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Gao L, Wang Y, Fu S, Cai S, Li J, Yang X. Pitfalls of ultrasound for deep vein thrombosis of the lower extremities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38597807 DOI: 10.1002/jcu.23689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/19/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
Venous ultrasound is the primary, widely accepted diagnostic tool to assess deep vein thrombosis (DVT) in the lower extremities. However, other focal lesions in the lower extremities can be identified on ultrasound. The sonographic appearance of these abnormalities may overlap the thrombosis, which included vascular tumors, Baker's cyst, hematoma, cancer thrombosis, and peripheral nerve tumors. This essay derives from cases diagnosed in our centers and published literature, with images available for illustrations, which may help to improve the clinical management of these findings.
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Affiliation(s)
- Luying Gao
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yahong Wang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shuai Fu
- Department of Ultrasound, Peking University Third Hospital, Beijing, China
| | - Sheng Cai
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Yang
- Department of Ultrasound, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Liu YT, Wang J, Sui YX, Zhao DL. Coexistence of submandibular epithelioid angiosarcoma and papillary thyroid carcinoma: A case report. Medicine (Baltimore) 2022; 101:e29341. [PMID: 35777039 PMCID: PMC9239595 DOI: 10.1097/md.0000000000029341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Reports on the coexistence of epithelioid angiosarcoma (EA) and papillary thyroid carcinoma (PTC) are rare. Over the past 50 years, only 2 cases of coexistence of EA and PTC have been reported in English literature. Therefore, we report a rare case of coexistence of EA and PTC treated with surgery and adjuvant radiation therapy. PATIENT CONCERNS A 64-year-old man visited our hospital with a painless mass in the left submandibular gland, with poor mobility. DIAGNOSIS Neck ultrasonography revealed nodules in the left submandibular gland and multiple cystic-solid mixed nodules in the left thyroid gland. Pathological findings revealed coexistence of EA in the left submandibular gland area and PTC in the left thyroid gland. INTERVENTIONS The patient underwent resection of the left submandibular gland, deep maxillofacial tumor, total thyroidectomy, left neck I, II, III, and VI regional lymph node dissection, and recurrent laryngeal nerve exploration under general anesthesia. Two months postoperatively, the patient also received adjuvant radiation therapy in the local and adjacent areas, with 4MV-X IMRT DT50GY at 2Gy/day 25 fractions. OUTCOMES The follow-up period was 37 months. The patient recovered well without focal neurological deficits, local recurrence, or distant metastasis after surgery, except for grade I skin reaction after adjuvant radiation therapy. CONCLUSIONS This is a rare case report of the coexistence of EA in the left submandibular gland and PTC in the left thyroid gland. Although multiple examinations were used, precise preoperative diagnosis was challenging owing to the coexistence of EA and PTC. Surgery and radiotherapy were effective treatments for the coexistence of EA and PTC in this case.
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Affiliation(s)
- Yi-Ting Liu
- Department of Oncological Radiotherapy, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Medical Oncology, Yan’an University Affiliated Hospital, Yan’an, Shaanxi Province, China
| | - Jing Wang
- Department of Endocrinology, Yan’an University Affiliated Hospital, Yan’an, Shaanxi Province, China
| | - Yan-Xia Sui
- Department of Pathology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- *Correspondence: Dong-Li Zhao, Department of Oncological Radiotherapy, First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi’an 710061, Shaanxi Province, China (e-mail: )
| | - Dong-Li Zhao
- Department of Oncological Radiotherapy, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- *Correspondence: Dong-Li Zhao, Department of Oncological Radiotherapy, First Affiliated Hospital of Xi’an Jiaotong University, 277 West Yanta Road, Xi’an 710061, Shaanxi Province, China (e-mail: )
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Markidan J, Hardy N, Kallen M, Ma L. Epithelioid hemangioma involving large arteries in the skin. J Cutan Pathol 2021; 49:377-380. [PMID: 34755378 DOI: 10.1111/cup.14166] [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: 07/10/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 11/28/2022]
Abstract
Epithelioid hemangioma (EH) is a benign vascular lesion, typically consisting of small vascular channels lined by epithelioid endothelial cells and associated with a dense lymphocytic infiltrate with eosinophils. Here, we report a rare case of EH involving large arteries. The patient presented with a 9-month history of an asymptomatic nodule on the forehead, which was thought to be an epidermal inclusion cyst. Skin biopsy revealed large arteries with clusters of epithelioid cells in the vascular walls and lumen. Scattered eosinophils were noted in the walls. Adjacent areas showed groups of small-caliber vessels lined by prominent endothelial cells and associated with a dense lymphoid infiltrate with eosinophils. No significant cytologic atypia was noted. Given the presence of the classic small-vessel involvement, along with CD31 reactivity for the epithelioid cells in the large vessels, the findings are classified as EH involving large arteries, which is an uncommon subtype. There have only been a handful of such cases reported in the literature.
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Affiliation(s)
- Janina Markidan
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Naomi Hardy
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Michael Kallen
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Linglei Ma
- Weill Cornell Medicine, New York, New York, USA
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Jung R, Janardhan HP, Dresser K, Cotton JL, Hutchinson L, Mao J, Trivedi CM. Response by Jung et al to Letter Regarding Article, "Sustained Activation of Endothelial YAP1 Causes Epithelioid Hemangioendothelioma". Arterioscler Thromb Vasc Biol 2021; 41:e493-e495. [PMID: 34550712 DOI: 10.1161/atvbaha.121.316810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Roy Jung
- Division of Cardiovascular Medicine (R.J., H.P.J., C.M.T.), University of Massachusetts Medical School, Worcester.,Department of Medicine (R.J., H.P.J., C.M.T.), University of Massachusetts Medical School, Worcester
| | - Harish P Janardhan
- Division of Cardiovascular Medicine (R.J., H.P.J., C.M.T.), University of Massachusetts Medical School, Worcester.,Department of Medicine (R.J., H.P.J., C.M.T.), University of Massachusetts Medical School, Worcester
| | - Karen Dresser
- Department of Pathology (K.D., L.H.), University of Massachusetts Medical School, Worcester
| | - Jennifer L Cotton
- Department of Molecular, Cell, and Cancer Biology (J.L.C., J.M., C.M.T.), University of Massachusetts Medical School, Worcester.,Li-Weibo Institute for Rare Diseases Research (J.L.C., J.M., C.M.T.), University of Massachusetts Medical School, Worcester
| | - Lloyd Hutchinson
- Department of Pathology (K.D., L.H.), University of Massachusetts Medical School, Worcester
| | - Junhao Mao
- Department of Molecular, Cell, and Cancer Biology (J.L.C., J.M., C.M.T.), University of Massachusetts Medical School, Worcester.,Li-Weibo Institute for Rare Diseases Research (J.L.C., J.M., C.M.T.), University of Massachusetts Medical School, Worcester
| | - Chinmay M Trivedi
- Division of Cardiovascular Medicine (R.J., H.P.J., C.M.T.), University of Massachusetts Medical School, Worcester.,Department of Medicine (R.J., H.P.J., C.M.T.), University of Massachusetts Medical School, Worcester.,Department of Molecular, Cell, and Cancer Biology (J.L.C., J.M., C.M.T.), University of Massachusetts Medical School, Worcester.,Li-Weibo Institute for Rare Diseases Research (J.L.C., J.M., C.M.T.), University of Massachusetts Medical School, Worcester
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Yan H, Zhou C, Yan F, Wen X, Luo Y. Case 290: Intravascular Cystic Synovial Sarcoma. Radiology 2021; 299:730-735. [PMID: 34029167 DOI: 10.1148/radiol.2021192863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
History A 26-year-old man presented with a 1-month history of chest pain, a palpable and painful right inguinal mass, and edema in the right lower extremity. One month earlier, he started to experience left chest pain with no cough. Pulmonary CT angiography (CTA) revealed a left lower lobe segmental pulmonary embolus. The local hospital made a diagnosis of pulmonary embolism. He received anticoagulants, and his chest pain was gradually relieved. At the time of current presentation, the patient was experiencing right lower extremity swelling and pain. Physical examination revealed a 4 × 3 cm palpable right inguinal mass with no redness. His medical history and family history were negative. The results of laboratory work-up were normal, with a d-dimer level of 0.16 mg/L fibrinogen equivalent units (reference range, <0.46 mg/L) and an international normalized ratio of 2.45 (therapeutic range, 2.0-3.0 for a patient taking warfarin), except the prothrombin time was 28.2 seconds (reference range, 9.6-12.8 seconds) and the activated partial thromboplastin time was 52.2 seconds (reference range, 24.8-33.8 seconds). Echocardiography, chest radiography, chest CT, and contrast-enhanced (CE) CT revealed no abnormalities. The patient underwent right lower extremity vascular conventional US (Philips IU22; Philips) with an L9-3 probe (3-9 MHz, venous condition) and contrast-enhanced US (1.5-2.0 mL, SonoVue; Bracco) with an intravenous bolus injection at the initial evaluation. Two days later, noncontrast and contrast-enhanced CT images of the lower abdomen (1.5 mL per kilogram of body weight, 300 mg/mL iomeprol, Iomeron; Bracco) were acquired for further evaluation.
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Affiliation(s)
- Hualin Yan
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Chenyun Zhou
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Feng Yan
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Xiaorong Wen
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
| | - Yan Luo
- From the Departments of Medical Ultrasound (H.Y., C.Z., X.W., Y.L.) and Medical Ultrasound, Laboratory of Ultrasound Imaging Drug (F.Y.), West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China
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Yven C, Gouny P, Nasr B. Epithelioid Hemangioendothelioma of the Lower Limb, Discovered by a Claudication. Ann Vasc Surg 2020; 72:665.e1-665.e4. [PMID: 33227473 DOI: 10.1016/j.avsg.2020.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/27/2020] [Accepted: 10/04/2020] [Indexed: 01/17/2023]
Abstract
Epithelioid hemangioendothelioma (EHE) is a rare case of a tumor with different clinical behaviors and a difficult anatomopathological diagnosis. The diagnosis of EHE is usually confirmed by postoperative histopathologic examination. Actually, it is a challenge to put a correct diagnosis and to propose aggressive treatment. We report a case of an EHE of the left lower limb discovered in a 53-year-old claudicant woman. Surgical resection, arterial, and venous bypass were performed. The histology demonstrated EHE with a low mitotic index, emerging for the femoral vein.
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Affiliation(s)
- Cedric Yven
- CHU Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Pierre Gouny
- CHU Brest, Service de Chirurgie Vasculaire, Brest, France
| | - Bahaa Nasr
- CHU Brest, Service de Chirurgie Vasculaire, Brest, France; INSERM UMR 1101, LaTIM, Brest, France.
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