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Kordzadeh A, Askari A, Navi A, Patel S, Parsa AD, Charalabopoulos A. Primary angiosarcoma of aorta: A systematic review. Vascular 2021; 30:650-660. [PMID: 34238080 DOI: 10.1177/17085381211026491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To elucidate the epidemiology, anatomical, presentation, classification, pathology, investigative modalities, management and prognosis of primary angiosarcoma of the aorta. MATERIAL AND METHODS A systematic review of literature from the database inception to January 2021 in PubMed and Embase, CINAHL and Cochrane Library in accordance to PRISMA was conducted. Retrieval and extraction was performed by two independent reviewers. The hierarchy of the evidence was assessed through the National Institute for Health and Care Excellence Checklist. Data were subjected to pooled prevalence analysis, Kaplan-Meier survival and test of probability using log-rank analysis. This review is registered with International Prospective Register of Systematic Reviews: RD42021231314. RESULTS 82 studies with n = 123 cases met the inclusion criterion. Abdominal (45%) aorta was the commonest anatomical site with female predominance in ascending aorta (4:1) and aortic arch (2:1). The longest survival was in the ascending aorta and the shortest in the abdominal aorta [540 (interquartile range [IQR], 7-1560 days vs. 180 (IQR, 1-5730 days)], respectively. The overall median survival was 210 days (IQR, 1-5730 days) or 7 months. Lack of metastasis (47%) was a marker of longer survival (p < 0.03) irrespective of other attributes. CONCLUSION The pathophysiology appears to be a trend of increasing fatigue, fever and weight loss associated with segmental dysfunction of the aorta projecting occlusive or destructive phenotypes. Computed tomography angiography features of volume-occupying, bulky, polypoid (intraluminal), protrusive vegetation, hyper vascular without atherosclerotic lesions are extremely suggestive of PA of the aorta at 5th and 6th decades of life.
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Affiliation(s)
- Ali Kordzadeh
- Mid & South Essex Foundation Trust, Broomfield Hospital, Chelmsford, UK
| | - Alan Askari
- 2152Cambridge UniversityHospitals NHS Foundation Trust, Cambridge, UK
| | - Ali Navi
- 2152Cambridge UniversityHospitals NHS Foundation Trust, Cambridge, UK
| | - Sandeep Patel
- Mid & South Essex Foundation Trust, Broomfield Hospital, Chelmsford, UK
| | - Ali D Parsa
- Faculty of Health, Education, Medicine and Social Sciences, Anglia Ruskin University, Cambridge, UK
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2
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Deiana G, Genadiev G, Giordano AN, Moro M, Spanu F, Urru F, Camparini S. Infiltrating Angiosarcoma of the Ascending, Arch and Descending Aorta Manifested as Acute Mesenteric Ischemia. Vasc Specialist Int 2021; 37:46-49. [PMID: 33775936 PMCID: PMC8021497 DOI: 10.5758/vsi.200083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/01/2021] [Accepted: 03/07/2021] [Indexed: 11/20/2022] Open
Abstract
Primary malignant aortic tumors are rare and aggressive. Most cases are diagnosed at advanced stages or during autopsies with a median overall survival of 8 months from diagnosis. We present the case of a 59-year-old male with angiosarcoma involving all segments of the thoracic aorta and a large floating thrombus causing acute mesenteric ischemia, which was treated successfully with embolectomy. Graft replacement of the aorta should be considered in cases of localized disease and when patients are fit for surgery. The best medical and surgical treatment remains unclear, and further studies are needed.
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Affiliation(s)
- Giuseppe Deiana
- Department of Vascular Surgery, Brotzu Hospital, Cagliari, Italy
| | - Genadi Genadiev
- Department of Vascular Surgery, Brotzu Hospital, Cagliari, Italy
| | | | - Mario Moro
- Department of Vascular Surgery, Brotzu Hospital, Cagliari, Italy
| | - Francesco Spanu
- Department of Vascular Surgery, Brotzu Hospital, Cagliari, Italy
| | - Flavia Urru
- Department of Vascular Surgery, Brotzu Hospital, Cagliari, Italy
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3
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Lock G, Bertram M, Oelckers M, Bitz U, Zipfel B, Jacobsen F. An Unusual Case of Iron-Deficiency Anemia: The Culprit Hides in the Aorta. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 59:551-555. [PMID: 33233005 DOI: 10.1055/a-1302-8340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In a 72-year-old patient with anemia (Hb 7 g/dl), duodenoscopy exhibited an area of polypous irregular-looking mucosa. Histology revealed duodenal infiltration by epithelioid tumor cells, immunhistochemically positive for endothelial cell markers (CD34, CD31, ERG). Ultrasonography showed thrombotic material in the otherwise unremarkable abdominal aorta with some uptake of contrast bubbles on CEUS. Histological and clinical diagnosis assumed an epithelioid angiosarcoma of the thoraco-abdominal aorta at the level of the visceral and renal arteries with duodenal metastases.To prevent further shedding of tumor cells and aortic rupture, a branched stent-graft was placed into the thoraco-abdominal aorta. Palliative chemotherapy with gemcitabine and docetaxel was started, leading to a partial remission after 6 cycles. Three months later, however, there was a progress of the duodenal masses with new pulmonal and osseous metastases. Thirteen months after the initial diagnosis, death occured due to a hemorrhagic shock caused by a hematothorax.Aortic tumors are exceedingly rare, with only slightly more than 220 cases reported so far. In most cases, diagnosis is made either at autopsy or after an emergency operation for embolic complications like embolic intestinal ischemia. With an overall median survival of 8 months, prognosis is very poor.This case sensitizes for the correct sonographic interpretation of aortic "thrombi" in an otherwise normally appearing aorta, possibly with the aid of CEUS. Besides, it demonstrates the relatively early and uncommon diagnosis of an aortic angiosarcoma by the combination of endoscopy, immunohistochemistry, and ultrasonography.
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Affiliation(s)
- Guntram Lock
- Klinik für Innere Medizin, Albertinen-Krankenhaus, Hamburg, Germany
| | | | - Michael Oelckers
- Klinik für Innere Medizin, Albertinen-Krankenhaus, Hamburg, Germany
| | - Ulrich Bitz
- Helios Klinikum Buch, Sarkomzentrum Berlin-Brandenburg, Berlin, Germany
| | - Burkhart Zipfel
- Dept. Endovaskuläre Chirurgie, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - Frank Jacobsen
- Institut für Pathologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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4
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Ricchetti T, Paci M, Cavazza A, Ferrari G, Annessi V, De Franco S, Sgarbi G. A Case of Metastatic Epithelioid Angiosarcoma in the Lamina Propria of a Sigmoid Tubulovillous Adenoma. TUMORI JOURNAL 2019; 91:210-2. [PMID: 15948556 DOI: 10.1177/030089160509100222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Epithelioid angiosarcoma is an extremely rare tumor. It is generally a secondary tumor and the preferred sites of such metastases are the heart, pericardium, lung, breast, liver, spleen, bone, and brain. In rare cases the lung has been described as the primary site. The prognosis of this neoplasm is extremely poor. We report a case of epithelioid angiosarcoma with multiple bilateral lung infiltration, bone metastasis, and metastasis of the lamina propria of a tubulovillous adenoma of the colon.
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Affiliation(s)
- Tommaso Ricchetti
- Department of Thoracic Surgery and Pathology, Santa Maria Nuova Hospital, Reggio Emilia, Italy.
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5
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Lv L, Xu P, Shi Y, Hao J, Hu C, Zhao B. Imaging features of soft tissue epithelioid angiosarcoma in the lower extremity: A case report. Oncol Lett 2016; 11:3457-3460. [PMID: 27123135 DOI: 10.3892/ol.2016.4407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 12/10/2015] [Indexed: 02/03/2023] Open
Abstract
Epithelioid angiosarcomas are extremely rare malignant tumors formed from endothelial cells. The majority of studies reporting these tumors have been concerned with the clinical and pathological aspects, with limited reporting of radiological diagnosis. The aim of the present study was to provide a reference to improve understanding of diagnosis, treatment choice and prognosis assessment of epithelioid angiosarcoma. The current study reports the case of a 44-year-old woman with epithelioid angiosarcoma located in the deep soft tissue of the lower extremities. Physical examination of the right thigh revealed a palpable hard mass and movement was clearly restricted and painful. X-ray, computed tomography (CT) scans and magnetic resonance imaging (MRI) were used to evaluate the imaging features of the tumor. Using X-ray and CT scanning, an inhomogenous tumor with osteolytic osseous destruction was observed. MRI revealed that the bordering skeletal muscles were infiltrated. The patient was treated with palliative surgery and chemotherapy, but succumbed to disease 1 year later.
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Affiliation(s)
- Lulu Lv
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Peng Xu
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu 221006, P.R. China
| | - Yibing Shi
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Jingming Hao
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Chunai Hu
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Baozhong Zhao
- Department of Computed Tomography and Magnetic Resonance Imaging, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
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6
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Rotura de aorta torácica descendente afectada por un angiosarcoma. Cir Esp 2014; 92:501-3. [DOI: 10.1016/j.ciresp.2012.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 07/14/2012] [Accepted: 08/09/2012] [Indexed: 11/19/2022]
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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. [DOI: 10.1016/j.avsg.2013.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 12/19/2022]
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8
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Matzke LAM, Knowling MA, Grant D, Cupples JB, Leipsic J, Ignaszewski A, Allard MF. A rare cardiac neoplasm: case report of cardiac epithelioid angiosarcoma. Cardiovasc Pathol 2010; 20:e197-201. [PMID: 21081277 DOI: 10.1016/j.carpath.2010.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Revised: 08/24/2010] [Accepted: 09/08/2010] [Indexed: 01/18/2023] Open
Abstract
Primary cardiac angiosarcoma is a rare neoplasm and the epithelioid variant is exceedingly rare. We report a case of an epithelioid angiosarcoma that involved the right atrium and aorta of a 47-year-old male. The patient presented with atrial fibrillation and presyncopal spells. Following clinical evaluation, including computed tomography scan and trans-esophageal echocardiography, the neoplasm was surgically removed. It was a poorly differentiated malignant neoplasm composed of medium-sized epithelioid cells with a moderate amount of amphophilic cytoplasm. Immunohistochemical staining, including positive staining for CK22, AE1/AE3, melan-A, vimentin, and CD31, indicated the neoplasm was best categorized as an epithelioid angiosarcoma.
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10
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Sattout AH, Deolekar MV, Tait WF, Williams GT. Femoral artery angiosarcoma presenting with distal embolization: Report of a case. Surg Today 2008; 38:541-4. [DOI: 10.1007/s00595-007-3643-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Accepted: 06/21/2007] [Indexed: 10/22/2022]
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11
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Chen TJ, Chiou CC, Chen CH, Kuo TT, Hong HS. Metastasis of mediastinal epithelioid angiosarcoma to the finger. Am J Clin Dermatol 2008; 9:181-3. [PMID: 18429648 DOI: 10.2165/00128071-200809030-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Epithelioid angiosarcoma (EA) is a rare malignant, vascular tumor that is usually observed in middle-aged and elderly males. Cutaneous metastasis of EA is extremely rare. We report the case of a 41-year-old woman presenting with a painful bluish, bulla-like lesion on the distal extent of the left third finger. The patient had recently been diagnosed with mediastinal EA with disseminated metastases. The skin biopsy specimen revealed metastatic EA. This is thought to be the first reported metastasis of EA to the finger. Whenever a patient has metastatic disease, acrometastases should be considered in the differential diagnosis of inflammatory lesions of the digits and a skin biopsy should be performed.
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Affiliation(s)
- Ting-Jui Chen
- Department of Dermatology, Buddhist Tzu Chi General Hospital, Taipei, Taiwan
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12
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Astudillo L, Cron C, Gomez-Brouchet A, Couret B, Arlet-Suau E. [Angiosarcoma of the aorta]. Rev Med Interne 2007; 28:718-20. [PMID: 17587469 DOI: 10.1016/j.revmed.2007.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2006] [Revised: 05/12/2007] [Accepted: 05/15/2007] [Indexed: 11/30/2022]
Abstract
Primary aortic tumors are extremely rare. A 73-year-old woman presented with a 8 kg weight loss associated with abdominal pain. Physical examination was normal. Laboratory tests disclosed increased acute phase reactants. Thoracic and abdominal CT scan showed diffuse splenic and renal hypodense lesions with thrombotic feature of the thoracic aorta extending on 9 cm length. Transesophageal echocardiography showed a large and heterogeneous floating mass advocating a thrombus developed on atheroma. Because of the high risk of embolism the patient underwent surgical replacement of the thoracic aorta. Histopathology revealed an epithelioid angiosarcoma of the aorta. A primary tumor of the aorta should be suspected in the presence of an intra-aortic process presenting features of thrombosis.
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Affiliation(s)
- L Astudillo
- Service de médecine interne, CHU Purpan, 1 place du Docteur-Baylac, 31059 Toulouse, France.
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13
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Dehqanzada ZA, Menezes G, Mukherjee D. Epithelioid angiosarcoma of the aorta in a 47-year-old man: a case report and literature review. JOURNAL OF SURGICAL EDUCATION 2007; 64:165-70. [PMID: 17574179 DOI: 10.1016/j.jsurg.2007.01.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2006] [Revised: 01/20/2007] [Accepted: 01/22/2007] [Indexed: 05/15/2023]
Abstract
Epithelioid angiosarcomas of the aorta are extremely rare neoplasms with only 26 previous reports in the literature. An extremely unusual case is reported of an aortic epithelioid angiosarcoma diagnosed in a 47-year-old man who was being evaluated for his rectal adenocarcinoma. This case prompted a review of literature for aortic intimal neoplasms. No previous reports of a synchronous aortic angiosarcomas and adenocarcinomas of the colorectum have been reported. Even though the occurrence of the aortic intimal neoplasia and rectal cancer in this patient is most likely coincidental, the onset of this disease in a young man without risk factors for either disease probably suggests a genetic basis of his disease.
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Affiliation(s)
- Zia A Dehqanzada
- Department of Vascular Surgery, Fairfax INOVA Hospital, Fairfax, Virginia, USA.
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14
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Abularrage CJ, Weiswasser JM, White PW, Arora S, Sidawy AN. Aortic Angiosarcoma Presenting as Distal Arterial Embolization. Ann Vasc Surg 2005; 19:744-8. [PMID: 16027993 DOI: 10.1007/s10016-005-5436-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aortic angiosarcoma is a rare, malignant neoplasm of the vasculature, with 24 case reports in the literature. Patients usually present with either aneurysmal or occlusive disease. Treatment consists of en bloc resection of the vessel and contiguous structures with postoperative chemoradiation therapy. Despite surgery and adjunctive measures, prognosis remains dismal as a result of early metastasis and late diagnosis. We report a case of aortic angiosarcoma that presented with distal thromboembolic phenomenon.
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Affiliation(s)
- Christopher J Abularrage
- Surgical Service, Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC, 20422, USA.,
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15
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Thalheimer A, Fein M, Geissinger E, Franke S. Intimal angiosarcoma of the aorta: Report of a case and review of the literature. J Vasc Surg 2004; 40:548-53. [PMID: 15337887 DOI: 10.1016/j.jvs.2004.06.035] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although extremely rare, the group of primary malignant tumors of the aorta (PMTA) exhibits enormous histologic heterogeneity. In most cases, diagnosis is established late in the course of the disease; the median survival time is only a few months. We present the case of a 75-year-old patient with an intimal angiosarcoma of the infrarenal abdominal aorta and discuss the clinical presentation, histopathologic diagnosis, and classification of primary aortic sarcomas. A critical review of the diagnostic and therapeutic management in this case revealed that the atypical aortic thrombus should have prompted a comprehensive preoperative diagnostic work-up, specifically with magnetic resonance tomography of the aorta and bone scintigraphy.
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