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Harada H, Ono T, Akiba J, Hirose T, Kawahara A, Abe H, Umeno H, Kurose A. Epithelioid angiosarcoma of the parotid area: A case report with immunohistochemical features and cytological correlation. ORAL AND MAXILLOFACIAL SURGERY CASES 2021. [DOI: 10.1016/j.omsc.2021.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ghosh S, Mehta AC, Abuquyyas S, Raju S, Farver C. Primary lung neoplasms presenting as multiple synchronous lung nodules. Eur Respir Rev 2020; 29:29/157/190142. [PMID: 32878970 DOI: 10.1183/16000617.0142-2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/08/2020] [Indexed: 12/26/2022] Open
Abstract
Multiple synchronous lung nodules are frequently encountered on computed tomography (CT) scanning of the chest and are most commonly either non-neoplastic or metastases from a known primary malignancy. The finding may initiate a search for primary malignancy elsewhere in the body. An exception to this rule, however, is a class of rare primary lung neoplasms that originate from epithelial (pneumocytes and neuroendocrine), mesenchymal (vascular and meningothelial) and lymphoid tissues of the lung. While these rare neoplasms also present as multiple synchronous unilateral or bilateral lung nodules on chest CT, they are often overlooked in favour of more common causes of multiple lung nodules. The correct diagnosis may be suggested by a multidisciplinary team and established on biopsy, performed either as part of routine diagnostic work-up or staging for malignancy. In this review, we discuss clinical presentations, imaging features, pathology findings and subsequent management of these rare primary neoplasms of the lung.
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Affiliation(s)
- Subha Ghosh
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sami Abuquyyas
- Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shine Raju
- Pulmonary, Critical Care and Sleep Medicine, University Hospital Cleveland Medical Center, Cleveland, OH, USA
| | - Carol Farver
- Dept of Pathology, Cleveland Clinic, Cleveland, OH, USA
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Nguyen Cuong P, Thanh Xuan N, Nhu Huy P, Nhu Tung T, Huu Son N. Histopathological Features of Deep Soft Tissue Epithelioid Angiosarcoma in the Lower Extremity: A Rare Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923933. [PMID: 32712619 PMCID: PMC7414833 DOI: 10.12659/ajcr.923933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Epithelioid angiosarcoma is an extremely rare malignant disease of the endothelial cells. Most of the previous reports about this disease were regarding clinical features and radiological findings, with limited descriptions of pathological diagnosis. This report aimed to present a reference to increase understanding of the timely diagnosis of epithelioid angiosarcoma. CASE REPORT A 65-year-old male was diagnosed with epithelioid angiosarcoma originating from the deep soft tissue of the lower leg. He had a history of 2 months of rapid swelling and painful in the left lower leg, which occurred after a muscle cramp, and was clinically suspicioius for hematoma. Radiological examination revealed a large heterogeneous soft-tissue mass. Histopathology results showed that the mass was malignant, and the differential diagnosis wasa malignant vascular tumor, melanoma, poorly differentiated carcinoma, clear cell sarcoma, epithelioid sarcoma, and anaplastic large-cell lymphoma. Immunohistochemistry findings confirmed that it was an epithelioid angiosarcoma. CONCLUSIONS This case underscores the difficult of diagnosing epithelioid angiosarcoma. It requires careful pathological investigation and immunophenotype labeling.
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Affiliation(s)
| | - Nguyen Thanh Xuan
- Department of Pediatric and Abdominal Emergency Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Pham Nhu Huy
- Emory College of Art and Sciences, Atlanta, GA, USA
| | - Tran Nhu Tung
- Forensic Center, Thua Thien Hue Province, Hue City, Vietnam
| | - Nguyen Huu Son
- Pediatric Center, Hue Central Hospital, Hue City, Vietnam
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Lv L, Xu P, Shi Y, Hao J, Hu C, Zhao B. Imaging features of soft tissue epithelioid angiosarcoma in the lower extremity: A case report. Oncol Lett 2016; 11:3457-3460. [PMID: 27123135 DOI: 10.3892/ol.2016.4407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 12/10/2015] [Indexed: 02/03/2023] Open
Abstract
Epithelioid angiosarcomas are extremely rare malignant tumors formed from endothelial cells. The majority of studies reporting these tumors have been concerned with the clinical and pathological aspects, with limited reporting of radiological diagnosis. The aim of the present study was to provide a reference to improve understanding of diagnosis, treatment choice and prognosis assessment of epithelioid angiosarcoma. The current study reports the case of a 44-year-old woman with epithelioid angiosarcoma located in the deep soft tissue of the lower extremities. Physical examination of the right thigh revealed a palpable hard mass and movement was clearly restricted and painful. X-ray, computed tomography (CT) scans and magnetic resonance imaging (MRI) were used to evaluate the imaging features of the tumor. Using X-ray and CT scanning, an inhomogenous tumor with osteolytic osseous destruction was observed. MRI revealed that the bordering skeletal muscles were infiltrated. The patient was treated with palliative surgery and chemotherapy, but succumbed to disease 1 year later.
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Affiliation(s)
- Lulu Lv
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Peng Xu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
| | - Yibing Shi
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Jingming Hao
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Chunai Hu
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Baozhong Zhao
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
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Tanaka H, Yorita K, Takahashi N, Usuma Y, Nakamura K, Kataoka H. Primary pulmonary angiosarcoma: A case report. Pathol Int 2015; 65:554-7. [PMID: 26272464 DOI: 10.1111/pin.12341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 07/23/2015] [Indexed: 11/28/2022]
Abstract
Primary sarcoma is uncommon in the lung, and primary angiosarcoma is exceedingly rare. We report a case of primary pulmonary angiosarcoma of the left lung with emphasis on its growth pattern in the lung. A 48-year-old Japanese man was admitted to our hospital because of dyspnea on exertion. He was subsequently found to have left pleural effusion. Computed tomography shows a nodular lesion measuring 7 × 4 cm in his left lung. Obstruction of the left inferior lobar bronchus was observed, and endobronchial biopsy suggested angiosarcoma. Left pneumonectomy was performed. On macroscopic examination of the cut surface, multiple nodular lesions were observed particularly in portions around branches of pulmonary artery along bronchioles. Histological examination revealed vascular channel-like structure with vague lumen formations by atypical polygonal or spindle-shaped neoplastic cells. Immunohistochemically, the neoplastic cells are positive for FLI-1, ERG, CD31 and von Willebrand factor/factor VIII-related antigen, but not CD34. Angiosarcoma is a particularly rare form of primary pulmonary tumors, and this case report describes its unique macroscopic growth pattern in the lung.
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Affiliation(s)
- Hiroyuki Tanaka
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kenji Yorita
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nobuyasu Takahashi
- Department of Anatomy, Ultrastructural Cell Biology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yasuhiro Usuma
- Department of Surgery, National Hospital Organization Miyazaki Higashi Hospital, Miyazaki, Japan
| | - Kunihide Nakamura
- Department of Surgery II, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroaki Kataoka
- Section of Oncopathology and Regenerative Biology, Department of Pathology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Primary pleural angiosarcoma in a 63-year-old gentleman. Case Rep Pulmonol 2013; 2013:974567. [PMID: 23844302 PMCID: PMC3697234 DOI: 10.1155/2013/974567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 06/03/2013] [Indexed: 11/25/2022] Open
Abstract
Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature. Herein, we report the case of a 63-year-old gentleman who presented with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. Chest X-ray showed bilateral pleural effusion with partial bibasilar atelectasis. Ultrasound-guided thoracocentesis showed bloody and exudative pleural fluid. Cytologic examination was negative for malignant cells. An abdominal contrast-enhanced computed tomography (CT) scan showed two right diaphragmatic pleural masses. Whole-body positron emission tomography/computed tomography (PET/CT) scan showed two hypermetabolic fluorodeoxyglucose- (FDG-) avid lesions involving the right diaphragmatic pleura. CT-guided needle-core biopsy was performed and histopathological examination showed neoplastic cells growing mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. Immunohistochemical analysis showed strong positivity for vimentin, CD31, CD68, and Fli-1 markers. The overall pathological and immunohistochemical features supported the diagnosis of epithelioid angiosarcoma. The patient was scheduled for surgery in three weeks. Unfortunately, the patient died after one week after discharge secondary to pulseless ventricular tachycardia arrest followed by asystole. Moreover, we also present a brief literature review on pleural angiosarcoma.
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Demirag F, Cakir E, Yazici U, Tastepe I. Pulmonary tumor thrombotic microangiopathy from metastatic epithelioid angiosarcoma. J Thorac Dis 2013; 5:E107-11. [PMID: 23825782 DOI: 10.3978/j.issn.2072-1439.2012.10.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/10/2012] [Indexed: 11/14/2022]
Abstract
The lung is most common site for metastatic disease via hematogenous route. Tumor emboli of the vessels of the lung induces fibrocellular and fibromuscular intimal proliferation. These histopathological changes may cause pulmonary tumor trombotic microangiopaty. Few cases are diagnosed antemortem. We report a 60 year old woman with by metastatic epithelioid angiosarcoma involving the lung. Tumor cells were positive for VEGF and topoisomerase II. VEGF may be involved in the pathogenesis pulmonary tumor trombotic microangioapy and topoisomerase II positivity showed sensitivity against catalytic topoisomerase II inhibitors.
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Affiliation(s)
- Funda Demirag
- Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Pathology, Ankara, Turkey
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Abstract
Bone epithelioid angiosarcoma is rare and generally shows positive immunostaining for epithelial markers. Multicentric bone epithelioid angiosarcoma is easily misdiagnosed as carcinoma, including metastatic carcinoma, multiple myeloma, and multiple lymphoma of bone. This article describes a case of multicentric bone epithelioid angiosarcoma. The patient was first misdiagnosed as having metastatic carcinoma. Examination showed osteolytic lesions in the bilateral heels and the lower left humerus. The diagnosis was confirmed postoperatively and corrected after immunohistochemical analysis of the biopsy. The immunohistochemical analysis revealed that the tumor mass was strongly positive for CD31, factor VIII, vimentin, and neuron-specific enolase. The patient refused chemotherapy and died of lung metastasis 4 months postoperatively.Most bone epithelioid angiosarcomas are immunopositive for epithelial markers (ie, keratin, cytokeratin, high-molecular-weight keratin, and epithelial membrane antigen), vascular endothelial markers (ie, CD31, CD34, and von Willebrand factor), and factor VIII-associated antigen. Bone epithelioid angiosarcoma shows a relatively high degree of malignancy. Patients often die of distant metastasis, including those found in the lung and lymph node tissue. A wide excision of epithelioid angiosarcoma should be performed during the operation of the primary tumor. A better understanding of the clinicopathologic features of this disease may help to clarify the confusion, provide better treatment, and improve the clinical prognosis.
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Affiliation(s)
- Zhengming Yang
- Department of Orthopedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Chen YB, Guo LC, Yang L, Feng W, Zhang XQ, Ling CH, Ji C, Huang JA. Angiosarcoma of the lung: 2 cases report and literature reviewed. Lung Cancer 2010; 70:352-6. [DOI: 10.1016/j.lungcan.2010.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/02/2010] [Accepted: 09/06/2010] [Indexed: 01/18/2023]
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Matzke LAM, Knowling MA, Grant D, Cupples JB, Leipsic J, Ignaszewski A, Allard MF. A rare cardiac neoplasm: case report of cardiac epithelioid angiosarcoma. Cardiovasc Pathol 2010; 20:e197-201. [PMID: 21081277 DOI: 10.1016/j.carpath.2010.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/24/2010] [Accepted: 09/08/2010] [Indexed: 01/18/2023] Open
Abstract
Primary cardiac angiosarcoma is a rare neoplasm and the epithelioid variant is exceedingly rare. We report a case of an epithelioid angiosarcoma that involved the right atrium and aorta of a 47-year-old male. The patient presented with atrial fibrillation and presyncopal spells. Following clinical evaluation, including computed tomography scan and trans-esophageal echocardiography, the neoplasm was surgically removed. It was a poorly differentiated malignant neoplasm composed of medium-sized epithelioid cells with a moderate amount of amphophilic cytoplasm. Immunohistochemical staining, including positive staining for CK22, AE1/AE3, melan-A, vimentin, and CD31, indicated the neoplasm was best categorized as an epithelioid angiosarcoma.
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Carillo GAO, Carretero MAC, Vazquez JER, Fontan EG, Ramos MB, Ventura JA, Rodriguez AP, Salmon AS, Tejedor JLG. Epithelioid Angiosarcoma of the Lung with Pleural Metastases: A Rare Cause of Haemoptysis. Heart Lung Circ 2010; 19:624-8. [DOI: 10.1016/j.hlc.2010.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/07/2010] [Accepted: 05/03/2010] [Indexed: 01/18/2023]
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13
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Application of immunocytochemistry to the diagnosis of primary epithelioid angiosarcoma of the lung. Med Mol Morphol 2009; 42:250-3. [DOI: 10.1007/s00795-008-0417-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 09/11/2008] [Indexed: 12/17/2022]
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Saitoh JI, Sakurai H, Suzuki Y, Katoh H, Takahashi T, Nakano T. Metastatic angiosarcoma of the lung with alveolar hemorrhage. Jpn J Radiol 2009; 27:381-4. [PMID: 19943151 DOI: 10.1007/s11604-009-0352-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 07/06/2009] [Indexed: 12/13/2022]
Abstract
A case of metastatic angiosarcoma of the lung with alveolar hemorrhage was experienced. A 76-year-old woman was diagnosed as stage IIb uterine cervical cancer. The cancer disappeared after radiotherapy. Five years later, she was readmitted because of severe pain around the right hip joint. Fracture of the neck of the right femur was found on roentgenogram. On chest CT and roentgenogram, spotted or restiform shadows with uncertain margins were found in the peripheral regions of the bilateral lung field. The lesions reached just underneath the pleura, and interstitial shadows such as ground-glass-like shadows and thickening of the interlobular walls were also found. These lesions were rapidly aggravated in the course of 1-2 weeks. She died after a short period of hospitalization (2 months) with pathological fracture. In autopsy, metastases of the tumor were found to bones, lungs, heart, and other organs that mainly occurred hematogenously. No recurrence of the uterine cervical cancer was detected. Tumor cells were polymorphic or ovoid, and occurred scattered individually or showed growth-forming small aggregates. By immunohistochemical staining, CD31, CD34 and Factor VIII were found to be positive, and the tumor was diagnosed as epithelioid angiosarcoma. The main findings in the lungs were intraalveolar hemorrhage consequent to tumor embolization.
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Affiliation(s)
- Jun-ichi Saitoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan.
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Pancoast tobias syndrome revealing primary epithelioid pleuro-pericardial angiosarcoma: A case report and review of the literature. Indian J Thorac Cardiovasc Surg 2009. [DOI: 10.1007/s12055-009-0009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Campione A, Forte G, Luzzi L, Comino A, Gorla A, Terzi A. Pulmonary Angiosarcoma Presenting as Spontaneous Recurrent Hemothorax. Asian Cardiovasc Thorac Ann 2009; 17:84-5. [DOI: 10.1177/0218492309102544] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
An incidental diagnosis of pulmonary angiosarcoma was made after surgical exploration for repeated episodes of bleeding in an 85-year-old woman. Spontaneous hemothorax is uncommon and deserves detailed investigation.
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Affiliation(s)
| | - Giuseppe Forte
- Department of Pathology, Hospital of Cuneo, Cuneo, Italy
| | | | - Alberto Comino
- Department of Pathology, Hospital of Cuneo, Cuneo, Italy
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Patsios D, de Perrot M, Tsao MS, Weisbrod G. Epithelioid angiosarcoma of the lung: a rare late complication of Lucite plombage. Br J Radiol 2006; 79:e36-9. [PMID: 16823053 DOI: 10.1259/bjr/12749434] [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] [Indexed: 11/05/2022] Open
Abstract
Epithelioid angiosarcoma of the lung is a rare late complication of Lucite plombage treatment of pulmonary tuberculosis. We describe the clinical, radiological and pathologic findings of a case of epithelioid angiosarcoma of the lung presenting with persistent haemoptysis who had undergone remote lung collapse therapy with Lucite plombage.
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Affiliation(s)
- D Patsios
- Department of Medical Imaging, University Health Network, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
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