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Guedot M, Renard D, Glomaud A, Girault A, Battistella M, Deschamps L, Richette P, Funck-Brentano T, Vanjak A. A chronic knee pain revealing an epithelioid angiosarcoma in a superficial femoral aneurysm. Joint Bone Spine 2025; 92:105853. [PMID: 39900197 DOI: 10.1016/j.jbspin.2025.105853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 01/08/2025] [Accepted: 01/18/2025] [Indexed: 02/05/2025]
Affiliation(s)
- Margot Guedot
- AP-HP, CHU Lariboisière, Service de Rhumatologie, 75475 Paris, France
| | - Domitille Renard
- AP-HP, CHU Lariboisière, Service de Rhumatologie, 75475 Paris, France
| | - Adrien Glomaud
- AP-HP, CHU Bichat, Service de Chirurgie Vasculaire, 75018 Paris, France
| | - Antoine Girault
- AP-HP, CHU Bichat, Service de Chirurgie Vasculaire, 75018 Paris, France
| | - Maxime Battistella
- AP-HP, CHU Saint-Louis, Service de Pathologie, Université Paris Cité, 75475 Paris, France
| | - Lydia Deschamps
- AP-HP, CHU Bichat, Service de Pathologie, 75018 Paris, France
| | - Pascal Richette
- AP-HP, CHU Lariboisière, Service de Rhumatologie, 75475 Paris, France
| | | | - Arnaud Vanjak
- AP-HP, CHU Lariboisière, Service de Rhumatologie, 75475 Paris, France.
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2
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Asano Y, Utsunomiya A, Meguro S, Sano M, Inuzuka K, Takeuchi H, Kawasaki H, Kosugi I, Enomoto Y, Fujihiro M, Baba S, Iwashita T. Development of an Undifferentiated Pleomorphic Sarcoma After Aortic Aneurysm Graft Replacement: A Case Report and Literature Review. Cureus 2024; 16:e61530. [PMID: 38827416 PMCID: PMC11144436 DOI: 10.7759/cureus.61530] [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] [Accepted: 06/01/2024] [Indexed: 06/04/2024] Open
Abstract
Aortic sarcomas are extremely rare. Sarcomas associated with aortic graft replacement are even rarer; only 17 cases have been examined through immunohistochemical staining to date, most of which were either angiosarcomas or intimal sarcomas. Here, we report the case of an 88-year-old man with an undifferentiated pleomorphic sarcoma (UPS) that developed after aortic graft replacement and was diagnosed through postmortem autopsy. To the best of our knowledge, this is the first case of graft-associated sarcoma diagnosed as an undifferentiated pleomorphic type following detailed immunohistochemical staining with sufficient antibodies and fluorescencein situ hybridization (FISH).
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Affiliation(s)
- Yotaro Asano
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Aoi Utsunomiya
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Shiori Meguro
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Masaki Sano
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Kazunori Inuzuka
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Hideya Kawasaki
- Institute for NanoSuit Research, Preeminent Medical Photonics Education & Research Center, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Isao Kosugi
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Yasunori Enomoto
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Mayu Fujihiro
- Department of Diagnostic Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
| | - Satoshi Baba
- Department of Diagnostic Pathology, Hamamatsu University Hospital, Hamamatsu, JPN
| | - Toshihide Iwashita
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, JPN
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3
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Komatsu M, Naito K, Chino S, Tanaka H, Ichimura H, Yamamoto T, Nakahara K, Fuke M, Wada Y, Seto T. Intimal Sarcoma after Endovascular Abdominal Aortic Aneurysm Repair. Ann Vasc Dis 2022; 15:344-347. [PMID: 36644265 PMCID: PMC9816019 DOI: 10.3400/avd.cr.22-00057] [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: 05/23/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
Abstract
A 72-year-old man, who was treated 10 years earlier with endovascular aortic aneurysm repair, presented with a fever. Considering the concern of stent graft infection, the patient was treated with antibiotics, but his condition did not improve. He underwent stent graft resection and reconstruction with a Dacron graft. Pathological analysis of the aortic wall and computed tomography revealed recurrent intimal sarcoma, and the patient underwent resurgery. During follow-up, he underwent two additional resections for local recurrence, but he died 17 months later. Our results suggest that intimal sarcoma should be considered during the follow-up after endovascular aortic aneurysm repair.
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Affiliation(s)
- Masaki Komatsu
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan,Corresponding author: Masaki Komatsu, MD. Department of Cardiovascular Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Nagano 390-8621, Japan Tel: +81-263-37-2657, Fax: +81-263-37-2721, E-mail:
| | - Kazuki Naito
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shuji Chino
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Haruki Tanaka
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Hajime Ichimura
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takateru Yamamoto
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Ko Nakahara
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Megumi Fuke
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yuko Wada
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tatsuichiro Seto
- Department of Cardiovascular Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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4
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Pecceu S, Van Herzeele I, Deolet E, Van Dorpe J, Moreels N, Desender L, Vermassen F, Randon C. Angiosarcoma after endovascular aneurysm repair: case report and literature review. Acta Chir Belg 2022; 123:317-324. [PMID: 34937527 DOI: 10.1080/00015458.2021.2021718] [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: 11/01/2022]
Abstract
INTRODUCTION Epithelioid angiosarcoma is a rare soft tissue sarcoma with a poor prognosis. We report two cases of patients who presented with a history of lower back pain, inflammatory signs and weight loss 5 and 6 years after endovascular aortic repair (EVAR) of an elective infrarenal abdominal aortic aneurysm (AAA). Imaging suggested graft infection but tissue samples revealed an epithelioid angiosarcoma. The objective is to report the clinical presentation, investigative modalities and immunohistochemical findings of an angiosarcoma after EVAR. PATIENTS AND METHODS Two cases are described of an angiosarcoma of the aorta after EVAR. A literature search using PubMed, Embase and Web of Science was performed in English about angiosarcoma after EVAR published between 2007 and 2021. Relevant reports were selected and analysed. RESULTS Fifteen case reports were identified, including the current two cases. Time to tumour detection after EVAR ranged from 6 to 120 months with a mean interval of 68 months. Most patients underwent endovascular repair of an AAA (13/15). Males (13 male/2 female patients) were predominant with a median age of 72 years (IQR 68-78 years). Over half of the patients had metastases at the time of diagnosis (9/15), most frequently in bones and liver. CONCLUSION Diagnosis of angiosarcoma after EVAR remains challenging due to indistinctive clinical and radiological findings mimicking graft infection or endoleak. Angiosarcoma should be included in the differential diagnosis in patients previously treated with EVAR presenting with unintended weight loss, abdominal back pain and contrast enhancement of the aortic wall.AbbreviationsAAAabdominal aortic aneurysmCTAcomputed tomography angiographyCRPc-reactive proteinEVARendovascular aortic repairESRerythrocyte sedimentation rateFDGfluoro-deoxyglucoseMRImagnetic resonance imagingMeSHmedical subject headings.
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Affiliation(s)
- Stefanie Pecceu
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Isabelle Van Herzeele
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Ellen Deolet
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Jo Van Dorpe
- Department of Pathology, Ghent University Hospital, Ghent, Belgium
| | - Nathalie Moreels
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Frank Vermassen
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Caren Randon
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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5
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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: 9] [Impact Index Per Article: 2.3] [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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6
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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: 0.2] [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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7
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van Baalen EA, Hendriksz TR, Brans B, Westenend PJ, van Bommel EFH. Intimal angiosarcoma masquerading as retroperitoneal fibrosis. VASA 2020; 50:240-243. [PMID: 32657231 DOI: 10.1024/0301-1526/a000889] [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: 11/19/2022]
Abstract
We present a rare case of intimal angiosarcoma arising from the iliac artery with unusual symptoms and signs mimicking retroperitoneal fibrosis (RPF). This 84-year-old male presented with constitutional symptoms, abdominal pain, increased acute-phase reactant levels, impaired renal function and a CT-documented left-sided parailiac soft-tissue mass with unilateral extrinsic ureteric obstruction. Whole-body 18F-fluorodeoxyglucose positron emission tomography scan showed highly increased FDG-uptake in a horseshoe-like pattern surrounding the left common iliac artery, but no pathologic activity elsewhere. Further diagnostic workup revealed no signs of malignancy. Because of its location, CT-guided biopsy of the mass was precluded. A tentative diagnosis of RPF was made and treatment with Tamoxifen 20 b.i.d. was started. However, his condition gradually deteriorated, eventually succumbing to severe pneumosepsis. Autopsy revealed extensive iliac intimal angiosarcoma with infiltrative expansion to the left ureter and tumor emboli in both lungs. The present case suggests that intimal angiosarcoma should be included in the differential diagnosis of suspected RPF.
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Affiliation(s)
- Eske A van Baalen
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Boudewijn Brans
- Nuclear Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | - Eric F H van Bommel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
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8
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Whittington EA, Duncan LD, McNally MM. Pleomorphic undifferentiated aortic sarcoma presenting as persistent endoleak after endovascular aneurysm repair. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:294-297. [PMID: 31334403 PMCID: PMC6614707 DOI: 10.1016/j.jvscit.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/20/2019] [Indexed: 01/09/2023]
Abstract
Sarcomas of the aorta are rare tumors with an unknown incidence and wide variety of clinical presentations. These malignant neoplasms are often manifested in an advanced state and with symptoms of nonmalignant vascular disease owing to a delay in diagnosis. We present the case of a 78-year-old man in whom workup was initially performed for a persistently enlarging abdominal aortic aneurysm after endovascular aortic repair but who was subsequently found to have a pleomorphic undifferentiated sarcoma of the aorta.
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Affiliation(s)
- Eric A Whittington
- Department of Surgery, University of Tennessee Medical Center, Knoxville, Tenn
| | - Lisa D Duncan
- Department of Pathology, University of Tennessee Medical Center, Knoxville, Tenn
| | - Michael M McNally
- Department of Surgery, University of Tennessee Medical Center, Knoxville, Tenn
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9
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Sachpekidis C, Langer R, Kollàr A, Wartenberg J. Detection of a primary tumor in the area of the renal artery with 18F-FDG PET/CT in a patient with metastatic undifferentiated sarcoma and a history of mid-aortic syndrome: A case report. Medicine (Baltimore) 2016; 95:e4622. [PMID: 27559958 PMCID: PMC5400325 DOI: 10.1097/md.0000000000004622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We present a case of a 57-year-old woman patient with a history of mid-aortic syndrome, treated with several vascular procedures, who was referred for investigation of metastatic disease of an undifferentiated sarcoma of unknown origin. METHODS Positron emission tomography/computed tomography (PET/CT) demonstrated multiple fluorodeoxyglucose (F-FDG) avid lung, liver, and osseous metastases as well as a focus of increased F-FDG uptake in the area of the stented left renal artery. RESULT Histologic evaluation of soft tissue from the region of the left renal artery revealed atypical spindle cells, consistent with an intimal sarcoma, and with histopathological characteristics identical to those of lung metastases, indicating the F-FDG avid lesion in the area of the renal artery as the origin of the metastatic disease. CONCLUSION This case highlights the capacity of F-FDG PET/CT to detect primary tumors even of small size and in unusual localisations. Moreover, it provides further indications regarding the potential association between foreign body reaction on the basis of chronic inflammation and sarcoma development.
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Affiliation(s)
- Christos Sachpekidis
- Institute of Nuclear Medicine
- Correspondence: Christos Sachpekidis, Institute of Nuclear Medicine, University Hospital Bern, Freiburgstrasse 4, CH 3010, Bern, Switzerland (e-mail: )
| | | | - Atilla Kollàr
- Department of Medical Oncology, University Hospital Bern, Sarcoma Center Inselspital, Bern, Switzerland
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10
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Multimodality Imaging Approach towards Primary Aortic Sarcomas Arising after Endovascular Abdominal Aortic Aneurysm Repair: Case Series Report. Cardiovasc Intervent Radiol 2015; 39:940-7. [PMID: 26721588 DOI: 10.1007/s00270-015-1280-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 11/22/2015] [Indexed: 01/30/2023]
Abstract
Primary aortic neoplasms are rare. Aortic sarcoma arising after endovascular aneurysm repair (EVAR) is a scarce subset of primary aortic malignancies, reports of which are infrequent in the published literature. The diagnosis of aortic sarcoma is challenging due to its non-specific clinical presentation, and the prognosis is poor due to delayed diagnosis, rapid proliferation, and propensity for metastasis. Post-EVAR, aortic sarcomas may mimic other more common aortic processes on surveillance imaging. Radiologists are rarely knowledgeable about this rare entity for which multimodality imaging and awareness are invaluable in early diagnosis. A series of three pathologically confirmed cases are presented to display the multimodality imaging features and clinical presentations of aortic sarcoma arising after EVAR.
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11
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Staats P, Tavora F, Burke AP. Intimal sarcomas of the aorta and iliofemoral arteries: a clinicopathological study of 26 cases. Pathology 2014; 46:596-603. [DOI: 10.1097/pat.0000000000000182] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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12
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De Caridi G, Butrico L, Grande R, Massara M, Spinelli F, de Franciscis S, Serra R. Concomitant Aortic Leiomyosarcoma and Takayasu Arteritis in a 55-Year-Old Male Patient. Ann Vasc Surg 2014; 28:1931.e13-6. [DOI: 10.1016/j.avsg.2014.06.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 05/31/2014] [Accepted: 06/11/2014] [Indexed: 12/20/2022]
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13
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Rusthoven CG, Liu AK, Bui MM, Schefter TE, Elias AD, Lu X, Gonzalez RJ. Sarcomas of the aorta: a systematic review and pooled analysis of published reports. Ann Vasc Surg 2014; 28:515-25. [PMID: 24485779 DOI: 10.1016/j.avsg.2013.07.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Aortic sarcomas are rare and aggressive tumors with a propensity for arterial embolization, disseminated metastases, and rapid clinical deterioration. Overall, little is known about the evaluation and management of this disease. METHODS A systematic review and pooled analysis were performed from a comprehensive search of the MEDLINE database for reports of primary aortic sarcomas published in the English language. RESULTS One hundred sixty-five cases were analyzed. The median age was 60 years, and the male:female ratio was 1.5:1. High tumor grade (87.3%), arterial embolization (46.7%), and metastatic disease at diagnosis (44.8%) were common. Typical histologies were undifferentiated (39.4%), angiosarcomatous (37%), leiomyosarcomatous (13.3%), and fibroblastic (7.3%). Management was diverse and included combinations of surgical resection (46.7%), palliative vascular surgeries (37.7%), chemotherapy (28.7%), and radiotherapy (14.7%). The median survival was 11 months, and the 1-, 3-, and 5-year survival rates were 46.7%, 17.1%, and 8.8%, respectively. On univariate analyses, metastatic disease at diagnoses, surgical resection, and chemotherapy were associated with survival. On multivariate analysis, only metastatic disease remained significant (P < 0.001). CONCLUSIONS Aortic tumors are devastating malignancies with distinct clinical features from sarcomas at other sites. Although prognosis is poor overall, long-term survivors have been reported, and aggressive management with surgical resection and adjuvant therapy should be considered in medically suitable patients. High embolic rates suggest a potential role for prophylactic anticoagulation.
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Affiliation(s)
- Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado-Denver, Aurora, CO.
| | - Arthur K Liu
- Department of Radiation Oncology, University of Colorado-Denver, Aurora, CO
| | - Marilyn M Bui
- Department of Anatomic Pathology, Moffitt Cancer Center, Tampa, FL
| | - Tracey E Schefter
- Department of Radiation Oncology, University of Colorado-Denver, Aurora, CO
| | - Anthony D Elias
- Department of Medical Oncology, University of Colorado-Denver, Aurora, CO
| | - Xian Lu
- Department of Biostatistics and Informatics, University of Colorado-Denver, Aurora, CO
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