioblastomas.
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Affiliation(s)
- S A Vinores
- Department of Pathology, University of Virginia School of Medicine, Charlottesville 22908
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45
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Abstract
Congenital primary intracranial angiosarcoma (CAS) is an exceptionally rare tumor. To our knowledge the imaging features of intracranial angiosarcomas have only been briefly mentioned in the neuropathologic literature. To our knowledge, only one case of CAS has been reported. We present a case of a pathologically proven CAS found in a neonate.
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Affiliation(s)
- I R Kirk
- University of Texas Health Science Center, Department of Radiology, Houston
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