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Lahmouch N, Britel D, Mouine N, Asfalou I, Lakhal Z, Benyass A. Rare case of cardiac angiosarcoma and alveolar hemorrhage in an adolescent patient initially suspected COVID19 infection: A case report and literature review. Radiol Case Rep 2024; 19:1722-1728. [PMID: 38384711 PMCID: PMC10877114 DOI: 10.1016/j.radcr.2024.01.045] [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: 12/26/2023] [Revised: 01/11/2024] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
Primary cardiac tumors are a rarity, and sarcomas emerge as the prevailing form of primary malignant cardiac tumors across age groups, encompassing both children and adults. Within this category, angiosarcoma stands out, constituting around 31% of all primary malignant cardiac tumors. Primary cardiac angiosarcoma displays a notably aggressive nature, characterized by early systemic metastasis, and is accompanied by a generally unfavorable prognosis. We describe a case concerning a previously healthy teenage girl who displayed persistent constitutional symptoms and hemoptysis for 15 days. Subsequent investigation uncovered alveolar hemorrhage, ultimately linked to a cardiac angiosarcoma. The difficulty in this instance arose from the vague nature of the initial symptoms, posing a challenge to promptly and accurately diagnose the condition. This case highlights the aggressive nature of primary cardiac angiosarcoma. The vague initial symptoms underscore the need for early detection and optimized treatment to improve the generally unfavorable prognosis associated with this condition. Increased awareness and a multidisciplinary approach are crucial in addressing the diagnostic and therapeutic challenges posed by primary cardiac angiosarcoma.
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Affiliation(s)
- Nouhaila Lahmouch
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Driss Britel
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Najat Mouine
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Ilyasse Asfalou
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Zouhair Lakhal
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
| | - Aatif Benyass
- Department of Cardiology, Mohammed V University, Faculty of Medicine and Pharmacy in Rabat Morocco, Mohammed V Military Hospital, Morocco
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Yang J, Park JE, Han S, Han CW, Kim C, Hyun CL, Kim J, Jo J. Diffuse alveolar hemorrhage from metastatic cardiac angiosarcoma of the lung successfully treated with paclitaxel chemotherapy: A case report and brief literature review. Respir Med Case Rep 2021; 34:101538. [PMID: 38234680 PMCID: PMC10792683 DOI: 10.1016/j.rmcr.2021.101538] [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: 09/30/2021] [Revised: 10/06/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a life-threatening syndrome caused by various etiologies. DAH has rarely been reported to be associated with metastatic angiosarcoma. However, due to the rarity of complications, it may not be well-recognized by most clinicians. Herein, we report the case of a 70-year-old man with newly diagnosed metastatic cardiac angiosarcoma presenting with DAH. After an immediate bronchoalveolar lavage study and bronchoscopic biopsy, the patient was successfully treated with paclitaxel chemotherapy. Although most patients with this phenomenon have an extremely grave prognosis in previous literature, our experience showed that appropriate evaluation and treatment may be beneficial.
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Affiliation(s)
- Jieun Yang
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Ji Eun Park
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Sanghoon Han
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Chi Wha Han
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Chang Lim Hyun
- Department of Pathology, Jeju National University Hospital, Jeju, Republic of Korea
| | - JeongJae Kim
- Department of Radiology, Jeju National University Hospital, Seoul, Republic of Korea
| | - Jaemin Jo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
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Drosos E, Kalyvas A, Komaitis S, Skandalakis GP, Kalamatianos T, Liouta E, Neromyliotis E, Alexiou GA, Stranjalis G, Koutsarnakis C. Angiosarcoma-related cerebral metastases: a systematic review of the literature. Neurosurg Rev 2019; 43:1019-1038. [PMID: 31165296 DOI: 10.1007/s10143-019-01127-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/01/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
- Evangelos Drosos
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | | | - Theodosis Kalamatianos
- Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Evangelia Liouta
- Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Eleftherios Neromyliotis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece
| | - George A Alexiou
- Neurosurgery Department, University of Ioannina, Leof. Stavrou Niarchou, Ioannina, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece. .,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece. .,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece.
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Piciucchi S, Dubini A, Tomassetti S, Sanna S, Ravaglia C, Carloni A, Gurioli C, Gurioli C, Colby TV, Poletti V. Angiosarcoma in the chest: radiologic-pathologic correlation: Case report. Medicine (Baltimore) 2016; 95:e5348. [PMID: 27902593 PMCID: PMC5134813 DOI: 10.1097/md.0000000000005348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE Angiosarcomas are rare, malignant vascular tumors. PATIENT CONCERNS They represents about 2% of all soft tissue sarcoma, which can often metastasize through the hematogenous route. The radiological features have been analyzed in 4 patients with metastatic angiosarcoma in the chest. DIAGNOSES The main radiologic findings included nodules, cysts, nodules with halo sign, and vascular tree-in-bud. Morphologic features, as observed in the histologic specimen, have been correlated with radiologic appearance. LESSONS Metastatic angiosarcomas to the lung are characterized by a wide variety of radiologic appearances that can be very characteristic. Computed tomographic findings observed include bilateral solid nodules, cystic, and bullous lesions sometimes associated with spontaneous hemopneumothoraces.
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Affiliation(s)
| | | | | | - Stefano Sanna
- Department of Thoracic Surgery, GB Morgagni- L Pierantoni Hospital, Forlì
| | | | - Angelo Carloni
- Department of Radiology, Santa Maria Hospital, Terni, Italy
| | | | | | - Thomas V. Colby
- Department of Pathology, Mayo Clinic Scottsdale, Scottsdale, Arizona
| | - Venerino Poletti
- Pulmonology Unit, Department of Thoracic Diseases
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Abstract
Angiosarcomas are rare, malignant, endothelial-cell tumors of vascular origin that can arise at any body site. They frequently metastasize to the lung, heralded by dyspnea, hemoptysis, chest pain, pneumothoraces, and diffuse pulmonary hemorrhage. However, in most cases lung metastases are discovered after the diagnosis of a primary angiosarcoma has already been established. Very rarely will an undiagnosed metastatic angiosarcoma present as diffuse pulmonary hemorrhage. We describe the case of a 59-year-old male who presented to hospital with dyspnea and hemoptysis. CT chest revealed rapidly progressing nodular changes and broncho-alveolar lavage returns were progressively bloody. Open lung wedge biopsy ultimately revealed metastatic angiosarcoma and extensive pulmonary hemorrhage. Our case highlights the key clinical, radiological, and pathological features of this rare malignancy that frequently metastasizes to the lung and reminds clinicians to consider it as a cause of hemoptysis and pulmonary hemorrhage.
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Affiliation(s)
- Meghan Aversa
- Division of Respirology, Department of Medicine, Toronto General Hospital, 585 University Avenue, 9N-965, Toronto ON, M5G 2N2, Canada
| | - Sacha Bhinder
- Division of Respirology, Department of Medicine, Toronto General Hospital, 585 University Avenue, 9N-965, Toronto ON, M5G 2N2, Canada
| | - Jeffrey Tanguay
- Division of Respirology, Department of Medicine, Toronto General Hospital, 585 University Avenue, 9N-965, Toronto ON, M5G 2N2, Canada
| | - John Thenganatt
- Division of Respirology, Department of Medicine, Toronto General Hospital, 585 University Avenue, 9N-965, Toronto ON, M5G 2N2, Canada
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Abstract
Diffuse alveolar hemorrhage is a life-threatening though rare manifestation of Wegener’s granulomatosis (WG). An active diagnostic workup, intensive observation, and aggressive immunosuppressive treatment are cornerstones of the management. The treatment modalities available for such complications are pulse cyclophosphamide therapy with steroids. We report here a case of WG with diffuse alveolar hemorrhage as the first manifestation of the disease in life that responded to steroids and cyclophosphamide.
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Affiliation(s)
- Vineet Mahajan
- Department of Pulmonary and Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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