Multidisciplinary approach to breast angiosarcoma in an elderly patient: Repeated local relapses and significant objective responses

Angiosarcomas are malignant tumors of endovascular origin, which may be divided into primary and secondary forms. Secondary breast angiosarcomas are an increasing problem, especially in patients treated with breast-conserving surgery followed by radiotherapy.We report a case of radiation-induced angiosarcoma of the breast in a 77-year-old woman who presented with a suspect lesion in her left breast. Excisional biopsy and subsequent immunohistochemical staining of the specimen was performed. Histological report was diagnostic for low-intermediate grade angiosarcoma. The tumor cells were diffusely positive for CD31 and CD34. We performed surgical resection with mastectomy.A multidisciplinary approach with bleomycin-based electrochemotherapy, radiation treatment, and chemotherapy with pegylated liposomal doxorubicin has been most useful to control subsequent local relapses. To date, the patient is under close observation and is performing well. No recurrence has been demonstrated after ending of chemotherapy.

Epithelioid angiosarcoma arising in schwannoma of the kidney: report of the first case and review of the literature

Background

Schwannoma and angiosarcoma are infrequent pathologies that have been rarely reported in the kidney. Angiosarcoma is an uncommon malignant tumor presenting a recognizable vascular differentiation. It can develop in any site but the most common locations include the skin, soft tissues, breast, bone, liver, and spleen while renal localization has been very rarely reported in the literature. Schwannoma is a benign peripheral nerve sheath tumor composed of cells with the immunophenotype and ultrastructural features of differentiated Schwann cells. It has a wide anatomical distribution but the most frequent locations include subcutaneous tissues of the extremities and the head and neck region and the retroperitoneal and mediastinal soft tissues. The occurrence of an angiosarcoma in a pre-existing schwannoma is an extremely rare event with <20 cases reported in worldwide literature. In the present study, a renal case of angiosarcoma arising in schwannoma is presented with a detailed review of the pertinent literature.

Case Presentation

A 56-year-old man was admitted with a few days history of lower back pain and hematuria. Abdominal ultrasound showed a mass inside the left renal medulla. Subsequent imaging investigations with computed tomography and magnetic resonance confirmed the presence of the lesion and showed a pulmonary metastasis.

Conclusions

The final histopathological examination led to the diagnosis of epithelioid angiosarcoma arising in a schwannoma. The patient came to death a few months later due to a massive hemothorax. To the best of our knowledge, the present is the first case of an angiosarcoma arising in a schwannoma of the kidney.

Primary thyroid angiosarcoma: an unusual localization

The finding of thyroid nodules is a very common occurrence in routine clinical practice. Approximately 5% to 7% of the entire population have thyroid nodules. Vascular lesions are one of the most controversial issues in thyroid pathology. These include benign lesions such as hemangiomas and, rarely, malignant tumors such as angiosarcomas or undifferentiated angiosarcomatoid carcinomas. In particular, angiosarcoma of the thyroid gland is a rare, highly aggressive malignant vascular tumor and in Italy the greatest geographical incidence of this lesion is witnessed near the Alps. Here, a case of thyroid angiosarcoma in a 71-year-old man with a history of goiter for about 20 years is described. The unusual localization of this lesion, the difficulties in reaching a definitive diagnosis for this particular histological type of primary tumor and a history of long-standing multinodular goiter in thyroid of an older man from outside the Alpine region prompted us to report this case of thyroid angiosarcoma mainly to discuss surgical, histopathological and immunohistochemical features.

[Peritoneal innervation and post-laparoscopic course. Role of CO2]

BACKGROUND

30-67% of patients undergoing laparoscopic surgery reports shoulder pain. Besides, post-surgical course of patients undergoing converted laparoscopic procedures is similar to the course of patients who received a completely laparoscopic procedure. It is supposed that there is a temporary neurotoxic damage of the peritoneal sensitive nervous fibres defined by CO2.

METHODS

A prospective review has been carried out by histologically analyzing 38 peritoneal biopsies from 10 selected patients, during different laparoscopic surgical procedures (6 cholecystectomies, 2 appendectomies, 1 selective bilateral ligature of the spermatic vessles) and at different times during each operation. Patients whom anamnesis, clinical or local conditions were suggestive for peritoneal flogosis were excluded from the study: therefore only 29 biopsies from 8 patients have been considered useful to the study.

RESULTS

Histological analysis has been carried out with different methods of coloration (hematoxylin eosin, argentic staining) and at different magnifications (30x, 60x, 100x), without electronical microscopy or immunohistochemical studies. No biopsy showed signs of damage of the nervous structures.

CONCLUSIONS

Certainly, the realization of a pneumoperitoneum at CO2 doesn't cause damages of the peritoneal sensitive fibres. It has been demonstrated that the abdominal introduction of CO2 causes a "relative peritoneal acidosis", directly depending from the percentage of CO2 employed: the peritoneal pH decreases to 6.9 after 15 min of pneumoperitoneum with CO2 at 100% and to 7.35% with CO2 at 5% of air. Probably this condition causes a temporary biochemical change that defines reduction of the nervous impulses and, therefore, the "peritoneization" of the patient subjected to laparoscopic procedure. The "biochemical hypoesthesia", based on a change of the peritoneal homeostasis, would translate itself in a beneficial effect for the patient, persisting also when converted to laparotomic operation due the impossibility to proceed under laparoscopy, held up by the residual pneumoperitoneum.

Fibroadenoma of the vulva. Report of a case

A case of fibroadenoma occurring in the vulva of a 24 year old woman is presented. This rare benign tumor appears as dermal or subcutaneous well circumscribed nodule. Histologically the fibroadenoma is characterized by epithelial and stromal proliferation. Two different concepts concerning histogenesis are cited; the authors believe that this tumor arises in ectopic mammary tissue.

[Signet ring cell carcinoma of the rectum in a 15-year-old youngster]

Primary colonic signet ring cell carcinoma is a rare neoplasia. The prognosis is particularly poor with only very few patients surviving more than one year following diagnosis. We report a case of primary signet ring cells carcinoma of the rectum, detected in a 15 year old young male, particularly interesting for the patient young age and for good prognosis.

[Idiopathic muscular hypertrophy of the esophagus. A report of a symptomatic case]

A case of idiopathic muscular hypertrophy of the esophagus in a 55 years old woman with a two months history of dysphagia is presented. Radiological, esophagoscopic and CT scanning appearance was of an infiltrating process, but intraoperative histological examination revealed the benign feature of the lesion. Thus adequate surgical treatment was performed.

Carcinoma of the Urachus. Report of a Case

The authors report a case of urachal carcinoma of a 60 year old woman of particular interest because of the clinical history, biological behavior and histotype. The tumor presented as an umbilical mass of 25 cm which had slowly increased during 20 years without evident clinical signs or infiltration of the peritoneum and abdominal organs. Histologic findings revealed an adenosquamous carcinoma, which represents less than 5 % of urachal neoplasms. Surgical excision is the treatment. The prognosis is poor because of regional recurrence and metastases. The authors review the literature analyzing the criteria for differential diagnosis between adenocarcinoma of vesical and of urachal origin.