ABSTRACT
Epithelioid angiosarcoma is a rare high-grade vascular neoplasm with a poor prognosis. We present an anticoagulated 77-year-old man, with a history of popliteal/soleal vein thrombosis in the previous month, complaining of ipsilateral persistent lower limb pain and claudication. Absent popliteal/distal pulses prompted an arterial doppler ultrasound (DUS), revealing thrombosis of the distal superficial femoral artery and a popliteal mass. As the arterial wall's integrity could not be appropriately evaluated by DUS, adventitial cystic disease of the popliteal artery was suspected. Computed tomography angiography and magnetic resonance imaging findings were also suggestive. Due to refractory pain, he was submitted to a popliteal mass excision along with a femoral-posterior tibial bypass. Pathology revealed an epithelioid angiosarcoma. He was referred to a Sarcoma Center, requiring hospitalization for agitation and fever. A positron emission tomography (PET) scan revealed extensive lower limb disease persistence and distant metastases. He died on the 56th day after surgery. To our knowledge, there are only 15 cases of angiosarcoma of the popliteal artery described in the literature. Ours stands out as the first one unrelated to a popliteal aneurysm. Being a highly-aggressive tumor, an early diagnosis is challenging but essential to a successful treatment, warranting the need for suspicion of this neoplasm. An early core biopsy or surgical sample may expedite the diagnosis.
Subject(s)
Hemangiosarcoma , Popliteal Artery , Vascular Neoplasms , Humans , Male , Aged , Hemangiosarcoma/pathology , Hemangiosarcoma/surgery , Hemangiosarcoma/diagnosis , Hemangiosarcoma/diagnostic imaging , Vascular Neoplasms/surgery , Vascular Neoplasms/pathology , Vascular Neoplasms/diagnosis , Vascular Neoplasms/diagnostic imaging , Popliteal Artery/pathology , Popliteal Artery/surgery , Popliteal Artery/diagnostic imaging , Fatal Outcome , Computed Tomography AngiographyABSTRACT
This case report describes a 35-year-old female patient who presented with palpitations and shortness of breath. Imaging findings suggested a cardiac tumor, histopathology confirmed primary cardiac angiosarcoma. This tumor is highly aggressive, usually occurs in the right atrium, lacks specificity in clinical presentation, is prone to early metastasis, and has a poor prognosis. Echocardiography is the method of choice for early detection and is important in assessing tumor size, location, mode of attachment and whether cardiac function is impaired.
Subject(s)
Echocardiography , Heart Neoplasms , Hemangiosarcoma , Humans , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/diagnosis , Female , Hemangiosarcoma/diagnostic imaging , Hemangiosarcoma/diagnosis , Adult , Echocardiography/methods , Heart Atria/diagnostic imaging , Diagnosis, DifferentialABSTRACT
A 10-year-old Cocker spaniel presented with lethargy. Triple-phase computed tomography was obtained with a contrast test bolus at the level of porta hepatis, which revealed a right lower abdominal mass. The mass was not connected to other abdominal organs; however, a linear structure was observed connecting the splenic hilum to the mass, which was suspected to be the feeding vessel. The arterial phase image was obtained again with a contrast bolus at the level of the celiac artery. A prominent contrast-enhanced feeding artery originating from the splenic artery to the mass was observed. Histopathology confirmed an accessory splenic hemangiosarcoma.
Subject(s)
Dog Diseases , Hemangiosarcoma , Splenic Neoplasms , Dogs , Animals , Hemangiosarcoma/diagnostic imaging , Hemangiosarcoma/veterinary , Splenic Neoplasms/diagnostic imaging , Splenic Neoplasms/veterinary , Tomography, X-Ray Computed/veterinary , Liver , Dog Diseases/diagnostic imaging , Dog Diseases/pathologyABSTRACT
Cardiac angiosarcoma (CAS) is the most prevalent malignant primary cardiac tumor in adults, often affecting young males. We present a case of this rare entity in a young female, highlighting the multidisciplinary team's role and multimodality imaging in the diagnosis and management.
Subject(s)
Heart Neoplasms , Hemangiosarcoma , Female , Humans , Diagnosis, Differential , Heart Atria , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/surgery , Hemangiosarcoma/diagnostic imaging , Hemangiosarcoma/therapyABSTRACT
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.
Subject(s)
Crohn Disease , Duodenal Neoplasms , Hemangiosarcoma , Intestinal Obstruction , Humans , Male , Crohn Disease/pathology , Duodenal Neoplasms/pathology , Hemangiosarcoma/diagnostic imaging , Hemangiosarcoma/surgery , Ileum/pathology , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestinal Obstruction/pathology , Intestine, Small/diagnostic imaging , Intestine, Small/surgery , Intestine, Small/pathology , Adult , Middle AgedABSTRACT
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.
Subject(s)
Hemangiosarcoma , Sarcoma , Soft Tissue Neoplasms , Surgeons , Female , Humans , Child , Adolescent , Hemangiosarcoma/diagnostic imaging , Hemangiosarcoma/surgery , Magnetic Resonance ImagingSubject(s)
Heart Neoplasms , Hemangiosarcoma , Lung Diseases, Interstitial , Lung Neoplasms , Pneumonia, Mycoplasma , Humans , Hemangiosarcoma/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/pathology , Heart Atria/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/pathologyABSTRACT
BACKGROUND: Paranasal sinus angiosarcoma is an uncommon malignancy, with only a few reported cases worldwide. Although it exhibits multiple symptoms, facial paralysis has not been previously documented as a noticeable presentation. CASE PRESENTATION: In this case, we report a 40-year-old male who presented with facial numbness and pain for one month, weakness of his facial muscles for 15 days, and recurrent right epistaxis for 1 year. He had a history of nasal inflammatory polyps with chronic sinusitis. Computed tomography and magnetic resonance imaging showed space-occupying lesions in the right nasal cavity and maxillary sinus, with bone destruction occurring in the sinus wall and turbinate. This patient then underwent endoscopic surgery. According to the histopathological and immunohistochemical results, he was eventually diagnosed with paranasal sinus angiosarcoma in April 2021. To date, this patient has not initiated any radiotherapy or chemotherapy and has survived with lymphatic metastasis for at least 3 years. CONCLUSIONS: This manuscript suggests that paranasal sinus angiosarcoma can present with facial paralysis. Moreover, pathological and immunohistochemical tests are still vital for diagnosing paranasal sinus angiosarcoma and differential diagnosis. Additionally, regular follow-up is crucial for patients with paranasal sinus angiosarcoma, enabling monitoring of recurrence, metastasis, and recovery while contributing valuable clinical data to understanding this rare disease and associated research endeavours.
Subject(s)
Facial Paralysis , Hemangiosarcoma , Male , Humans , Adult , Hemangiosarcoma/diagnosis , Hemangiosarcoma/diagnostic imaging , Facial Paralysis/etiology , Maxillary Sinus/diagnostic imaging , Maxillary Sinus/pathology , Nasal Cavity/pathology , Epistaxis/pathologyABSTRACT
Angiosarcoma is the most invasive and malignant cardiac tumor and most commonly originates from the right atrium. Early diagnosis is essential, and echocardiography has an important role in diagnosis. This tumor grows aggressively, and metastases to other sites makes it difficult to control. Surgical treatment remains the best option for patients who do not respond to chemoradiotherapy. We herein report a case of a 17-year-old patient with cardiac angiosarcoma who presented with dyspnea, chest pain, dry cough, and fever. Although we considered the most probable diagnosis to be constrictive pericarditis, pathologic examination revealed a primary angiosarcoma originating from the pericardium. The patient underwent total pericardiectomy. However, despite receiving chemotherapy for 2 weeks postoperatively, she developed complications including leukopenia and eventually died of respiratory failure. Late diagnosis of angiosarcoma often occurs, resulting in progression to end-stage disease and a very poor prognosis. Therefore, a thorough understanding of this entity, knowledge of its pitfalls in management, and establishment of an accurate treatment guideline would help to develop a reliable and life-saving treatment approach for these patients.
Subject(s)
Heart Neoplasms , Hemangiosarcoma , Mediastinal Neoplasms , Thymus Neoplasms , Female , Humans , Adolescent , Hemangiosarcoma/diagnostic imaging , Hemangiosarcoma/surgery , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/surgery , ChemoradiotherapyABSTRACT
A male patient in his 30s presented to the emergency room with a 1-week history of dyspnoea that progressed to haemoptysis, having coughed up approximately 200 mL of blood on two occasions. On diagnostic investigation, a mediastinal tumour infiltrating the free wall of the right atrium and multiple pulmonary nodules were discovered. The first suspicion was a neoplasm of pulmonary origin, and a bronchoscopy was performed, histology reported a probable cardiac origin for the neoplasm. A subsequent biopsy confirmed the presence of a primary cardiac angiosarcoma. An extension CT scan revealed brain metastases. The patient received chemotherapy treatment, resulting in a partial response to date. This case is one of the few reported instances of cardiac neoplasm presenting with respiratory symptoms.
Subject(s)
Hemangiosarcoma , Hemoptysis , Humans , Male , Hemoptysis/etiology , Hemangiosarcoma/diagnosis , Hemangiosarcoma/diagnostic imaging , Cough , Affect , Heart Atria/diagnostic imagingABSTRACT
ABSTRACT: The primary angiosarcoma of bone is rare. It typically occurs in tubular bones, pelvis, and trunk. However, its occurrence in the lumbar pedicle, and transverse process is infrequent. Thus, we present the imaging findings of FDG PET/CT in a rare case of primary angiosarcoma of lumbar pedicle and transverse process. It presented as solitary osteolytic bone destruction in the right pedicle and transverse process of L4 with intense FDG uptake. This case added knowledge of another rare occurrence site of primary angiosarcoma of bone, which should be considered as a differential diagnosis when we meet similar image appearance on FDG PET/CT.
Subject(s)
Fluorodeoxyglucose F18 , Hemangiosarcoma , Humans , Positron Emission Tomography Computed Tomography , Hemangiosarcoma/diagnostic imaging , Positron-Emission Tomography , Biological TransportABSTRACT
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.
Subject(s)
Brain Neoplasms , Hemangiosarcoma , Meningeal Neoplasms , Humans , Male , Middle Aged , Asian People , Hemangiosarcoma/diagnosis , Hemangiosarcoma/diagnostic imaging , Hemangiosarcoma/surgery , Hemosiderin/analysis , Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/diagnostic imaging , Meningeal Neoplasms/surgery , Brain Neoplasms/diagnosis , Brain Neoplasms/diagnostic imaging , Brain Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
RATIONALE: Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is considered a reliable and indispensable imaging method when evaluating distant metastases and clinical staging of angiosarcomas. Here, we report 2 cases of angiosarcoma with bone metastases with "false negative" findings on 18F-FDG PET/CT. PATIENT CONCERNS: Case 1, a 39-year-old woman, who had undergone mastectomy for primary angiosarcoma 2 years prior, presented with a 5-month history of right coxalgia. Case 2 was a 37-year-old woman, who had undergone mastectomy for primary angiosarcoma 4 months prior. During postoperative follow-up, multiple bone lesions were detected on magnetic resonance imaging (MRI). DIAGNOSES: Based on the histopathological findings, both cases were diagnosed with bone metastases of angiosarcoma. Although MRI showed multiple bone metastatic lesions, 18F-FDG PET/CT showed no uptake or osteolytic destruction in both cases. INTERVENTIONS: Weekly paclitaxel was initiated as a salvage chemotherapy in both cases. OUTCOMES: No uptake or osteolytic lesions were observed on 18F-FDG PET/CT, despite multiple bone metastases detected on MRI. LESSONS: False-negative findings on 18F-FDG PET/CT should be considered when evaluating bone metastases of angiosarcoma. Even with negative findings on 18F-FDG PET/CT, open biopsy should be performed if MRI indicates bone metastases.