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Virarkar M, Tayyab S, Thampy R, Bhosale P, Viswanathan C. Primary pulmonary angiosarcoma: case reports and review of the literature. Asian Cardiovasc Thorac Ann 2019; 27:347-352. [PMID: 30857394 DOI: 10.1177/0218492319836910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary artery angiosarcoma is a rare malignant vascular tumor with an aggressive clinical course and a poor prognosis. Hemoptysis and shortness of breath have been reported as common clinical presentations. The exact clinicopathology is unknown. A tissue specimen obtained by percutaneous fine-needle aspiration cytology or open/thoracoscopic biopsy can confirm the diagnosis based on histopathological and immunohistochemical features. The differential diagnosis includes pulmonary thromboembolism, vascular malformations, and lung carcinoma. There is a paucity of literature describing this tumor, with only a few case reports available. There is also a lack of standardized guidelines for management, which further worsens the survival outcome. We report 3 cases of pulmonary artery angiosarcoma and review the recent literature.
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Affiliation(s)
- Mayur Virarkar
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sidra Tayyab
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rajesh Thampy
- 2 Department of Diagnostic Radiology, The University of Texas Health Science Center, Houston, Texas, USA
| | - Priya Bhosale
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chitra Viswanathan
- 1 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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2
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Wang R, Wang X, Ji B, Guan Q, Chen B. Primary Common Iliac Artery Angiosarcoma With Multiple Bone Metastases Revealed by Dual-Time Point FDG PET/CT Imaging. Clin Nucl Med 2019; 44:232-233. [DOI: 10.1097/rlu.0000000000002435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Yeung DF, Johnston A, Simmons C, Goddard K, Dewar LR, Yee J, Kelliher E, Tsang MYC, Gin K, Jue J, Nair P, Lee PK, Tsang TSM. Multimodality imaging of a pulmonary artery sarcoma. Echocardiography 2017; 35:123-125. [PMID: 29178279 DOI: 10.1111/echo.13754] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Pulmonary artery sarcoma is a rare malignant neoplasm. Here, we describe a patient with a pulmonary artery sarcoma, which was only subtly visible and therefore not fully appreciated on initial transthoracic echocardiogram. Characterization of the tumor was aided by the use of multimodality imaging that included computed tomography, magnetic resonance imaging, and positron emission tomography. Familiarity with its appearance on multiple imaging modalities including echocardiography is important to ensure timely diagnosis, although the optimal treatment strategy is still unknown, and the prognosis remains poor.
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Affiliation(s)
- Darwin F Yeung
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Angela Johnston
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christine Simmons
- Division of Medical Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Karen Goddard
- Department of Radiation Oncology, University of British Columbia, Vancouver, BC, Canada
| | - Leith R Dewar
- Division of Cardiac Surgery, University of British Columbia, Vancouver, BC, Canada
| | - John Yee
- Division of Thoracic Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Edel Kelliher
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Michael Y C Tsang
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Kenneth Gin
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - John Jue
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Parvathy Nair
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Pui-Kee Lee
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Teresa S M Tsang
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
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4
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Manmadhan A, Malhotra SP, Weinberg CR, Reyentovich A, Latson LA, Bhatla P, Saric M. Intimal spindle cell sarcoma masquerading as adult-onset symptomatic pulmonic stenosis: a case report and review of the literature. J Cardiothorac Surg 2017; 12:93. [PMID: 29084562 PMCID: PMC5663046 DOI: 10.1186/s13019-017-0654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/05/2017] [Indexed: 01/22/2023] Open
Abstract
Background Pulmonary artery intimal spindle cell sarcomas are rare and carry with them a poor prognosis and high rate of recurrence. In extremely rare cases, this tumor can infiltrate the pulmonic valve and manifest as adult-onset pulmonic stenosis. Case presentation We report an unusual case of a patient with symptomatic, adult-onset severe pulmonic stenosis who was referred for possible balloon valvuloplasty but was subsequently found to have pulmonary artery intimal sarcoma infiltrating the pulmonary valve leading to progressive exertional dyspnea. Conclusion The presence of adult-onset pulmonic stenosis should prompt the clinician to investigate further as most cases of pulmonic stenosis are congenital in nature and present early in life. Careful diagnostic evaluation in concert with multimodal imaging should take place to arrive at the correct and challenging diagnosis of sarcoma-induced adult-onset severe pulmonic stenosis. Given the poor prognosis and rapid progression of disease, early diagnosis is crucial. Electronic supplementary material The online version of this article (10.1186/s13019-017-0654-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arun Manmadhan
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Sunil P Malhotra
- Department of Cardiothoracic Surgery, Division of Pediatric and Adult Congenital Cardiac Surgery, New York University School of Medicine, New York, NY, USA
| | - Catherine R Weinberg
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Alex Reyentovich
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Larry A Latson
- Department of Radiology, Cardiac and Thoracic Imaging, New York University School of Medicine, New York, NY, USA
| | - Puneet Bhatla
- Department of Radiology, Cardiac and Thoracic Imaging, New York University School of Medicine, New York, NY, USA.,Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Muhamed Saric
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA. .,Echocardiography Lab, New York University Langone Medical Center, New York, NY, 10016, USA.
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5
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Gaballah AH, Jensen CT, Palmquist S, Pickhardt PJ, Duran A, Broering G, Elsayes KM. Angiosarcoma: clinical and imaging features from head to toe. Br J Radiol 2017; 90:20170039. [PMID: 28471264 DOI: 10.1259/bjr.20170039] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Angiosarcoma is a rare, aggressive subtype of soft-tissue sarcoma with a propensity for local recurrence and metastasis associated with a generally poor prognosis, unless diagnosed early. Given the vascular endothelial cell origin of angiosarcoma, tumours may develop in essentially any organ; however, there is a predilection for the skin where half of all tumours arise, increasing in prevalence with age. The most common risk factors are chronic lymphoedema and history of radiation. We review the most important radiological findings along the spectrum of angiosarcoma from head to toe throughout the body, including uncommon and rare locations. Key imaging features of angiosarcoma across multiple organ systems will be described, as well as the impact on management and prognosis.
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Affiliation(s)
- Ayman H Gaballah
- 1 Department of Diagnostic Radiology, University of Missouri-Columbia, Columbia, MO, USA
| | - Corey T Jensen
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sarah Palmquist
- 3 Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Perry J Pickhardt
- 4 Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Alper Duran
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory Broering
- 3 Department of Diagnostic Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Khaled M Elsayes
- 2 Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Piciucchi S, Dubini A, Tomassetti S, Sanna S, Ravaglia C, Carloni A, Gurioli C, Gurioli C, Colby TV, Poletti V. Angiosarcoma in the chest: radiologic-pathologic correlation: Case report. Medicine (Baltimore) 2016; 95:e5348. [PMID: 27902593 PMCID: PMC5134813 DOI: 10.1097/md.0000000000005348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Angiosarcomas are rare, malignant vascular tumors. PATIENT CONCERNS They represents about 2% of all soft tissue sarcoma, which can often metastasize through the hematogenous route. The radiological features have been analyzed in 4 patients with metastatic angiosarcoma in the chest. DIAGNOSES The main radiologic findings included nodules, cysts, nodules with halo sign, and vascular tree-in-bud. Morphologic features, as observed in the histologic specimen, have been correlated with radiologic appearance. LESSONS Metastatic angiosarcomas to the lung are characterized by a wide variety of radiologic appearances that can be very characteristic. Computed tomographic findings observed include bilateral solid nodules, cystic, and bullous lesions sometimes associated with spontaneous hemopneumothoraces.
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Affiliation(s)
| | | | | | - Stefano Sanna
- Department of Thoracic Surgery, GB Morgagni- L Pierantoni Hospital, Forlì
| | | | - Angelo Carloni
- Department of Radiology, Santa Maria Hospital, Terni, Italy
| | | | | | - Thomas V. Colby
- Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | - Venerino Poletti
- Pulmonology Unit, Department of Thoracic Diseases
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Lee Y, Kim HJ, Yoon H, Choi CM, Oh YM, Lee SD, Lim CM, Kim WS, Koh Y, Lee JS. Clinical Characteristics and Treatment Outcomes of Primary Pulmonary Artery Sarcoma in Korea. J Korean Med Sci 2016; 31:1755-1760. [PMID: 27709853 PMCID: PMC5056207 DOI: 10.3346/jkms.2016.31.11.1755] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 07/20/2016] [Indexed: 01/18/2023] Open
Abstract
Pulmonary artery sarcomas (PAS) are rare malignant neoplasms. Right heart failure due to tumour location is the main cause of death in PAS patients. The hemodynamic influence of PAS may effect prognosis, but this has not been proven. We aimed to identify the clinical characteristics and prognostic factors of PAS in Korea, their association with pulmonary hypertension (PH). PAS patients treated at the Asan Medical Center between 2000 and 2014 were reviewed. We examined demographic characteristics, diagnostic and treatment modalities. Potential prognostic factors were evaluated by univariate and multivariate analysis. Twenty patients were diagnosed with PAS. Ten patients were male, the median age was 54 years (range, 33-75 years). The most common symptom observed was dyspnea (65%). The most common histologic type was spindle cell sarcoma (30%). Ten patients had a presumptive diagnosis of pulmonary embolism (PE) and received anticoagulation therapy. Seventeen patients underwent surgery, but only 5 patients had complete resection. Eleven patients received post-operative treatment (chemotherapy = 3, radiotherapy = 5, chemoradiotherapy = 3). PH was observed in 12 patients before treatment and in 6 patients after treatment. Overall median survival was 24 months. Post-treatment PH was associated with poor prognosis (HR 9.501, 95% CI 1.79-50.32; P = 0.008) while chemotherapy was negatively associated with mortality (HR 0.102, 95% CI 0.013-0.826; P = 0.032) in univariate analysis. Post-treatment PH was also associated with poor prognosis in multivariate analysis (HR 5.7, 95% CI 1.08-30.91; P = 0.041). PAS patients are frequently misdiagnosed with PE in Korea. Post-treatment PH is associated with a poor prognosis.
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Affiliation(s)
- Yunkyoung Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hyun Jung Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea
| | - Heeyoung Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chang Min Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yeon Mok Oh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chae Man Lim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jae Seung Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
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Wang X, Ren W, Yang J. Pedunculated Pulmonary Artery Sarcoma Suggested by Transthoracic Echocardiography. Echocardiography 2015; 33:647-51. [PMID: 26718742 DOI: 10.1111/echo.13148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Xiaobing Wang
- Department of Ultrasonography; Shengjing Hospital; China Medical University; Shenyang China
- Echo Lab; The First Hospital; China Medical University; Shenyang China
| | - Weidong Ren
- Department of Ultrasonography; Shengjing Hospital; China Medical University; Shenyang China
| | - Jun Yang
- Echo Lab; The First Hospital; China Medical University; Shenyang China
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