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Samargandi R. Etiology, pathogenesis, and management of angiosarcoma associated with implants and foreign body: Clinical cases and research updates. Medicine (Baltimore) 2024; 103:e37932. [PMID: 38701315 PMCID: PMC11062743 DOI: 10.1097/md.0000000000037932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/28/2024] [Indexed: 05/05/2024] Open
Abstract
Angiosarcomas are rare and highly malignant soft tissue sarcomas originating from endothelial cells lining the lymphatic or vascular system. While they predominantly emerge from (sub)cutaneous regions, occurrences have been reported throughout the body. The etiology of angiosarcoma remains elusive in most clinical cases. Nevertheless, several prognosis risk factors play a pivotal role, including chronic lymphedema, therapeutic irradiation, environmental carcinogens, familial syndromes, and the presence of foreign materials like metallic objects and biomedical implants. Despite evidence implicating retained foreign material in angiosarcoma development, understanding its prognosis and pathogenesis remains limited. The pathogenesis of angiosarcoma appears to involve a complex interplay of chronic inflammation, tissue remodeling, and genetic factors that create a conducive microenvironment for malignant transformation. Management of these sarcomas remains challenging due to their infiltrative nature owing to the high chance of metastasis and local recurrence. The primary treatment modalities currently include surgery, radiotherapy, and chemotherapy, but recent advances in targeted immunotherapy and gene therapy hold promise for more effective approaches. This comprehensive review delves into the potential etiological and pathogenic roles of foreign materials, such as metallic objects, biomedical implants, and biomaterials, in the development of angiosarcoma. Further research into the underlying molecular mechanisms could provide valuable insights for tailored management and developing novel targeted therapeutic strategies.
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Affiliation(s)
- Ramy Samargandi
- Department of Orthopedic Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
- Service de Chirurgie Orthopédique et Traumatologique, CHRU Trousseau, Faculté de Médecine de Tours, Université de Tours, Chambray-les-Tours, France
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Skants N, Rönty M, Komulainen O, Keski-Keturi M, Huotari K, Alander-Pekkarinen M, Sihvo M, Laitinen M, Linko R. Case report and review: Angiosarcoma with thrombocytopenia after total hip arthroplasty. Front Surg 2023; 10:1212491. [PMID: 37583390 PMCID: PMC10423994 DOI: 10.3389/fsurg.2023.1212491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/11/2023] [Indexed: 08/17/2023] Open
Abstract
Total hip arthroplasty (THA) is a common treatment for osteoarthritis and is also performed for other conditions, such as secondary arthritis due to developmental dysplasia of the hip. Various THA types may be complicated by osteolysis and an inflammatory pseudotumor due to an adverse reaction to metal debris. Rarely, THA has been associated with malignant tumors, but their causality remains unclear. In this case report, we describe a female patient with developmental dysplasia of the hip. She had undergone left metal-on-polyethylene THA, acetabular revision of the THA, and left total knee arthroplasty. In addition, she had a history of dyslipidemia and telangiectasia of the eyes, anemia, hiatal hernia, and pleuritis. A THA-associated mass (suspected to be a pseudotumor) had been detected during a previous hospital admission due to pleuritis. She was hospitalized due to swelling in her left lower limb, fatigue, and bruises. A clinical examination revealed anemia, thrombocytopenia, and growth of the suspected pseudotumor. Within 6 weeks, she presented with bleeding of the oral mucosa, hemoptysis, melena, severe thrombocytopenia that did not respond to treatment, elevated D-dimer and C-reactive protein levels, severe pain, increased osteolysis, and fractures around the THA. Infection or malignancy was suspected, but two trocar biopsies suggested an inflammatory pseudotumor. Since her anemia and thrombocytopenia were considered to have been caused by an inflammatory process within the suspected pseudotumor, her suspected pseudotumor and all THA components were surgically removed. However, she developed severe alveolar hemorrhaging and hypoxia and died 2 weeks after her surgery. Histopathological analysis of her surgical and autopsy samples revealed highly malignant angiosarcoma. Although individual cases of malignancies associated with THA have been reported, the literature lacks a clear association between THA and increased cancer risk. Most pseudotumors are non-malignant. The patient's case presented in this report exemplifies the challenges to the differential diagnosis of a THA-associated pseudotumor and rare angiosarcoma. Atypically rapid tumor growth, severe osteolysis, and deterioration in the general wellbeing suggest a malignant disease.
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Affiliation(s)
- Noora Skants
- Perioperative and Intensive Care, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
| | - Mikko Rönty
- Department of Pathology, HUSLAB, Hospital District of Helsinki and Uusimaa, Diagnostic Center and University of Helsinki, Helsinki, Finland
| | - Olli Komulainen
- Musculoskeletal and Plastic Surgery, Arthroplasty Center, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
| | - Miikka Keski-Keturi
- Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaisa Huotari
- Department of Infectious Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maria Alander-Pekkarinen
- Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Marjut Sihvo
- Internal Medicine and Rehabilitation, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Minna Laitinen
- Musculoskeletal and Plastic Surgery, Bridge Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rita Linko
- Perioperative and Intensive Care, Peijas Hospital, Helsinki University Hospital and University of Helsinki, Vantaa, Finland
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Arts L, Roesti A, Haller C, Danzer D. Angiosarcoma after popliteal aneurysm exclusion surgery. A systematic review. Ann Vasc Surg 2022; 86:482-489. [PMID: 35820530 DOI: 10.1016/j.avsg.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/30/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Expansion after popliteal artery aneurysm exclusion with bypass is a common phenomenon. Popliteal angiosarcoma is seldom reported in literature and in most cases after popliteal artery aneurysm surgery. This paper aims to present the case of a popliteal angiosarcoma, initially diagnosed as late aneurysmal growth after exclusion surgery, to conduct a systematic review of popliteal angiosarcoma and assess any association between angiosarcoma and previous popliteal aneurysm surgery. METHODS We performed a secondary popliteal aneurysmorraphy through posterior approach for symptomatic aneurysm expansion in a 79-year-old woman, 9 years after medial femoropopliteal venous bypass and aneurysm exclusion. The postoperative course was complicated by recurrent hematomas and wound spillages requiring multiple revisions. Pathological analysis identified an angiosarcoma. Staging revealed bone invasion and pulmonary metastasis. Despite transfemoral amputation and adjuvant chemotherapy the patient died eight months later. We performed a systematic review through MEDLINE on 'primary' and 'secondary' (with previous vascular surgery) angiosarcoma in popliteal artery aneurysm. Research was done using the terms '(hem)angiosarcoma', 'aneurysm', 'popliteal aneurysm or artery', 'femoral aneurysm or artery'. Other soft tissue sarcoma or non-popliteal locations were excluded. RESULTS Including this case, only 13 angiosarcomas in popliteal aneurysms are currently described. Two were reported without previous surgery considered a primary angiosarcoma and 11 after popliteal artery aneurysm surgery (secondary angiosarcoma). Patient age ranges from 8 months to 83 years with a male predominance (10/3). Nine of the 11 patients with secondary angiosarcoma were initially diagnosed as popliteal aneurysm expansion after previous bypass surgery, the two other secondary cases presented respectively with pain and inflammatory syndrome without expansion. All prior surgical exclusion were carried out by a medial approach. Interval with the index operation ranges from 3 months to 15 years. Death was reported in 8 of the 13 cases within the first year of diagnosis. CONCLUSION Although seldom reported, popliteal angiosarcomas are mainly described after popliteal artery aneurysm exclusion surgery, raising suspicion on a potential association, yet causality cannot be demonstrated. Angiosarcoma should be included in the differential diagnosis of popliteal aneurysm growth or unexpected outcome after exclusion bypass surgery. Systematic imaging and pathological studies should be undertaken to allow early diagnosis and treatment. Routine use of a posterior approach, with aneurysm resection, when feasible as initial popliteal artery aneurysm treatment, might reduce the risk of late sarcomatous transformation.
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Affiliation(s)
- Laure Arts
- Department of vascular surgery, Centre Hospitalier du Valais Romand, Switzerland.
| | - Aurore Roesti
- Department of vascular surgery, Centre Hospitalier du Valais Romand, Switzerland
| | - Claude Haller
- Department of vascular surgery, Centre Hospitalier du Valais Romand, Switzerland
| | - Daniel Danzer
- Department of vascular surgery, Centre Hospitalier du Valais Romand, Switzerland
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May Lee M, Pierobon E, Riva G, Germi L, Feliciani C, Naldi L. Angiosarcoma and Vascular Surgery A Case Report and Review of the Literature to Focus on a Possible Risk Factor. Vasc Endovascular Surg 2022; 56:762-766. [PMID: 35694959 DOI: 10.1177/15385744221108248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Angiosarcomas (AS) are rare and aggressive neoplasms originating from the endothelium: they represent less than 2% of all soft tissue sarcomas and usually have a poor prognosis. Although more often primary, different risk factors have been described and some cases are associated with vascular surgery. Materials and Methods: We present the case of an 84-year-old man who developed an AS on his thigh 3 years after a popliteal bypass with autologous saphenous vein. We performed a thorough review of the literature describing the main characteristics of the 25 cases (including ours) of AS associated with vascular surgery reported from 1981 to 2022. Results: Most of the patients were males (21 men vs 4 women) with a range age of 50-84 years. Most of AS are associated with Dacron grafts (12 cases), the overall mean time to onset is 7.8 years after surgery. The most common presenting symptoms are pain (20 cases) and weight loss (10 cases), while cutaneous presentation is uncommon; indeed, violaceous and painful papules, plaques, nodules, and skin ulceration have been found in 3 cases only. Due to unspecific symptoms, differential diagnosis is often difficult and a biopsy for histological confirmation is mandatory. Conclusion: Even if it seems to be a very rare complication, AS should always be considered in patients with compatible symptoms and who have undergone vascular surgery in the past.
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Affiliation(s)
- Marco May Lee
- Department of Medicine and Surgery, Section of Dermatology, 9370University of Parma, Parma, Italy
| | - Elena Pierobon
- Department of Medicine and Surgery, Section of Dermatology, 9370University of Parma, Parma, Italy
| | - Giulio Riva
- Pathology Unit and Health and Risk Management, 198202Ospedale San Bortolo, Vicenza, Italy
| | - Lerica Germi
- Dermatology Unit, 198202Ospedale San Bortolo, Vicenza, Italy
| | - Claudio Feliciani
- Department of Medicine and Surgery, Section of Dermatology, 9370University of Parma, Parma, Italy
| | - Luigi Naldi
- Dermatology Unit, 198202Ospedale San Bortolo, Vicenza, Italy
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Rajan SS, Haider A, Burrell H, Whisker L, Tamimy M, McCulloch T, Lee AHS. Angiosarcoma arising in the capsule of a mammary silicone implant. Diagn Cytopathol 2022; 50:E119-E122. [PMID: 34994526 DOI: 10.1002/dc.24919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022]
Abstract
A 40-year-old woman with silicone implants inserted 21 years before presented with sudden onset of painful right breast swelling. Clinical examination revealed a firm swollen breast with appearance of old bruising. Ultrasound showed fluid around the implant. Cytology of the fluid showed cells with large pleomorphic nuclei with prominent nucleoli including elongated forms and very occasional vacuoles. The cell block also contained small fragments with atypical spindle cells around slit-like spaces that were positive for CD31 and CD34. MRI showed a 25 mm serpiginous area of enhancement on the inner aspect of the fibrous capsule with haematoma between the capsule and the implant. The capsule and adjacent area were excised. Histology showed angiosarcoma extending from the inner aspect of the capsule into the cavity around the implant. The location of the tumour on the inner aspect of the capsule is the same site that breast implant associated anaplastic large cell lymphomas arise and suggests a possible causal link between the implant and the angiosarcoma. This case emphasises the value of cytological assessment of fluid around breast implants and the role of cell blocks and immunohistochemistry.
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Affiliation(s)
| | - Asma Haider
- Histopathology Department, Nottingham University Hospitals, Nottingham, UK
| | - Helen Burrell
- Breast Institute, Nottingham University Hospitals, Nottingham, UK
| | - Lisa Whisker
- Breast Institute, Nottingham University Hospitals, Nottingham, UK
| | - Muhammad Tamimy
- Plastic Surgery Department, Nottingham University Hospitals, Nottingham, UK
| | - Tom McCulloch
- Histopathology Department, Nottingham University Hospitals, Nottingham, UK
| | - Andrew H S Lee
- Histopathology Department, Nottingham University Hospitals, Nottingham, UK
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Cleret de Langavant B, Flaris AN, Dasnoy D. Epithelioid Angiosarcoma after EVAR. A Case Report. Ann Vasc Surg 2021; 80:395.e1-395.e6. [PMID: 34808264 DOI: 10.1016/j.avsg.2021.10.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/18/2021] [Accepted: 10/27/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Endovascular aneurysm repair (EVAR) has become a standard in the treatment of aneurysms. However, complications still occur. Endoleaks are the most common. Graft infection diagnosis might be challenging. Even uncommon, we describe a case of epithelioid angiosarcoma after EVAR. CASE REPORT A 64-year-old male came to our emergency department with left lumbar and left thigh flexion pain, increasing since a month. Four years before, he had been treated for a left common iliac artery aneurysm extending to the aortic bifurcation by EVAR with a bifurcated unibody aortic (AFX Endologix) endograft. The year before the admission, he was treated twice by percutaneous angioplasty for a symptomatic mural thrombus of the left endograft limb. On admission, CT angiogram showed a recurrence of the aneurysm associated with elevated lab inflammatory markers. FDG-PET-CT showed an abnormal tracer uptake in the endograft limbs and in the left inguinal area. White blood cell scintigraphy did not show any sign of endograft infection. CT angiogram performed 2 months later showed an additional increase of the infrarenal aortic and left common iliac aneurysms. We removed the endograft. Histological analysis showed an epithelioid angiosarcoma. Patient died a few weeks later during chemotherapy. CONCLUSION For patients that have undergone EVAR and have subsequently developed morphological changes of the aortic wall and aneurysmal sac, an aortic tumor should be considered. Imaging diagnosis was challenging for this rare case of epithelioid angiosarcoma.
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Affiliation(s)
- Boris Cleret de Langavant
- Department of Digestive Surgery, Cliniques Universitaires St-Luc Université Catholique de Louvain, Brussels, Belgium.
| | | | - Denis Dasnoy
- Department of Cardiovascular Surgery, Grand Hôpital de Charleroi, Gilly, Belgium
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Derouane F, Brigitte H, Placide N. Epithelioid angiosarcoma arising after an endovascular aneurysm repair: case report and review of the literature. Acta Clin Belg 2021; 76:397-401. [PMID: 32186994 DOI: 10.1080/17843286.2020.1742489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: We report the case of a 68-year-old male who was hospitalized for suspicion of endoleak and thrombosis of an aortic endoprosthesis, arising after multiple endovascular interventions during the last few months. During the intervention, amass was discovered, and biopsies were made. The anatomopathology results were in favor of an epithelioid angiosarcoma with atypical expression of CD31 and ERG- and no amplification of c-MYC. The main objective of this review is to highlight the difficulty of differential diagnosis, but also to evaluate overall survival according to treatments.Methods: We performed a large review of the literature using PubMed for reports concerning angiosarcoma arising from Dacron grafts from 1981 to 2019. Articles presenting potentially relevant studies were read and analyzed.Results: In our review, most of the patients were male (10 cases over 11 described), with amedian age of 63 years old (50-84 years old, 11 cases described). The overall interval time for the diagnosis after the endoprosthesis placement was 7.8 years (from 3.5 years to 17 years, 10 cases with the description) and the overall survival was 5 months (from 0 to 10 months, the only patient alive is not included, and only 8 cases had the description).Conclusion: In most of the reviewed cases, there was no information concerning immunohistochemistry. Biopsies remain the standard for the diagnosis with immunochemistry and molecular test to avoid amisdiagnosis. Epithelioid angiosarcomas derived from Dacron grafts are a rare entity, which are difficult to diagnose because of the paucity of cases. Prognosis is poor, even if surgical option is possible.
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Affiliation(s)
- Françoise Derouane
- Department of Oncology, Cliniques Universitaires Saint-Luc, Université Catholique De Louvain, Brussels, Belgium
| | - Honhon Brigitte
- Department of Oncology, Grand Hôpital De Charleroi, Charleroi, Belgium
| | - Ngendahayo Placide
- Department of Anatomo-pathology, Institut De Pathologie Génétique (IPG), Gosselies, Belgium
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Elastomeric Cardiowrap Scaffolds Functionalized with Mesenchymal Stem Cells-Derived Exosomes Induce a Positive Modulation in the Inflammatory and Wound Healing Response of Mesenchymal Stem Cell and Macrophage. Biomedicines 2021; 9:biomedicines9070824. [PMID: 34356888 PMCID: PMC8301323 DOI: 10.3390/biomedicines9070824] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 12/11/2022] Open
Abstract
A challenge in contractile restoration of myocardial scars is one of the principal aims in cardiovascular surgery. Recently, a new potent biological tool used within healing processes is represented by exosomes derived from mesenchymal stem cells (MSCs). These cells are the well-known extracellular nanovesicles released from cells to facilitate cell function and communication. In this work, a combination of elastomeric membranes and exosomes was obtained and tested as a bioimplant. Mesenchymal stem cells (MSCs) and macrophages were seeded into the scaffold (polycaprolactone) and filled with exosomes derived from MSCs. Cells were tested for proliferation with an MTT test, and for wound healing properties and macrophage polarization by gene expression. Moreover, morphological analyses of their ability to colonize the scaffolds surfaces have been further evaluated. Results confirm that exosomes were easily entrapped onto the surface of the elastomeric scaffolds, increasing the wound healing properties and collagen type I and vitronectin of the MSC, and improving the M2 phenotype of the macrophages, mainly thanks to the increase in miRNA124 and decrease in miRNA 125. We can conclude that the enrichment of elastomeric scaffolds functionalized with exosomes is as an effective strategy to improve myocardial regeneration.
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Lee JB, Jung JW, Kim WO, Ryoo YW, Lee KJ, Kim SA. Case of Rapidly Progressing Angiosarcoma after Total Hip Arthroplasty. Ann Dermatol 2021; 33:377-381. [PMID: 34341642 PMCID: PMC8273325 DOI: 10.5021/ad.2021.33.4.377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 11/08/2022] Open
Abstract
The occurrence of malignant tumor in proximity to an arthroplasty prosthesis has been a matter of debate since it was first reported in 1978. Upon considering the number of orthopedic implants used, the occurrence of malignancy is rare. Especially in case of angiosarcoma, only a few cases have been reported worldwide. In this case, we report an extremely rare case of angiosarcoma arising at the site of a revision total hip arthroplasty. A 69-year-old female had received total hip replacement on her left hip due to osteoarthritis 8 months ago. Four months later, she complained pain on her operated area, X-ray showed loosening of implanted cup on her left hip. Thereafter, erythematous and purpuric papules and nodules were developed and spread around on her left hip. Through the skin biopsy she was diagnosed with angiosarcoma, and then she died of a sharp deterioration. Herein, we report a rare case of angiosarcoma occurred after total hip replacement with a review of the literature.
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Affiliation(s)
- Joon Bum Lee
- Department of Dermatology, School of Medicine, Keimyung University, Daegu, Korea
| | - Jin Woong Jung
- Department of Dermatology, School of Medicine, Keimyung University, Daegu, Korea
| | - Won Oh Kim
- Department of Dermatology, School of Medicine, Keimyung University, Daegu, Korea
| | - Young Wook Ryoo
- Department of Dermatology, School of Medicine, Keimyung University, Daegu, Korea
| | - Kyung Jae Lee
- Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu, Korea
| | - Sung Ae Kim
- Department of Dermatology, School of Medicine, Keimyung University, Daegu, Korea
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Takamura K, Kobayashi H, Rubin BP, Kondo S, Asami F, Aoyagi R, Ajioka Y. Aortic Angiosarcoma in Association with Endovascular Aneurysm Repair: Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931740. [PMID: 34118148 PMCID: PMC8212843 DOI: 10.12659/ajcr.931740] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Primary aortic sarcoma often poses diagnostic challenges for pathologists and clinicians because of a very low incidence and controversy over nomenclature and definition. We report a case of aortic angiosarcoma in association with a graft. We also conducted a clinicopathological review of cases of primary aortic sarcomas associated with implanted grafts. CASE REPORT The patient was an 82-year-old woman. She underwent thoracic endovascular aneurysm repair (TEVAR) at age 78 because of an aneurysm in the descending aorta. Approximately 4 years after the TEVAR, computed tomography revealed a type II endoleak and expansion of the aneurysm. Her c-reactive protein level rose to 34 mg/dL, and Ga scintigraphy showed 67Ga accumulation at the aneurysm. She had fever up to 39°C, and a stent graft infection was suspected. Despite administration of antibiotics, her condition deteriorated, and she died. Postmortem examination identified epithelioid aortic angiosarcoma at the aorta with aneurysm repair and the graft, and the aortic angiosarcoma invaded the left lower lobe of the lung. CONCLUSIONS Our clinicopathological review revealed that the proper clinical diagnosis was very difficult owing to confusion of aortic sarcoma after the implantation with the infected graft, atypical endoleak, or pseudoaneurysm. The histological diagnosis was ambiguous because immunohistochemical and genetic studies were not adequately conducted. Overall prognosis of aortic sarcoma is poor as most patients die within a year, with no effective treatments. It is hoped that recent projects for genomic medicine will provide useful insights about the diagnosis and treatment of these cancers.
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Affiliation(s)
- Kaori Takamura
- Division of Clinical Pathology, Niigata University Faculty of Medicine, Niigata, Japan
| | - Hiroshi Kobayashi
- Department of Pathology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Brian P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Shuhei Kondo
- Division of Clinical Pathology, Niigata University Faculty of Medicine, Niigata, Japan
| | - Fuyuki Asami
- Department of Cardiovascular Surgery, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Ryuji Aoyagi
- Department of Nephrology, Tachikawa General Hospital, Nagaoka, Niigata, Japan
| | - Yoichi Ajioka
- Division of Clinical Pathology, Niigata University Faculty of Medicine, Niigata, Japan
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Bleeding "sarcomatosis" as a rare presentation of vascular graft-related angiosarcoma: case report and review of the literature. BMC Surg 2020; 20:291. [PMID: 33218319 PMCID: PMC7678180 DOI: 10.1186/s12893-020-00966-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 11/15/2020] [Indexed: 01/21/2023] Open
Abstract
Background Angiosarcoma is a rare malignant tumor, originating from vascular endothelial cells, accounting for approximatively 1–2% of soft tissue sarcomas. It is characterized by a rapid proliferation and high metastatic potential. Some cases of angiosarcoma are described in association with vascular prosthesis, orthopedic devices and foreign bodies. Hereby, we report a case of a patient treated with the endovascular placement of a PTFE aorto bis-iliac prosthesis for aortic aneurysm, who developed a graft-related angiosarcoma with bone and peritoneal localizations. The peritoneal “sarcomatosis” led to an acute presentation with hemoperitoneum and anemia. We perform a thorough review of the literature summarizing the description of similar cases, their epidemiology and the possibilities for treatment. Case presentation An 84-year-old male with a history of abdominal aortic aneurysm endovascular repair presented to our emergency department complaining with low back pain radiating to the left limb. He underwent a type II endoleak embolization of the aneurysmal sac nine days before. During hospitalization he underwent a spine MRI which documented a vertebral alteration of non-univocal interpretation. Vertebral biopsy was performed revealing groups of cells of uncertain nature. He lately underwent percutaneous L2–L4 arthrodesis. Forty-two days after admission, he developed acute anemia. Emergency laparotomy revealed a massive hemoperitoneum and actively bleeding peritoneal nodules. Abdominal packing was performed, and several nodules were sent for definitive histological examination. After surgery, he developed progressive and severe hypovolemic shock and expired on postoperative day 5. Conclusions Angiosarcoma associated with foreign bodies, especially vascular prosthesis, is a very rare entity. In patients who have a history of prosthetic vascular graft placement that present with lumbar pain, osteolytic changes at radiologic imaging or the development of ascites, angiosarcoma should be considered in the differential diagnosis. Despite the poor prognosis, a prompt diagnosis might give access to an adequate treatment planning, with the aim for disease control and increased survival.
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Machado I, Giner F, Lavernia J, Cruz J, Traves V, Requena C, Llombart B, López-Guerrero JA, Llombart-Bosch A. Angiosarcomas: histology, immunohistochemistry and molecular insights with implications for differential diagnosis. Histol Histopathol 2020; 36:3-18. [PMID: 32885407 DOI: 10.14670/hh-18-246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Angiosarcomas (AS) represent a heterogenous group of tumors with variable clinical presentation. AS share an important morphologic and immunohistochemical overlap with other sarcomas, hence the differential diagnosis is challenging, especially in poorly-differentiated tumors. Although molecular studies provide significant clues, especially in the differential diagnosis with other vascular neoplasms, a thorough hematoxylin and eosin analysis remains an essential tool in AS diagnosis. In this review, we discuss pathological and molecular insights with emphasis on implications for differential diagnosis in cutaneous, breast, soft tissue and visceral AS.
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Affiliation(s)
- Isidro Machado
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain.,Pathology Department, Hospital Quirón, Valencia, Spain.
| | - Francisco Giner
- Pathology Department, University Hospital La Fe, Valencia, Spain
| | - Javier Lavernia
- Department of Oncology, Instituto Valenciano de Oncología, Valencia, Spain
| | - Julia Cruz
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Víctor Traves
- Pathology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Celia Requena
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - Beatriz Llombart
- Dermatology Department, Instituto Valenciano de Oncología, Valencia, Spain
| | - José Antonio López-Guerrero
- Laboratory of Molecular Biology, Instituto Valenciano de Oncología, Valencia, Spain.,IVO-CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF), Valencia, Spain.,Department of Pathology, School of Medicine, Catholic University of Valencia 'San Vicente Mártir', Valencia, Spain
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13
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Sultan S, Mustafa M, Bennani F, Atteia E, Acharya Y, Hynes N. Challenges in diagnosing aortic leiomyosarcoma post endovascular repair of abdominal aortic aneurysm. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:666-670. [PMID: 33251394 PMCID: PMC7683213 DOI: 10.1016/j.jvscit.2020.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022]
Abstract
Primary aortic tumors after endovascular aortic repair are rarely reported in the literature. Here, we report an elderly male with abdominal aortic leiomyosarcomas (LMS) after an endovascular aneurysm repair in 2012 for a 5-cm symptomatic abdominal aortic aneurysm using an Endurant II aortic stent graft (Medtronic, Minneapolis, Minn). The autopsy confirmed the aortic LMS after the patient rapidly deteriorated and succumbed to death. The vascular LMS are rapidly progressive and diagnostically challenging malignant soft tissue tumors with poor prognosis, which necessitates a strong clinical suspicion and attentiveness to radiologic signs for prompt diagnosis.
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Affiliation(s)
- Sherif Sultan
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland.,Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland Galway Affiliated Hospital, Galway, Ireland
| | - Mohamed Mustafa
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland
| | - Fadel Bennani
- Department of Pathology, Mayo University Hospital, National University of Ireland Galway Affiliated Hospital, Galway, Ireland
| | - Emad Atteia
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland
| | - Yogesh Acharya
- Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland Galway, Galway, Ireland.,Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland Galway Affiliated Hospital, Galway, Ireland
| | - Niamh Hynes
- Department of Vascular Surgery and Endovascular Surgery, Galway Clinic, Doughiska, Royal College of Surgeons in Ireland and the National University of Ireland Galway Affiliated Hospital, Galway, Ireland
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14
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Hajzamani D, Shokrollahi P, Najmoddin N, Shokrolahi F. Effect of engineered PLGA‐gelatin‐chitosan/
PLGA‐gelatin
/
PLGA‐gelatin‐graphene
three‐layer scaffold on adhesion/proliferation of
HUVECs. POLYM ADVAN TECHNOL 2020. [DOI: 10.1002/pat.4915] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Dorfam Hajzamani
- Department of Biomedical Engineering, Science and Research BranchIslamic Azad University Tehran Iran
- Department of BiomaterialsIran Polymer and Petrochemical Institute Tehran Iran
| | - Parvin Shokrollahi
- Department of BiomaterialsIran Polymer and Petrochemical Institute Tehran Iran
| | - Najmeh Najmoddin
- Department of Biomedical Engineering, Science and Research BranchIslamic Azad University Tehran Iran
| | - Fatemeh Shokrolahi
- Department of BiomaterialsIran Polymer and Petrochemical Institute Tehran Iran
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15
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Colonic Angiosarcoma Arising in Association with Amyloid Deposits. Case Rep Gastrointest Med 2020; 2020:3780763. [PMID: 32509358 PMCID: PMC7246417 DOI: 10.1155/2020/3780763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 11/29/2022] Open
Abstract
Angiosarcoma of the colon is rare, as is colonic amyloidosis. To our knowledge, there have been no reported cases of angiosarcoma arising in association with amyloid deposition. Herein, we described a case of 77-year-old man who presented with hematochezia, and a sigmoid mass was found on colonoscopy. Histologic examination of the resected specimen showed extensive nodular deposition of AL-lambda amyloid material in the colonic wall, as well as high-grade angiosarcoma which was closely intermingled with the amyloid deposits. While the occurrence of both colonic amyloidosis and angiosarcoma in this patient may represent pure coincidence, given the intimate association of the angiosarcoma and the amyloid deposition and the rarity of both of these lesions, we hypothesize that angiosarcoma could be secondary to amyloid deposition.
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16
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Natsume K, Shiiya N, Tsuchida T, Nagakura Y. Intimal sarcoma in an ascending aortic Dacron graft mimicking a thrombus. Interact Cardiovasc Thorac Surg 2020; 29:983-985. [PMID: 31369080 DOI: 10.1093/icvts/ivz192] [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] [Received: 06/03/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 11/12/2022] Open
Abstract
Although aortic sarcomas are extremely rare, they may arise in association with a Dacron graft. Here, we report a case of an intimal sarcoma in an ascending aortic Dacron graft implanted 17 years earlier. The patient presented with multiple cerebral infarctions; clinically, a thrombus was found to cause the embolic stroke. He successfully underwent re-replacement of the ascending aorta. Although the initial postoperative histopathological diagnosis was a thrombus, he died of multiple metastases of the malignant tumour after 5 months of the surgery. A histopathological re-evaluation of the explant using immunohistochemistry revealed that the mass was an intimal sarcoma.
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Affiliation(s)
- Kayoko Natsume
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Takashi Tsuchida
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Yuka Nagakura
- First Department of Surgery, Hamamatsu University School of Medicine, Shizuoka, Japan
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17
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Park WK, Park KL, Cho YS, Han A, Ahn S, Min SK. Intravascular Epithelioid Angiosarcoma in the Abdominal Aorta Mimicking an Infected Aneurysm. Vasc Specialist Int 2019; 35:232-236. [PMID: 31915668 PMCID: PMC6941772 DOI: 10.5758/vsi.2019.35.4.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/19/2019] [Accepted: 11/25/2019] [Indexed: 12/31/2022] Open
Abstract
Primary aortic angiosarcoma is very rare, and preoperative diagnosis is challenging with resultant poor prognosis. Angiosarcoma may mimic an infected aneurysm or a mural thrombus. Clinical suspicion of angiosarcoma is vital for an early diagnosis and proper surgical treatment, especially in cases with atypical rapid growth of an aortic abdominal aneurysm with a thrombotic mass. Herein, we report a case of angiosarcoma in the abdominal aorta mimicking an infected aneurysm and present computed tomography and positron emission tomography findings.
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Affiliation(s)
- Woong Ki Park
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyong Lin Park
- Department of Surgery, National Cancer Center, Goyang, Korea
| | - Yo Seok Cho
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ahram Han
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sanghyun Ahn
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Kee Min
- Division of Vascular Surgery, Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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18
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A Novel Biodegradable Multilayered Bioengineered Vascular Construct with a Curved Structure and Multi-Branches. MICROMACHINES 2019; 10:mi10040275. [PMID: 31022873 PMCID: PMC6523450 DOI: 10.3390/mi10040275] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 04/17/2019] [Accepted: 04/21/2019] [Indexed: 12/18/2022]
Abstract
Constructing tissue engineered vascular grafts (TEVG) is of great significance for cardiovascular research. However, most of the fabrication techniques are unable to construct TEVG with a bifurcated and curved structure. This paper presents multilayered biodegradable TEVGs with a curved structure and multi-branches. The technique combined 3D printed molds and casting hydrogel and sacrificial material to create vessel-mimicking constructs with customizable structural parameters. Compared with other fabrication methods, the proposed technique can create more native-like 3D geometries. The diameter and wall thickness of the fabricated constructs can be independently controlled, providing a feasible approach for TEVG construction. Enzymatically-crosslinked gelatin was used as the material of the constructs. The mechanical properties and thermostability of the constructs were evaluated. Fluid-structure interaction simulations were conducted to examine the displacement of the construct’s wall when blood flows through it. Human umbilical vein endothelial cells (HUVECs) were seeded on the inner channel of the constructs and cultured for 72 h. The cell morphology was assessed. The results showed that the proposed technique had good application potentials, and will hopefully provide a novel technological approach for constructing integrated vasculature for tissue engineering.
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19
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Morris R, Lee CJ. Development of Angiosarcoma in a Saphenous Vein Graft after Femoral to Above-Knee Popliteal Artery Bypass. Ann Vasc Surg 2018. [DOI: 10.1016/j.avsg.2018.01.087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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20
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Dong BS, Xie CH, Chen LJ, Xiong K, Yang J. [Surgical correction of conjunctival sac narrowing after orbital implantation using polyester fiber heart patches]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:1396-1399. [PMID: 29070473 PMCID: PMC6743960 DOI: 10.3969/j.issn.1673-4254.2017.10.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To test the feasibility of correcting conjunctival sac narrowing following orbital implantation using polyester fiber heart patches instead of the skin autograft. METHODS Twelve patients of conjunctival sac narrowing after orbital implantation (including 3 with orbital implant exposure) admitted in Nanfang Hospital between 2012 and 2016 received surgical correction of the conjunctival sac using polyester fiber heart patches. During the surgery, the central conjunctival sac was opened, the exposed area was covered with suitable polyester fiber heart patches, and the palpebral margin was sutured. RESULTS Three months after the operation, 10 patients showed improved appearance after implantation of the prosthetic eye. Two patients received a second operation to remove the patches due to graft rejection and infections and skin autograft was implanted for reconstruction of the conjunctival sac. CONCLUSION Polyester fiber heart patches are ideal materials for repairing Conjunctival sac narrowing and orbital implant exposure, but this approach is not suitable in cases of severe narrowing or occlusion of the conjunctival sac.
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Affiliation(s)
- Bing-Song Dong
- Department of Ophthalmology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. E-mail:
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21
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Angiosarcoma around total hip arthroplasty: case series and review of the literature. Musculoskelet Surg 2017; 102:21-27. [PMID: 28741174 DOI: 10.1007/s12306-017-0496-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 07/18/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Angiosarcoma (AS) is a rare and malignant tumor which mainly arises in the skin and superficial soft tissue and less frequently in deep soft tissue and bones. Some cases of AS are described in association with vascular and orthopedic devices. Nonetheless, only a few cases of AS around THA are reported in the literature. MATERIALS AND METHODS We describe five cases of AS arising around total hip arthroplasty who received surgery at our institution (Istituto Ortopedico Rizzoli, Bologna, Italy), and we report the cases described in literature. RESULTS Foreign bodies such as polyethylene were demonstrated to have a carcinogenic role in animals, but reports of similar cases in humans are rare. Nevertheless, osteolysis induced by wear particles of polyethylene is a frequent event and could induce to desist form considering other more rare causes of osteolysis such as AS. This could be the reason why the diagnosis in several cases was significantly delayed. Common features of these cases could be helpful for doing a prompt diagnosis. The initial presentation is suggestive for septic or aseptic loosening with a massive osteolysis around the cup and/or the stem associated with peculiar aspects as bleeding and loss of weight. Frequently, needle biopsy is negative because foreign-body reaction might have "covered" the most relevant condition of epithelioid AS. CONCLUSIONS In conclusion in a patient who presents with uncontrollable bleeding, loss of weight and massive osteolysis, AS must be actually considered as possible diagnosis.
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22
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Zhu W, Feng B, Ma Q, Li YL, Song XT, Weng XS. Angiosarcoma around Hip Joint Prosthesis. Chin Med J (Engl) 2017; 129:2642-2643. [PMID: 27779174 PMCID: PMC5125346 DOI: 10.4103/0366-6999.192783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Wei Zhu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Bin Feng
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Qi Ma
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yu-Long Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xi-Tao Song
- Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xi-Sheng Weng
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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