Characterization of pulmonary intimal sarcoma cells isolated from a surgical specimen: In vitro and in vivo study

Pulmonary artery intimal sarcoma mimicking pulmonary thromboembolism: A case report and literature review

Pulmonary artery intimal sarcoma (PAIS) is a rare and highly aggressive form of hemangiosarcoma. The non-specific clinical manifestations, signs and routine imaging findings of this sarcoma often mimic those of pulmonary thromboembolism (PTE), resulting in frequent misdiagnosis as PTE prior to pathological confirmation in most patients. This delay in achieving an accurate diagnosis poses challenges for promptly initiating optimal treatment and further contributes to the unfavorable prognosis. The current study presents the case of a 68-year-old female who presented with acute chest tightness and dyspnea. Transthoracic echocardiography revealed the presence of atypical echogenic structures within the primary pulmonary artery, while computed tomography pulmonary angiography showed marked filling defects in the main trunk and branches of the pulmonary artery. The patient was initially misdiagnosed with PTE but did not respond well to anticoagulant therapy. Subsequent surgical resection confirmed the diagnosis of PAIS through pathological examination. Despite postoperative treatment with molecular-targeted antitumor drugs, the patient experienced tumor recurrence and intrapulmonary metastasis, ultimately succumbing to disease progression. This exceptional case is being presented to enhance the clinical understanding of PAIS, to encourage further extensive research for reliable diagnostic approaches and to provide further data that will help form efficacious therapeutic strategies to ameliorate the unfavorable prognosis of affected patients.

Pulmonary artery sarcoma: An important mimic of pulmonary embolism-Case reports and literature review

Pulmonary artery intimal sarcoma (PAIS) is a rare malignancy which closely mimics acute or chronic pulmonary thromboembolism. There are clinical and radiological characteristics which may raise suspicion of this important differential diagnosis. These include disproportionately low d-dimer, troponin T or NT-proBNP, as well as characteristic findings on CT pulmonary angiography such as the 'wall eclipsing sign' and an non-dependent position of filling defects in the large arteries. Prompt diagnosis avoids inappropriate anticoagulation and facilitates early surgical management which may improve prognosis. There is emerging evidence of an effective treatment paradigm with surgical resection and adjuvant chemotherapy. We present two cases of PAIS diagnosed at a single centre within a 2-year period. We review the literature and demonstrate the features at presentation in our cases which were suggestive of the diagnosis.

Longitudinal observation of solitary fibrous tumor translation into malignant pulmonary artery intimal sarcoma

BACKGROUND

Pulmonary artery intimal sarcoma (PAIS) is a rare malignant tumor that was usually misdiagnosed as chronic pulmonary thromboembolism.

CASE PRESENTATION

We previously reported a solitary fibrous tumor in the pulmonary artery presented with acute pulmonary embolism, which was identified by ^99mTc-Galacto-RGD₂ imaging. However, this patient had a recurrence in situ two-year after surgery, post-operative pathology revealed pulmonary artery intimal sarcoma. At one-year post-operation, ¹⁸F-FDG PET/CT was performed for exclusion of tumor metastasis, which showed FDG avid lesion in the T5, T10, and L5 vertebral bodies, as well as in bilateral ilium and right ischium.

CONCLUSIONS

This is the first longitudinal observation of a solitary fibrous tumor (SFT) development into a pulmonary artery intimal sarcoma (PAIS) and presented with multiple bone metastases.