Primary ovarian angiosarcoma: a case report and literature review

Angiosarcoma of the ovary treated with polyadenosine ribose polymerase Inhibition, a case report and review of the literature

•Primary angiosarcoma of the ovary historically has no standard treatment due to its rarity, and outcomes have been variable.•Olaparib may represent a viable treatment option for primary angiosarcoma of the ovary with a somatic BRCA mutation.•Next-generation sequencing may play an important component in treatment of very rare cancers to guide new or uncommon therapies.

Primary ovarian angiosarcoma: Two case reports and review of literature

BACKGROUND

Angiosarcoma (AS) is a rare and highly aggressive soft tissue disease that most commonly arises in deep soft tissues. There are only a few reported cases of AS involving the ovary and even fewer reports of the underlying molecular abnormalities. Here, we briefly review two cases of primary ovarian AS (oAS) with specific molecular events and immune checkpoints. The clinical features and prognosis of the disease, diagnosis, differential diagnosis, and new treatment approaches are discussed based on a literature review.

CASE SUMMARY

Case 1: A 51-year-old female patient was admitted with right lower limb pain for 5 mo, and lower abdominal pain with hematuria for 1 mo. Partial removal of rectus abdominis muscle and fascia, partial hysterectomy, bilateral salpingo-oophorectomy, and inguinal and pelvic lymphadenectomy were performed. Pathology revealed primary oAS. Fluorescence in situ hybridization revealed c-MYC gene amplification. MESNA + ADM + IFO + DTIC (MAID) regimen was administered, but stable disease was achieved. The patient died 1 mo later. Case 2: A 41-year-old female patient presented with fatigue, nausea, decreased appetite, and diffuse abdominal pain. On physical examination, the abdomen was distended and a complex cystic mass was palpable in the right pelvic cavity. Pathology revealed primary oAS. MAID chemotherapy was administered and programmed death ligand 1 (PD-L1) staining was performed on the tumor samples. The patient benefited from anti-PD-1 immunotherapy and is alive without any evidence of disease 27 mo off therapy in follow-up.

CONCLUSION

Long-term survival benefit for primary oAS can be achieved by alternative therapeutic strategies using pathological indicators to inform treatment.

Primary ovarian angiosarcoma: a rare and recognizable ovarian tumor

The diagnosis of primary angiosarcoma of ovary is still a challenge as it has no specific clinical symptoms and is easily confused with other malignant neoplasms in morphology. Here, we described a case of primary ovarian angiosarcoma and reviewed the literature. A 47-year-old female showed a left ovary mass. Grossly, the cut surface of the tumor was solid and gray-white with intermediate texture. Some areas were spongy and atropurpureus with a soft texture. Microscopically, the tumor cells were arranged into a variety of different structures with visible hemorrhage. Immunochemically, the tumor cells were positive for CD31, ERG, Fli1, D2-40 and vimentin in a strong and diffused manner. CD34 stain showed focal positivity. Epithelial markers (e.g. CK, CK7, CK8/18 and PAX8) were all negative. Negative immunostaining for SMA, S-100, P53 and calretinin also were detected. The proliferative index (Ki-67) was approximately 40%. After surgery, the patient was treated with radiotherapy, targeted therapy and immunotherapy. In the 9-month follow-up, the patient was survival without evidence of disease. The diagnosis of ovarian angiosarcoma required the careful observation of morphology and the reasonable application of immunohistochemistry. Targeted therapy and immunotherapy are the potential directions for the treatment of angiosarcoma.

Angiosarcoma-related cerebral metastases: a systematic review of the literature

Angiosarcoma-related cerebral metastases have only been recorded in a few case reports and case series and have not been systematically reviewed to date. Our objective was therefore to perform a systematic literature review on cases of angiosarcomas metastasizing to the brain to inform current practice. All three major libraries-PubMed/MEDLINE, Embase, and Cochrane-were systematically searched, until January 2019. Articles in English reporting angiosarcoma-related cerebral metastases via hematogenous route were included. Our search yielded 45 articles (38 case reports, 5 retrospective studies, 1 case series and 1 letter to the editor), totaling 48 patients (mean age 47.9 years). The main primary site was the heart. The mean time of diagnosis of cerebral metastases following primary tumor identification was 4.9 months. In 15 cases, the brain was the only metastatic site. In cases of multiple extracerebral metastases, the most common sites were the lung and bone. Acute intracerebral supratentorial hemorrhage was the most common presenting radiological feature. Treatment strategies were almost equally divided between the surgical (with or without adjuvant treatment) and the medical arm. Mean overall survival was 7.2 months while progression-free survival was 1.5 months. To our knowledge, this is the first systematic literature review on angiosarcoma-related cerebral metastases. This pathology proves to be an extremely rare clinical entity and carries a poor prognosis, and no consensus has been reached regarding treatment.

Three-year survival in primary cardiac angiosarcoma

A healthy 18-year-old girl was referred to our hospital for further evaluations of cardiac angiosarcoma. Transthoracic echocardiography showed an immobile 4.6 cm×3.7 cm cardiac mass. The mass was occupying right atrial chamber and partially, invading into annulus of tricuspid valve on transesophageal echocardiography. At surgery, the mass was seen to be protruding from right atrial appendage and adhering to right side of pericardium. The histological findings were consistent with cardiac angiosarcoma and immunological staining was positive for CD34 and CD31. Afterward, although she received radiochemotherapy, she died of metastasis of cardiac angiosarcoma more than three years after surgical resection. J. Med. Invest. 64: 181-183, February, 2017.

Gemcitabine-based regimen for primary ovarian angiosarcoma with MYC amplification

Angiosarcoma is a rare and aggressive type of sarcoma, and primary angiosarcoma of the ovary is extremely rare. We report the case of a 29-year-old woman who was diagnosed with ovarian angiosarcoma and possible bone metastases. We treated this patient with a gemcitabine-based regimen as postoperative adjuvant chemotherapy, after which she achieved at least 7 years of progression-free survival, an extremely long duration given the aggressive features of this tumour. We retrospectively performed immunohistochemical analyses and fluorescence in situ hybridization to make a pathology diagnosis and to investigate the tumour features. MYC amplification and c-Myc protein overexpression were positively detected. It might be possible to correlate the effectiveness of the gemcitabine-based chemotherapeutic regimen with MYC gene amplification and c-Myc protein overexpression.

Primary angiosarcoma of the ovary with prominent fibrosis of the ovarian stroma. Case report of an 81-year old patient

Primary angiosarcoma of the ovary (AS) is a rare entity with only 31 reported cases. The majority are pure angiosarcomas, the remainder are associated either with teratomas or conventional epithelial tumors. More than 50% of ovarian AS are disseminated at the time of diagnosis, the minority is detected in stage I. The prognosis of ovarian angiosarcoma in general is poor. Most reports refer to younger individuals, aged from 7 to 46 years, and only 2 case reports could be found for patients older than 64 years. Here we present a very unusual case of angiosarcoma in a 81-year-old patient.

Angiosarcoma of the ovary arising in a mucinous cystadenoma

We report the case of a 39-year-old woman who presented with a pelvic mass extending into the upper abdomen. Transabdominal sonography revealed a complex left adnexal mass. Color Doppler imaging and spectral Doppler analysis showed increased vascularity with low impedance blood flow signals, suggestive of neovascularization. The patient underwent a laparotomy and a 56-kg predominantly cystic tumor was removed from the left adnexal region. The patient died 3 months later with pulmonary metastases and massive pulmonary hemorrhage. Postmortem resampling of the ovarian tumor initially diagnosed as mucinous cystadenoma showed nodular areas of malignant pleomorphic cells consistent with angiosarcoma.

Angiosarcoma arising in an ovarian fibroma: a case report

Primary ovarian angiosarcoma is a very rare gynaecological sarcoma, with poor prognosis. These tumors are though to arise from carcinosarcomas, teratomas, or the ovarian vasculature and occur at any age. There are only a few cases reported in the international literature, most commonly associated to surface epithelial-stromal or germ cell tumours. Herein, the authors report the clinicopathologic features of an angiosarcoma arising in an ovarian fibroma. A 65-year-old patient was admitted with a palpable mass in the hypogastrium. Grossly, the removed ovary was completely replaced by a solid tumor mass. On histological analysis, the lesion revealed the typical histological features of angiosarcoma with sinusoidal patterns and anaplastic cells, admixed with spindle-shaped cells arranged in fascicles or in a storiform pattern, compatible with a fibroma. The vascular component was strongly immunopositive for CD31 and CD34. The patient was submitted to chemotherapy, and she was alive for two months after surgical proceedings.

Primary angiosarcoma of the ovary complicated by hemoperitoneum: a case report and review of the literature

BACKGROUND

Sarcomas of the female genital tract are very rare. A small subset of these, primary ovarian angiosarcoma, is even more rare, with only 26 cases reported in the literature. Most cases of advanced-stage disease are aggressive and demonstrate a poor response to both surgery and chemotherapy with an overall poor prognosis.

CASE

We present a case of a previously healthy 67-year-old woman who presented with abdominal pain and profound anemia. She underwent a full staging and optimal debulking that revealed Stage IIIC primary ovarian angiosarcoma. The patient died 3 weeks post-operatively secondary to hemorrhage from progressive, metastatic tumor sites prior to initiation of chemotherapy.

CONCLUSION

Primary ovarian angiosarcoma is extremely rare, often presenting in later stages with nonspecific symptoms. Immunohistochemical staining of pathological specimens can aid in the diagnosis. The optimal regimen for adjuvant chemotherapy is unknown, and the prognosis is very poor.

Primary angiosarcoma of the ovary: A case report of Stage I disease

BACKGROUND

There are 20 documented cases of primary ovarian angiosarcoma. Most patients present with metastatic disease and respond poorly to chemotherapy. There is little information available to counsel early-staged patients on the need for or efficacy of adjuvant chemotherapy.

CASE

We present a case of Stage Ic primary ovarian angiosarcoma treated with 3 cycles of adjuvant MAID chemotherapy. The patient is without evidence of disease 10 months post-operatively.

CONCLUSION

A review of the literature indicates a potential role for MAID chemotherapy in the treatment of ovarian angiosarcomas. Detection of Stage I disease appears to confer a better prognosis regardless of the utilization of adjuvant chemotherapy.

Pregnancy following recurrent angiosarcoma of the ovary—A case report and review of literature

BACKGROUND

Ovarian angiosarcomas are rare tumors which may to be distinguished from other unusual primary ovarian tumors such as clear cell carcinoma, yolk sac tumor and leiomyosarcoma on the basis of histological appearance and immunohistochemistry. Angiosarcomas of the ovary occur in all age groups but are more frequent in women of child bearing age (less than 40 years). Surgery and radiotherapy have been the traditional treatment modalities.

CASE

The case we present is the only reported long-term survivor of recurrent ovarian angiosarcoma. Her initial treatment was surgical, both at presentation and relapse but since she wished conservation of fertility, radical surgery and radiotherapy were avoided and she underwent further adjuvant chemotherapy with doxorubicin and ifosfamide. She remains in remission 6 years after treatment of recurrence of the primary tumor and has had a successful pregnancy following treatment.

CONCLUSION

Adjuvant chemotherapy of ovarian angiosarcoma with a combination of doxorubicin and ifosfamide appears effective and should be considered in women at risk of relapse who wish to conserve fertility.

Primary ovarian angiosarcoma presenting as malignant cells in ascites: Case report and review of the literature

Primary angiosarcoma of the ovary is a rare tumor, with less than 25 cases reported in the literature. These tumors are thought to arise from carcinosarcomas, teratomas or the ovarian vasculature, and occur at any age. The prognosis is dismal in the majority of cases. We present the case of a 19-year old female who presented with abdominal distention and abdominal pain. Tapping of peritoneal effusion showed groups of pleomorphic cells that were negative for epithelial and germ cell markers. Immunohistochemistry performed on the surgical specimen of the ovary, and subsequently on the effusion specimen showed staining for endothelial markers. The patient was treated post-operatively with chemotherapy, but died one year following diagnosis. This is the first reported case of an ovarian angiosarcoma that metastasized to the peritoneal cavity, with a resulting malignant effusion. Despite the rarity of metastasis from gynecological sarcomas in effusions, this possibility needs to be included in the differential diagnosis of malignant effusions that are negative for epithelial and germ cell markers.