Histopathology of Spindle Cell Vascular Tumors

A Case Report of Metastatic Retroperitoneal Angiosarcoma Mimicking Reactive Angioendotheliomatosis

Angiosarcoma is a malignant proliferation of vascular and lymphoendothelial origin. In terms of pathology outlines, this entity may resemble other growths derived from blood vessels. Reactive angioendotheliomatosis, an intravascular proliferation, is frequently hard to discern histologically from angiosarcoma. In this study, we outline a case initially presenting with features supporting reactive angioendotheliomatosis. Clinical progression and inconclusive histopathology raised suspicion, and further investigation was decided. Computed tomography imaging revealed a large retroperitoneal tumor, and subsequent surgery with additional histological examinations of the excised mass and cutaneous samples was performed, along with immunohistostaining. As a result, diagnosis and prognosis pointed to an entirely different direction.

Complete remission in a rare pelvic angiosarcoma with liposomal doxorubicin: A comprehensive case report and review of literature

Angiosarcoma, an aggressive sarcoma subtype originating from lymphatic or vascular endothelial cells, is rare, constituting less than 2% of all soft tissue sarcomas. Predominantly affecting adult and elderly patients, it manifests diversely across various anatomical locations, with cutaneous lesions being the most common, particularly in the head and neck region. Noteworthy for its infiltrative nature, angiosarcoma demonstrates high rates of local recurrence and metastasis, leading to poor overall survival. The diagnosis may be difficult due to nonspecific clinical symptoms, and histological examination is essential in this disease. Treatment typically requires radical surgery, with addition of either chemo- or radiotherapy, or occasionally both, but there is a lack of formal evidence for the order of the modalities employed. Emerging therapies, such as targeted medicines and immunotherapy, show promising results in improving outcomes. This report presents a comprehensive analysis of a rare case of a young male with pelvic angiosarcoma. The patient underwent multiple operations, chemotherapy, and radiation, which highlights the complexities in management and the need for a multidisciplinary approach. Despite challenges, the patient achieved complete remission and is disease-free over 16 years after pelvic exenteration, demonstrating the potential for successful long-term outcomes. The case underscores the importance of personalized, multimodal treatment plans and close collaboration between surgeons and oncologists. Continued research into tailored therapies offers hope for improved prognosis and quality of life for individuals facing this uncommon sarcoma.

Classic Kaposi sarcoma: Diagnostics, treatment modalities, and genetic implications - A review of the literature

BACKGROUND AND PURPOSE

Classic Kaposi sarcoma (CKS) is a rare vascular disease mainly found in populations of Mediterranean origin. The pathogenesis involves Human Herpes Virus 8 (HHV8) and genetic mutations such as SNP309 in the MDM2 gene. The recently discovered BPTF mutation in cells of CKS patients demonstrated higher latency-associated nuclear antigen (LANA) staining and altered vital transcriptomics, implicating a potential role in tumorigenesis. This review explores the genetic underpinnings and treatments for CKS.

MATERIAL AND METHODS

A comprehensive literature search was conducted from 2004 to 2024, yielding 70 relevant papers. Ongoing clinical trials investigating novel treatments such as talimogene and abemaciclib were included in the search and presented in the results.

RESULTS

Clinical diagnosis and treatment can be challenging as the number of studies on CKS and treatment modalities is limited. Treatment strategies vary by disease stage, with local therapies like surgical intervention and radiation therapy recommended for early stages, while systemic therapies are considered in cases of systemic disease.

INTERPRETATION

While advancements in CKS treatment offer hope, further studies on immunotherapy are warranted to broaden the therapeutic options, such as anti-bromodomain or BPTF-targeted therapy.

Kaposi sarcoma in an individual recently diagnosed with HIV

Kaposi Sarcoma (KS) commonly manifests with multiple vesicular cutaneous and mucosal nodules, with four subtypes clinically recognized. Although commonly seen in younger men, our patient presented with presumed epidemic KS at an older age. Additionally, our patient presented with Kaposi sarcoma during primary HIV infection which is atypical for Kaposi sarcoma presentation. The patient's clinical course is important to follow, as his rectal involvement indicates the patient would benefit from systemic therapy. Furthermore, our case highlights the need for a keen clinical index of suspicion in all patients with new HIV diagnosis and new onset suspicious lesions, regardless of age.

Fine-Needle Aspiration of Sarcomas Metastatic to Lymph Nodes: A Cytomorphologic Study over a 10-Year Period

INTRODUCTION

Metastasis of sarcomas to lymph nodes is an uncommon event in its natural history. We aimed to present our experience with fine-needle aspiration (FNA) of metastatic sarcomas to lymph nodes over a 10-year period.

MATERIAL AND METHODS

The cytopathology archives were searched for FNA of lymph nodes involved by metastatic sarcomas. Available clinicopathologic data were recorded. All slides were retrieved and reviewed.

RESULTS

Thirty-three lymph nodes, from 30 patients, with metastatic soft tissue sarcomas were identified. The lymph node metastases occurred in 16 males and 14 females (median age, 56 years). The size of the lymph nodes ranged from 1.2 to 7.5 cm (median size, 2.9 cm). The inguinal lymph nodes were the most commonly involved nodes, followed by thoracic and cervical neck nodes. The most common metastatic soft tissue sarcoma encountered was Kaposi sarcoma (n = 7, 23.3%), followed by angiosarcoma (n = 6, 20%) and rhabdomyosarcoma (n = 6, 20%). The most common site of primary soft tissue sarcoma was the head and neck (n = 8, 26.6%), followed by lower extremity (n = 7, 23.3%). The initial diagnosis of sarcoma was established in 6 cases. Seventen patients had metachronous involvement of lymph nodes, while the remaining patients had synchronous involvement. Seventen patients died of disease, and the survival after lymph node metastasis ranged from 1 to 43 months.

CONCLUSION

FNA is an accurate and effective method in the diagnosis of metastatic sarcoma to lymph nodes. Knowledge of clinical findings and primary tumor diagnosis along with careful assessment of the cytomorphology is extremely helpful for an accurate diagnosis of metastases.

Spindle cell hemangioma of the lung: An unusual presentation

Spindle cell hemangioma (SCH) is a benign vascular tumour, first identified by Weiss and Enzinger in 1986. Habitually, the SCH affects almost exclusively the dermis and subcutaneous tissues of distal extremities. So far, only 2 cases have been described in the lung. We describe herein the third case of SCH occurring in the lung in a 47 year-old woman. The patient was successfully treated by right lower lobectomy. The histopathological and immunohistochemistry examination of the excised tumour leads to the definitive diagnosis. Our case is instructive by its different clinical and radiological presentation compared to the previous two cases.

Rare case of spindle cell haemangioma of oral cavity

Spindle cell haemangioma (SCH) is a slow growing, benign vascular lesion with a preference for the distal extremities. Its occurrence in the oral cavity is rare. Clinically, it presents as solitary or multiple subcutaneous nodules, therefore, it could be considered in the differential diagnosis of benign soft tissue tumours. Microscopically it mimics some malignant vascular tumours and it is necessary to differentiate it from other malignant vascular lesions. We report a case of SCH in anterior mandibular region of a young male in his 20s. Although it is a benign lesion, the reported case displayed extensive areas of muscle infiltration and necrosis. After studying the radiographic findings and considering the absence of cellular atypia, a final diagnosis of SCH was made. Literature survey suggests that this is the eleventh case of SCH reported in oral cavity.

CT angiography and MRI of hand vascular lesions: technical considerations and spectrum of imaging findings

Vascular lesions of the hand are common and are distinct from vascular lesions elsewhere because of the terminal vascular network in this region, the frequent hand exposure to trauma and microtrauma, and the superficial location of the lesions. Vascular lesions in the hand may be secondary to local pathology, a proximal source of emboli, or systemic diseases with vascular compromise. In most cases, ischaemic conditions are investigated with Doppler ultrasonography. However, computed tomography angiography (CTA) or dynamic contrast-enhanced magnetic resonance angiography (MRA) is often necessary for treatment planning. MR imaging is frequently performed with MRA to distinguish between vascular malformations, vascular tumours, and perivascular tumours. Some vascular tumours preferentially affect the hand, such as pyogenic granulomas or spindle cell haemangiomas associated with Maffucci syndrome. Glomus tumours are the most frequent perivascular tumours of the hand. The purpose of this article is to describe the state-of-the-art acquisition protocols and illustrate the different patterns of vascular lesions and perivascular tumours of the hand.

Successful Outcome After Intralesional Curettage for Spindle Cell Hemangioma of Fibula in an Infant: A Case Report

Spindle cell hemangioma (SCH), a non-neoplastic reactive vascular lesion, rarely locates in bones. We herein report a successful case of intralesional curettage for an infant with SCH of fibula. An 11-month-old boy was admitted to our center with a painless mass in the right proximal calf. Preoperative digital radiograph demonstrated a massive vascular lesion with an irregular bone destruction of proximal fibula. The lesion was removed via the intralesional curettage approach and pathologically diagnosed as SCH. The patient gained bone structure recovery of right proximal fibula. Two years after the surgery, he experienced no local recurrence. For the management of SCH of fibula with partial bone destruction, we suggest early-stage intralesional curettage as its safety and effectiveness.

Angiosarcomas: histology, immunohistochemistry and molecular insights with implications for differential diagnosis

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.

The course of Kaposi's sarcoma, a marker disease for the initial diagnosis of AIDS, under ongoing cART

While Kaposi's sarcoma (KS) was common in the 1980s and early 1990s in HIV-positive patients and one of the most common AIDS-defining diseases, its prevalence today has decreased significantly due to the early and widespread use of chimeric antigen receptor T-cell (cART) therapy. The rapid initiation of cART or, if occurring during ongoing cART, an optimization of antiretroviral therapy leads to a healing of this tumour disease in most patients. The aim of the therapy is immune reconstitution, as the immunodeficiency resulting from the HIV disease (reduced CD4+-T helper cells) promotes the development and spread of KS. This case report describes the course of KS in the first diagnosis of AIDS in a 36-year-old patient. The HIV copy count was below the detection limit and the CD3+/CD4+ T-helper cell count was only slightly below the normal value in the six-month follow-up after initial diagnosis and initiation of cART therapy. However, the clinical findings in the one-year follow-up showed only a partial response, whereby it was noted that new tumour lesions also developed focally in addition to individual progressive lesions. This was demonstrated clinically, dermatoscopically and by laser Doppler fluxmetry measurements of the lesions. Such a progression was observed in about one-third of the patients affected in various studies and is called Immune Reconstitution Inflammatory Syndrome. Other therapies in addition to cART are necessary here to suppress this immunological phenomenon (including cytostatic drugs). Promising studies are currently underway, including utilising checkpoint inhibitors. These are of great therapeutic interest due to the high immunological activity of KS itself and usually of systemic inflammatory response syndrome.

Spindle cell hemangioma in the infratemporal fossa: A unique case report

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Spindle cell hemangioma (SCH) is a rare vascular tumor that was considered to be intermediate -or low-grade malignancy, with biological behavior between a hemangioma and angiosarcoma.

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The SCH is commonly found in the distal extremities. So far, only 16 cases have been described in the head and neck area. No previous case has been described in the infratemporal fossa.

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SCH shows a proliferation of spindle cells composed of endothelial cells, pericytes and fibroblasts between dilated vascular spaces and immunoreactivity to endothelial markers.

Introduction

Spindle cell hemangioma (SCH) is a rare vascular tumor which was first described in 1986. It affects mostly the distal extremities. The head and neck are rarely involved. This article reports the first case of SCH in the infratemporal fossa.

Presentation of case

A 41-year-old woman presented with an 8-month history of right cheek swelling. Facial CT scan and MRI showed an intensely and heterogeneously enhancing tumor of the infratemporal fossa suggesting an angiomatous neoplasm. The mass was excised surgically through an anterior maxillary approach. The histopathological and immunohistochemistry analysis revealed a SCH.

Conclusion

This case report presents a unique presentation of a Spindle cell hemangioma in an unexpected location of the head and neck region. it underlines the importance for clinicians and pathologists to consider the Spindle cell hemangioma as a possible etiological diagnosis of infratemporal fossa tumors.

CT and MRI Findings of Glomangiopericytoma in the Head and Neck: Case Series Study and Systematic Review

Glomangiopericytoma is a rare sinonasal mesenchymal tumor of borderline or low malignant potential. We reviewed the CT and MR imaging findings of head and neck glomangiopericytoma via a retrospective case series study and systematic review. Our study revealed that glomangiopericytoma is a well-defined lobulated avidly enhancing soft-tissue mass with erosive bony remodeling that is most commonly found in the sinonasal cavity. Typically, it is hyperintense on T2-weighted images with vascular signal voids, has a high mean ADC value, and a wash-in and washout pattern on dynamic contrast-enhanced MR imaging. Although the CT findings are nonspecific, typical MR imaging findings, including those on the ADC map and dynamic contrast-enhanced MR imaging, may be helpful for differentiating glomangiopericytomas from other hypervascular tumors in the head and neck.

Multiple spindle cell hemangiomas in both lungs: a rare case report and review of the literature

Background

Spindle cell hemangioma (SCH) was an extremely rare benign tumor which typically arised in the subcutis of the distal extremities of young people. In this study, we reported a case of multiple spindle cell hemangioma in both lungs.

Case presentation

A 19-year-old HIV-negative female was found to have multiple lung nodules by the chest X-ray during the physical examination. Her chest CT scan revealed multiple round-like pulmonary nodules in both lungs. Based on the morphological features and immunohistochemical examination for vascular markers CD31, CD34 and D2–40, the mass was diagnosed as SCH after surgery.

Conclusion

SCH was an extremely rare tumor especially in both lungs. It should be considered in differential diagnosis of multiple lung nodules. Pathological features, the expression of CD31, CD34 and D2–40 could help to diagnosis of SCH.

Spindle cell hemangioma of the spleen: A case report

RATIONALE

Spindle cell hemangioma (SCH) is considered a benign vascular lesion. It typically develops as a solitary nodule or multiple masses located in the dermal or subcutaneous layers of the distal extremities. To the best of our knowledge, there are no prior reports of SCH in the spleen.

PATIENT CONCERNS

A 41-year-old male was admitted to our hospital with recurrent headaches, nausea, and vomiting persisting for 5 days. Ultrasound, computed tomography, and magnetic resonance imaging revealed multiple space-occupying lesions in the spleen, and the biggest lesion was 4.8 cm × 5.4 cm in size.

INTERVENTIONS

The patient underwent laparoscopic splenectomy.

DIAGNOSIS

A diagnosis of spindle cell hemangioma of the spleen was made based on the histopathology.

OUTCOMES

No evidence of local recurrence or distant metastases was observed over 4-year follow-up.

LESSONS

Splenic SCH may exhibit relatively high proliferative activity and be comorbid with epithelioid hemangioendothelioma or angiosarcoma, raising the possibility of malignant potential. However, the patient remained alive and disease-free 4 years after the operation. The nature of SCH in deep soft tissues requires further study.

Cutaneous Spindle Cell Neoplasms: Pattern-Based Diagnostic Approach

Context.—

Spindle cell neoplasms arising in the skin comprise a heterogeneous group of tumors with divergent lineages. Cutaneous spindle cell neoplasms are relatively common and present surgical pathologists with diagnostic challenges. Recognition of their histopathologies is important for correct diagnosis and management. The current review presents a pattern-based diagnostic approach to common cutaneous spindle cell neoplasms that often cause diagnostic difficulties.

Objective.—

To provide a useful guide for diagnosis of cutaneous spindle cell neoplasms.

Data Sources.—

PubMed (US National Library of Medicine) reports and the authors' personal experiences are reviewed.

Conclusions.—

The authors briefly summarize the histologic features and differential diagnoses of common cutaneous spindle cell neoplasms.

Cutaneous Malignant Vascular Neoplasms

Accurate diagnosis of cutaneous malignant vascular tumors, including angiosarcoma and epithelioid hemangioendothelioma, is critical for determination of appropriate clinical management and prognosis. Although there have been significant advances in understanding genetic aspects of cutaneous vascular biology, differential diagnosis of malignant vascular tumor involving skin and superficial soft tissue is a frequent source of difficulty. This brief overview highlights the clinicopathologic features of primary and secondary cutaneous angiosarcoma and epithelioid hemangioendothelioma and also provides a short summary of newer molecular data.