Angiosarcoma arising within a nonfunctioning arteriovenous fistula

Epithelioid angiosarcoma at a non-functioning arteriovenous fistula site in a renal transplant patient

We present a case of biopsy-proven epithelioid angiosarcoma in an arteriovenous fistula (AVF). Angiosarcomas developing in non-functioning AVF in renal transplant recipients are rare clinical entities with poor prognosis. A 59-year-old male adequately immunosuppressed kidney transplant patient presented with pain and swelling at the site of a previously asymptomatic fistula. A duplex scan confirmed the presence of thrombosis present along the length of the AVF; however, in light of worsening pain and skin changes, an MRI scan was requested. This demonstrated a thrombosed brachiocephalic AVF and a more sinister appearing irregular segment infiltrating the underlying anterior compartment musculature with associated muscle oedema and internal irregular enhancement. A staging CT thorax showed indeterminate lymphadenopathy in the left axilla with no pulmonary lesions. Core needle biopsy of the primary lesion at the fistula site and subsequent biopsy of the axillary lymph nodes revealed metastatic angiosarcoma. A multidisciplinary decision was made to perform radical surgery with above-elbow amputation and simultaneous left axillary lymph node clearance. We focus on relevant imaging findings to facilitate early recognition of angiosarcoma, in particular, the importance of requesting urgent imaging of vascular access sites (functioning or not) in post-transplant patients presenting with swelling. Although rare, angiosarcoma is an important entity that should be considered in the differential diagnosis of soft tissue masses arising from a vascular access, especially in immunocompromised patients.

Investigating risk factors and outcomes in rare disease of angiosarcomas in arteriovenous fistulas: A case report with review of literature

Angiosarcomas are rare, aggressive tumors with a poor prognosis. Early detection is essential, as surgically removing localized tumors gives the best chance for a cure. While angiosarcomas predominantly occur in the head and neck region, they can arise from endothelial cells lining blood or lymphatic vessels throughout the body. This case study highlights a rare instance of angiosarcoma developing in a non-functioning arteriovenous fistula (AVF) many years post-renal transplantation. A 50-year-old male with a history of end-stage renal disease (ESRD), initially treated with hemodialysis through a left brachiocephalic AVF, underwent a deceased donor kidney transplant in 2016. In March 2023, patient developed pain and numbness in his left hand, revealing a thrombosed AVF and chronic arterial occlusions. Surgical interventions included a left brachial-brachial artery bypass and ulnar endarterectomy, but his condition deteriorated, leading to the identification of a 4.9 × 3.1 × 2.4 cm mass in the proximal ulnar shaft in January 2024. Biopsy results confirmed epithelioid angiosarcoma, which was subsequently treated with left upper extremity amputation and tumor resection. Metastatic disease was detected in the right lung, necessitating further surgical interventions. This case underscores the necessity for vigilance in monitoring AVFs in transplant patients. We further completed a comprehensive literature review, using PubMed, Cochrane, and Google Scholar, from 2000 to 2024, focused on angiosarcoma arising from AVFs to provide further insights into the rare association between AVFs and angiosarcoma.

Angiosarcoma in arteriovenous fistula after kidney transplantation

Angiosarcoma is a rare complication of both functioning and nonfunctioning fistulas. It is an aggressive soft tissue sarcoma arising from vascular or lymphatic endothelial cells. We report a case of angiosarcoma from a nonfunctional fistula in a kidney transplantation patient receiving immunosuppressive drugs. The patient had presented with arm pain mimicking a thrombosed arteriovenous fistula.

Angiosarcoma in an arteriovenous fistula after kidney transplantation: Case report and review of treatment options

We present a patient with an angiosarcoma in an arteriovenous fistula and we reviewed current treatments for angiosarcomas. We extended the systematic review by Oskrochi et al. on this topic in 2015, using the same search query. We searched systematically OVID, EMBASE and PubMed from April 2015 until January 2020 with the aim to update the state of the art in managing this rare but serious condition. We retrieved 12 new case reports about 11 unique patients. Mean age was 61.5 ± 11 years. Six arteriovenous fistulas had failed spontaneously. Two fistulas were operatively closed post-transplant. Nine patients (81.8%) were receiving ongoing immunosuppressive therapy. Pain and growing lesions, mass or swelling were the most frequent symptoms. Angiosarcoma mostly presents with a nonspecific clinical picture of pain, growing lesions and swelling of a previously normal arteriovenous fistula. Amputation of the limb was most frequently conducted as treatment in localized disease. Treatment of systemic disease included supportive care, chemotherapy, especially with paclitaxel and change of immunosuppressive regimen. Metastasized angiosarcoma has a very poor prognosis. Classical chemotherapy has rather low response rates. There is limited data supporting treatment of angiosarcomas with tyrosine kinase inhibitors or immunotherapy. Further comparative research is needed.

Colonic Angiosarcoma Arising in Association with Amyloid Deposits

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.

Arteriovenous graft in kidney transplant patients: Lookout for the rare but fearsome angiosarcoma

INTRODUCTION

Angiosarcomas are rare tumors, comprising less than 1% of all sarcomas. However, they portend a poor prognosis, as they tend to metastasize early, being of uttermost importance a prompt diagnosis and treatment.

CASE DESCRIPTION

We present the case of a 55-year-old female with history of kidney transplantation, immunosuppressed with tacrolimus, prednisolone, and mofetil mycophenolate. Fifteen years after the transplant, she developed an ulcerated lesion on the site of a nonfunctioning arteriovenous graft, which was excised. Histology was compatible with a high grade angiosarcoma that invaded the margins, and immunosuppression was switched to everolimus. Staging imaging exams revealed lymph node, muscle, and lung metastases. Shortly after, nodular lesions appeared compatible with local recurrence of the disease, and the patient showed severe deterioration of her clinical condition, being proposed for palliative chemotherapy. However, the disease showed an explosive progression and the patient died before starting the treatment.

CONCLUSION

This case emphasizes the importance of including inspection of the vascular access (functioning or not) in regular post-transplant consultation and value any alterations in the attempt of a timely diagnosis. Although rare, angiosarcoma is an important entity that should be considered in the differential diagnosis of soft tissue masses arising from a vascular access, especially in immunocompromised patients. Aggressive treatment should be offered whenever possible.