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Thaveenthiran P, Bae L, Wewelwala C, Zhou K. Primary small intestine angiosarcoma mimicking Crohn's disease. BMJ Case Rep 2024; 17:e255424. [PMID: 38290985 PMCID: PMC10828878 DOI: 10.1136/bcr-2023-255424] [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] [Indexed: 02/01/2024] Open
Abstract
A man in his 40s presented to an emergency department after experiencing worsening abdominal pain for 2 days. Contrast-enhanced CT of the abdomen and pelvis revealed circumferential mural thickening and luminal narrowing of the distal ileum and upstream dilatation of the small intestine, indicating small intestine obstruction. This prompted emergency laparotomy, where two lesions in the distal ileum were identified as the source of his bowel obstruction and resected. Immunohistochemistry of the resected segment revealed a primary small intestine angiosarcoma acting positively for vascular markers ERG and CD31. A subsequent positron emission tomography (PET) scan revealed positive mediastinal metastatic lymphadenopathy without organ metastases.Following his surgery, the patient recovered well and was promptly referred to an oncology unit at a specialised health centre for further treatment. Primary small intestine angiosarcoma is a rare entity in which patients present with non-specific symptoms requiring prompt tissue diagnosis to facilitate multidisciplinary management.
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Affiliation(s)
- Prasanthan Thaveenthiran
- General Surgery, Monash Health, Clayton, Victoria, Australia
- Trauma, National Trauma Research Institute, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Lily Bae
- General Surgery, Monash Health, Clayton, Victoria, Australia
| | | | - Kevin Zhou
- Radiology, Monash Health, Clayton, Victoria, Australia
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Schizas D, Mastoraki A, Giannakodimos I, Giannakodimos A, Ziogou A, Katsaros I, Frountzas M, Koutelidakis I, Vassiliu P, Pikoulis E. Primary Angiosarcoma of the Gastrointestinal Tract: A Systematic Review of the Literature. J INVEST SURG 2020; 35:400-408. [PMID: 33342318 DOI: 10.1080/08941939.2020.1853283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Primary Gastrointestinal Angiosarcoma (PGAS) constitutes a rare malignant tumor arising from vascular or lymphatic endothelial cells. The aim of this study was to review the available literature on PGAS and to elucidate its biological behavior and optimal therapeutic approach. PubMed and Embase bibliographical databases were systematically searched (last search April 8th, 2020) for studies concerning PGAS. Ninety-eight studies met our inclusion criteria, involving 110 patients (male/female = 1.5) with an age of 62.40 ± 17.84 (mean, SD) years. They were most frequently located at small (44.5%) and large intestine (35.5%), while 12.7% were multifocal. Surgical resection of the tumor was conducted at 84.0% of the cases combined with adjuvant therapy at 12.3%. One-year cumulative survival was 55.18% (95% CI: 34.33%-71.84%) for large intestine, 30.2% (95% CI: 17.1%-44.5%) for small intestine, whereas multifocal PGAS had a 6-months cumulative survival of 23.08% (95% CI: 5.58%-47.46%). Therefore, PGAS is an extremely rare entity with atypical clinical presentation, challenging diagnosis and aggressive behavior. High clinical suspicion is crucial for its prompt management. Further studies and the development of novel therapeutic agents are required in order to improve survival.
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Affiliation(s)
- Dimitrios Schizas
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Aikaterini Mastoraki
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Ilias Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Alexios Giannakodimos
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Afroditi Ziogou
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Greece
| | - Ioannis Katsaros
- First Department of Surgery, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece
| | - Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens Medical School, Athens, Greece
| | - Ioannis Koutelidakis
- Second Department of Surgery, Aristotle University of Thessaloniki, G.Gennimatas General Hospital, Thessaloniki, Greece
| | - Pantelis Vassiliu
- Fourth Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Greece
| | - Emmanouil Pikoulis
- Third Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Chaidari, Greece
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