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Zhao B, Zaqqa A, McDonald MM, de Armas IAS, Gregoric ID, Buja LM. Cardiac Mass in a 78-Year-Old Patient With a History of Cancer: Diagnostic and Treatment Challenges. Tex Heart Inst J 2024; 51:e238299. [PMID: 39093814 PMCID: PMC11298980 DOI: 10.14503/thij-23-8299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Primary cardiac angiosarcoma is a rare, aggressive malignancy that commonly metastasizes to various organs. The presenting symptoms are typically nonspecific, so a comprehensive examination is required to confirm the diagnosis promptly. This case report describes the presentation of an older patient with a history of neoplasms. Echocardiography and biopsy were performed, but despite surgical intervention to resect a large right atrial mass, the patient died. A final diagnosis of primary angiosarcoma was made based on the resected specimen.
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Affiliation(s)
- Bihong Zhao
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | - Ayah Zaqqa
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Ismael A. Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas
| | - Igor D. Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, University of Texas Health Science Center at Houston, Houston, Texas
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Basiri R, Ziaei Moghaddam A, Rikhtegar A, Jafarian A. Primary Pulmonary Angiosarcoma Found Incidentally in a Complicated Patient: A Rare Case Report. THE CLINICAL RESPIRATORY JOURNAL 2024; 18:e13818. [PMID: 39107956 PMCID: PMC11303451 DOI: 10.1111/crj.13818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Primary pulmonary angiosarcoma (PPA) is a highly aggressive and rare malignancy originating from the endothelial cells of blood vessels in the lungs. PPA is an extremely rare subtype, with less than 30 cases reported to date. PPA is not only challenging to diagnose but also has a poor prognosis, often resulting in a high mortality rate within a year of diagnosis, regardless of the treatment approach. METHOD We present the case of a 33-year-old woman with no significant past medical history who presented with abdominal pain and was incidentally found to have a right hilar mass with pleural effusion and empyema. After undergoing surgery for a perforated gastric ulcer, her pulmonary lesions were further worked up. Despite an extensive diagnostic evaluation, including imaging, bronchoscopy, and thoracotomy, establishing a diagnosis was challenging. Ultimately, PPA was diagnosed on surgical lung biopsy, and the patient was started on pazopanib and paclitaxel chemotherapy but expired after 1 month due to multiple complications. CONCLUSION This case highlights the difficulty in diagnosing this rare tumor and its poor prognosis regardless of therapy. Greater awareness of PPA and more research are needed to improve early detection and treatment options for this deadly disease.
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Affiliation(s)
- Reza Basiri
- Lung Disease Research Center, Faculty of MedicineMashhad University of Medicine SciencesMashhadIran
| | | | - Arezoo Rikhtegar
- Department of Internal Medicine, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
| | - Amir Hossein Jafarian
- Department of Pathology, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
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3
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Elmalki H, Berkane MT, Moutaouekkil M. A Giant Primary Angiosarcoma Invading the Right Heart in a Young Male: An Emergency Surgery. Cureus 2024; 16:e56309. [PMID: 38629001 PMCID: PMC11019469 DOI: 10.7759/cureus.56309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
Primary cardiac angiosarcoma is very rare. In this report, we describe an interesting case of a 25-year-old male with a giant primary angiosarcoma invading the right heart. He was urgently admitted to the hospital for respiratory distress. Once the diagnosis was suspected by chest x-ray, echocardiography, and CT scan, and given the patient's hemodynamic and respiratory instability, an emergency open-heart surgery was necessary to prevent complications. Through a right atriotomy and a pulmonary infundibulotomy, the tumor was resected. Invaded by the tumoral process, the tricuspid valve was replaced with a biological prosthesis. The postoperative course was marked by severe right ventricular dysfunction with multiorgan failure. Histopathologic examination of the surgical specimen confirmed a primary cardiac angiosarcoma.
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Affiliation(s)
- Hicham Elmalki
- Cardiothoracic Surgery, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed First University, Oujda, MAR
| | | | - Mehdi Moutaouekkil
- Cardiothoracic Surgery, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery Experimental and Medical Simulation (LAMCESM) Mohammed First University, Oujda, MAR
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Yamashita H, Higashida T, Huchioka A, Asakawa Y, Nambu A, Ohyatsu S, Kohyama T, Takahashi M, Hayashi T, Tago M. Cardiac angiosarcoma with metastatic to lung, brain, and bone. Radiol Case Rep 2024; 19:473-478. [PMID: 38046925 PMCID: PMC10692493 DOI: 10.1016/j.radcr.2023.10.056] [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: 05/10/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023] Open
Abstract
Cardiac angiosarcoma is a malignant tumor derived from vascular endothelium with a dismal prognosis. The imaging findings of cardiac angiosarcoma are nonspecific and endomyocardial and pericardial biopsies have insufficient accuracy. For these reasons, the diagnosis is sometimes difficult. Primary and metastatic tumors tend to bleed easily, causing hemoptysis and neurological symptoms. Brain metastases are not often known to be fatal when they cause hemorrhage. We report a 27-year-old man diagnosed with right atrium angiosarcoma, with metastases in the lung, brain, and bone. The patient had only respiratory symptoms at the first visit and did not show any symptoms derived from brain metastases yet died after 27 days due to hemorrhage from brain metastases. If brain metastasis from angiosarcoma is suspected based on imaging findings, urgent radiotherapy should be considered before histological examination for a definitive diagnosis.
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Affiliation(s)
- Hiroshi Yamashita
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Tomohiko Higashida
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Aya Huchioka
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Yasuma Asakawa
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Atsushi Nambu
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Sho Ohyatsu
- Department of Internal Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Tadashi Kohyama
- Department of Internal Medicine, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Mikiko Takahashi
- Department of Pathology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Takaki Hayashi
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
| | - Masao Tago
- Department of Radiology, Teikyo University School of Medicine University Hospital, Mizonokuchi, 213-8507, 5-1-1 Futako, Takatsu-ku, Kawasaki-city, Kanagawa, Japan
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5
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Tolentino-de la Mora A, Verdugo-Carrión ZE, Vázquez-Castro RA, Vega-Barrientos R. Primary cardiac angiosarcoma presenting with haemoptysis. BMJ Case Rep 2023; 16:e256596. [PMID: 37734864 PMCID: PMC10514630 DOI: 10.1136/bcr-2023-256596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
A male patient in his 30s presented to the emergency room with a 1-week history of dyspnoea that progressed to haemoptysis, having coughed up approximately 200 mL of blood on two occasions. On diagnostic investigation, a mediastinal tumour infiltrating the free wall of the right atrium and multiple pulmonary nodules were discovered. The first suspicion was a neoplasm of pulmonary origin, and a bronchoscopy was performed, histology reported a probable cardiac origin for the neoplasm. A subsequent biopsy confirmed the presence of a primary cardiac angiosarcoma. An extension CT scan revealed brain metastases. The patient received chemotherapy treatment, resulting in a partial response to date. This case is one of the few reported instances of cardiac neoplasm presenting with respiratory symptoms.
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Kumari N, Bhandari S, Ishfaq A, Butt SRR, Ekhator C, Karski A, Kadel B, Altayb Ismail MA, Sherpa TN, Al Khalifa A, Khalifah B, Nguyen N, Lazarevic S, Zaman MU, Ullah A, Yadav V. Primary Cardiac Angiosarcoma: A Review. Cureus 2023; 15:e41947. [PMID: 37461430 PMCID: PMC10350284 DOI: 10.7759/cureus.41947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 07/20/2023] Open
Abstract
Primary cardiac angiosarcoma is a rare and aggressive malignancy originating from the endothelial lining of cardiac blood vessels. This review covers various aspects of the disease, including its pathogenesis, clinical presentation, diagnosis, treatment, and prognosis. The primary characteristic of cardiac angiosarcoma is the rapid growth of abnormal blood vessels that invade the heart muscle, leading to the destruction of healthy tissue. Due to its infiltrative nature and early spread, diagnosing and treating cardiac angiosarcoma present significant challenges. Transesophageal echocardiography (TEE) plays a crucial role in diagnosing cardiac tumors such as angiosarcoma due to its high sensitivity. Additional imaging techniques such as computed tomography (CT) and cardiac magnetic resonance imaging (MRI) help assess tumor anatomy and identify metastases. Histopathological examination and immunohistochemistry are essential for confirming the diagnosis, as they reveal distinct histological features and specific endothelial markers associated with primary cardiac angiosarcoma. Targeted therapies directed at the angiogenic mechanisms and molecular abnormalities hold promise for improving treatment outcomes. Early detection of primary cardiac angiosarcoma remains challenging due to its rarity, and the prognosis is generally poor due to advanced disease at the time of diagnosis. The review emphasizes the importance of a multidisciplinary approach and collaboration among different specialties to optimize the diagnosis, treatment, and follow-up care of patients with primary cardiac angiosarcoma. The ultimate goal is to enhance diagnostic methods and therapeutic approaches by advancing knowledge and promoting further research into this aggressive malignancy.
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Affiliation(s)
- Naina Kumari
- Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, PAK
| | | | | | - Samia Rauf R Butt
- General Practice, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Chukwuyem Ekhator
- Neuro-Oncology, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
| | - Amanda Karski
- Emergency Medicine, American University of Antigua, Miami, USA
| | - Bijan Kadel
- Internal Medicine, Nepal Medical College and Teaching Hospital, Kathmandu, NPL
| | | | - Tenzin N Sherpa
- Internal Medicine, Kathmandu University, Nepal Medical College, Kathmandu, NPL
| | - Ahmed Al Khalifa
- Medicine, College of Medicine, Sulaiman Alrajhi University, Al Bukayriyah, SAU
| | | | - Nhan Nguyen
- Internal Medicine, University of Debrecen, Debrecen, HUN
| | | | | | | | - Vikas Yadav
- Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
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7
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Wuest F, Gebhardt A, Grosswendt C, Griff S, Zhilina A, Taber S, Kollmeier J, Bauer TT. Diffuse Alveolar Hemorrhage Associated with Epithelioid Angiosarcoma of the Lung: A Challenging Diagnosis. Case Rep Pulmonol 2023; 2023:5553209. [PMID: 37360588 PMCID: PMC10289867 DOI: 10.1155/2023/5553209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/04/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
A 68-year-old patient presented with persistent hemoptysis and weight loss. A CT scan showing diffuse bilateral ground-glass opacities and nodules was followed by bronchoscopy. While diffuse alveolar hemorrhage (DAH) could be seen, specimens obtained during bronchoscopy did not provide conclusive histological findings. The decision was made to conduct video-assisted wedge resection, after which histological examinations revealed the diagnosis of bifocal nodular manifestation of an epithelioid angiosarcoma in the lung. Being a rare entity even among sarcomas, these kinds of tumors can be primary lung tissue angiosarcomas or metastatic lesions with primaries in places like the skin, breast, and heart. Treatment usually includes chemotherapy, but prognosis remains grim. This case highlights that in DAH, uncommon causes should be considered, and sufficient probe gathering is the key to early diagnosis and treatment.
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Affiliation(s)
- Felix Wuest
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Walterhoeferstrasse 11 14165 Berlin, Germany
| | - Andreas Gebhardt
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Walterhoeferstrasse 11 14165 Berlin, Germany
| | - Claudia Grosswendt
- Institute of Diagnostic and Interventional Radiology, Nuclear Medicine and Molecular Imaging, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Sergej Griff
- Institute of Pathology, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Antonina Zhilina
- Institute of Pathology, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Samantha Taber
- Department of Thoracic Surgery, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Jens Kollmeier
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Walterhoeferstrasse 11 14165 Berlin, Germany
| | - Torsten T. Bauer
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Walterhoeferstrasse 11 14165 Berlin, Germany
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8
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Lin Y, Yu H, Wang C, Zhang D. Primary pulmonary angiosarcoma mimicking diffuse pulmonary hemorrhage: A case report. Oncol Lett 2023; 25:211. [PMID: 37123023 PMCID: PMC10131260 DOI: 10.3892/ol.2023.13797] [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: 01/04/2023] [Accepted: 03/09/2023] [Indexed: 05/02/2023] Open
Abstract
Pulmonary angiosarcomas are usually secondary tumors, and a primary angiosarcoma of the lung is extremely rare. The present study reports a case of an elderly patient diagnosed with primary pulmonary angiosarcoma (PPA). A 78-year-old man presented with a 3-month history of cough and blood in phlegm. A computed tomography scan of the chest indicated pulmonary infection with ground-glass opacity in the right upper lobe. The patient underwent lobectomy of the right upper lobe as his clinical symptoms did not significantly improve after anti-infection treatment. The postoperative pathological examination confirmed a diagnosis of PPA. He developed left lung and pelvic metastases 1 month after surgery. After four cycles of liposomal doxorubicin therapy, the patient achieved partial remission. The patient remained in sustained remission after 6 months of follow-up. The present case report is intended to provide diagnostic insight into PPA. In addition, the findings indicate that timely diagnosis and treatment of PPA are very important due to its increased risk of local recurrence and distant metastasis.
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Affiliation(s)
- Yong Lin
- Department of Gastroenterology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Han Yu
- Department of Pathology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Changying Wang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Dongdong Zhang
- Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
- Correspondence to: Dr Dongdong Zhang, Department of Oncology, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, 15 Jiefang Road, Xiangyang, Hubei 441000, P.R. China, E-mail:
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9
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Weeraddana P, Sandhu MK, Anand S, Othman H, Makar M, Matta B. Pulmonary Angiosarcoma With Synchronous Invasive Aspergillosis Presenting as Diffuse Alveolar Hemorrhage and Acute Kidney Injury: A Case Report of a Previously Unreported Combination Posing a Diagnostic Challenge. Cureus 2023; 15:e38507. [PMID: 37284386 PMCID: PMC10240848 DOI: 10.7759/cureus.38507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Angiosarcoma is a rare soft tissue sarcoma originating from endothelial cells. It can occur anywhere when there is a blood vessel or lymphatic channel, making highly perfused cutaneous sites their usual location, though they can also develop within visceral structures. Pulmonary angiosarcoma is usually caused by metastasis from other primary sites. The clinical course of pulmonary angiosarcoma is very aggressive, and the prognosis is poor. We present a case of a 55-year-old man who presented to the hospital with progressive exertional dyspnea and right-sided pleuritic chest pain for the past few days. He was found to have recurrent anemia and acute kidney injury. His hospital course was complicated by the development of hypoxia and hemoptysis. Computed tomography of the chest without contrast revealed bilateral nodular, ground-glass opacities compatible with diffuse alveolar hemorrhage. Further investigation with a lung biopsy revealed epithelioid angiosarcoma with extensive microvascular tumor emboli and invasive pulmonary aspergillosis (Aspergillus fumigatus) with patchy necrotizing pneumonia. He later developed acute hypoxic respiratory failure and worsening kidney failure, so he was transferred to the intensive care unit. Upon discussing with the family, the patient was put on comfort measures, and he passed away the following day. We present a rare presentation of concurrence of pulmonary angiosarcoma and invasive aspergillosis. Upon searching the literature, our case is one of the first to report such concurrence. Because of its rarity, the non-specific clinical presentation makes the diagnosis challenging.
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Affiliation(s)
| | | | | | | | - Mina Makar
- Internal Medicine, Danbury Hospital, Danbury, USA
| | - Bhavna Matta
- Internal Medicine, Danbury Hospital, Danbury, USA
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10
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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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11
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Adzic NM, Obradovic KV, Urban VP, Mijaljevic MB, Radmanovic BJ, Milosevic ZC. Computed tomography features of pulmonary metastases from angiosarcoma: Lessons learned from one case study. Radiol Case Rep 2021; 16:2646-2650. [PMID: 34345325 PMCID: PMC8319485 DOI: 10.1016/j.radcr.2021.06.044] [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: 05/28/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/25/2022] Open
Abstract
A distinctive feature of some angiosarcomas is that two or more atypical forms of pulmonary metastases may be detected concomitantly. In this case report, we present a 37-year-old man diagnosed with angiosarcoma of the neck, with extreme diversity of lung metastases on chest computed tomography (CT). We analyzed CT features of metastases and discussed possible reasons for their pleomorphism, as well as clinical implications of these findings.
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Affiliation(s)
- Nina M Adzic
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia
| | - Katarina V Obradovic
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia
| | - Vladimir P Urban
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia
| | - Marija B Mijaljevic
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia
| | - Branka J Radmanovic
- Institute of Oncology and Radiology of Serbia, Clinic of Surgical Oncology, Belgrade, Serbia
| | - Zorica C Milosevic
- Institute of Oncology and Radiology of Serbia, Department or Radiology, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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12
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Rêgo Salgueiro F, Vieira I, Gomes I, Petrova M. Primary angiosarcoma of superior vena cava: an unexpected diagnosis after an oncological emergency. BMJ Case Rep 2021; 14:14/4/e241266. [PMID: 33863773 PMCID: PMC8055115 DOI: 10.1136/bcr-2020-241266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Angiosarcoma (AS) is a rare malignant tumour representing 1%-2% of all sarcomas. Primary AS of superior vena cava (SVC) was reported in two cases worldwide. We report a 69-year-old woman with neck discomfort, headache and dyspnoea for 3 months. CT angiography showed thrombosis in SVC and brachiocephalic veins resulting in an SVC syndrome. The patient began anticoagulant therapy and underwent balloon angioplasty with clinical improvement. Additionally, a positron emission tomography scan confirmed the presence of a mediastinal mass involving the SVC locally. The tumour was excised and a prosthesis was placed on the SVC. Histology revealed a heterogeneous tumour matrix, either myxoid and composed by fusiform cells with vimentin, homogeneous CD31 and a 30% Ki67 immunoexpression, supporting the diagnosis of an AS. Due to multiple complications, the patient never started chemotherapy, and after tumour recurrence, she died within 5 months after diagnosis.
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Affiliation(s)
- Fábio Rêgo Salgueiro
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Inês Vieira
- Endocrinology and Metabolism, Centro Hospitalar Universitário de Coimbra EPE, Coimbra, Portugal
| | - Inês Gomes
- Medical Oncology, Instituto Português de Oncologia de Coimbra Francisco Gentil EPE, Coimbra, Portugal
| | - Maja Petrova
- Internal Medicine, Centro Hospitalar Universitário de Coimbra EPE, Coimbra, Portugal
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13
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Saito M, Saraya T, Oda M, Minamishima T, Kongoji K, Isomura A, Fujiwara M, Soejima K, Ishii H. Rapidly progressive respiratory failure with multiple halo signs on computed tomography in a patient with primary cardiac angiosarcoma derived from the right atrium: a case report. BMC Pulm Med 2020; 20:321. [PMID: 33297995 PMCID: PMC7727232 DOI: 10.1186/s12890-020-01366-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/03/2020] [Indexed: 11/18/2022] Open
Abstract
Background Primary cardiac neoplasms are extremely rare, with an autopsy incidence of 0.0001–0.003%. Primary cardiac sarcoma is usually derived from the right atrium and it manifests as chest pain, arrhythmia, hemoptysis, dyspnea, and fatigue. The most common target organ for metastasis of primary angiosarcoma is the lungs, but the radiological-pathological correlation has been rarely reported. Case presentation A 38-year-old healthy Japanese man was admitted to our hospital with persistent hemoptysis, exaggerated dyspnea, and two episodes of loss of consciousness in the past 3 months. Non-enhanced thoracic computed tomography (CT) revealed multiple scattered nodules with halo signs. Contrast-enhanced thoracic CT revealed a filling defect in the right atrium, which corresponded to the inhomogeneously enhancing tumor in the right atrium on enhanced electrocardiogram-gated cardiac CT. On day 2, acute respiratory failure occurred, and the patient was placed on mechanical ventilation. The patient was diagnosed with primary cardiac angiosarcoma based on the urgent transcatheter biopsied specimen of the right atrium mass and was treated with intravenous administration of doxorubicin. However, his respiratory status rapidly deteriorated, and he died on day 20. Postmortem biopsy showed that the multiple lung nodules with the halo signs corresponded to the intratumoral hemorrhagic necrosis and peripheral parenchymal hemorrhage in their background, suggesting the fragility of the lung tissue where the tumor had invaded, which caused hemoptysis. Furthermore, two episodes of loss of consciousness occurred probably due to a decreased cardiac output because of a massive tumor occupying the right atrium, recognized as an inhomogeneous centripetal enhancement on enhanced electrocardiogram-gated cardiac CT. Conclusions This case clearly demonstrated that primary cardiac angiosarcoma could expand in the right atrial cavity, which led to a decreased cardiac output resulting in repeated syncope, together with the fragility of lung tissue by tumor invasion, thereby generating a halo sign on thoracic CT.
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Affiliation(s)
- Masaoki Saito
- Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Takeshi Saraya
- Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
| | - Miku Oda
- Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Toshinori Minamishima
- Department of Cardiology, Kyorin University School of Medicine, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Ken Kongoji
- Department of Cardiology, Kyorin University School of Medicine, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Aya Isomura
- Department of Pathology, Kyorin University School of Medicine, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Masachika Fujiwara
- Department of Pathology, Kyorin University School of Medicine, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University School of Medicine, Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Haruyuki Ishii
- Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
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14
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Issakwisa M, Mwakyusa N, Torres L, Ngatunga C, Chaula B, Maro H, Mboma L, Nguma I, Nqwata L, Mujwahuzi L. Metastatic angiosarcoma of unknown primary site misdiagnosed as tuberculosis. Clin Case Rep 2020; 8:3018-3023. [PMID: 33363871 PMCID: PMC7752315 DOI: 10.1002/ccr3.3243] [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: 04/19/2020] [Revised: 07/08/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022] Open
Abstract
Tuberculosis in endemic areas is likely to be overdiagnosed in patients with atypical clinical and imaging findings mimicking tuberculosis, as in our case of angiosarcoma. Detailed history, physical examination, imaging, and histopathology avert diagnosis of tumors as tuberculosis in resource-limited settings, where countless diseases have common clinical and imaging presentations.
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Affiliation(s)
- Mwakyula Issakwisa
- Department of Internal MedicineMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Ngwilo Mwakyusa
- Department of RadiologyMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Liset Torres
- Department of PathologyMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Cecilia Ngatunga
- Department of RadiologyMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Baraka Chaula
- Department of Internal MedicineMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Haika Maro
- Department of RadiologyMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Lazaro Mboma
- Department of SurgeryMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Irene Nguma
- Department of Internal MedicineMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
| | - Lamla Nqwata
- Division of PulmonologyChris Hani Baragwanath Academic HospitalBertshamSouth Africa
- University of the WitwatersrandJohannesburgSouth Africa
| | - Leodegard Mujwahuzi
- Department of Internal MedicineMbeya Zonal Referral Hospital and University of Dar es SalaamMbeya College of Health and Allied SciencesMbeyaTanzania
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15
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Ricchetti T, Paci M, Cavazza A, Ferrari G, Annessi V, De Franco S, Sgarbi G. A Case of Metastatic Epithelioid Angiosarcoma in the Lamina Propria of a Sigmoid Tubulovillous Adenoma. TUMORI JOURNAL 2019; 91:210-2. [PMID: 15948556 DOI: 10.1177/030089160509100222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Epithelioid angiosarcoma is an extremely rare tumor. It is generally a secondary tumor and the preferred sites of such metastases are the heart, pericardium, lung, breast, liver, spleen, bone, and brain. In rare cases the lung has been described as the primary site. The prognosis of this neoplasm is extremely poor. We report a case of epithelioid angiosarcoma with multiple bilateral lung infiltration, bone metastasis, and metastasis of the lamina propria of a tubulovillous adenoma of the colon.
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Affiliation(s)
- Tommaso Ricchetti
- Department of Thoracic Surgery and Pathology, Santa Maria Nuova Hospital, Reggio Emilia, Italy.
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16
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Shirey L, Coombs D, Talwar A, Mickus T. Pulmonary epithelioid angiosarcoma responsive to chemotherapy: A case report. Radiol Case Rep 2018; 13:479-484. [PMID: 29682139 PMCID: PMC5906771 DOI: 10.1016/j.radcr.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 02/03/2018] [Indexed: 11/25/2022] Open
Abstract
Primary pulmonary epithelioid angiosarcoma (AS) is an extremely rare cancer with a poor prognosis. The presenting symptoms and imaging results are nonspecific and hold similarities with more common lung pathology, contributing to missed or delayed diagnosis. Complementing radiological imaging with patient information, such as presenting symptoms and exposures, is important for early consideration of pulmonary epithelioid AS. Even with supportive imaging findings and clinical suspicion for pulmonary epithelioid AS, the most reliable and definitive method for diagnosis is through immunohistochemistry. We describe the case of a 65-year-old patient who presented with dyspnea, cough, and hemoptysis in whom pauci-immune vasculitis was initially suspected before immunohistochemical diagnosis of primary pulmonary epithelioid AS. Due to the rarity of this disease, treatment options have not been well-studied and consist of any combination of surgical resection, chemotherapy, and radiation therapy. Although typically poorly responsive to chemotherapy, our patient achieved a reduction in size of his pulmonary nodules after a course of steroids followed by cyclophosphamide and was later maintained with gemcitabine and docetaxel until his death nearly a year after presentation.
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Affiliation(s)
- Lora Shirey
- Drexel University College of Medicine, Philadelphia, PA, USA
| | | | - Aditya Talwar
- Department of Pathology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Timothy Mickus
- Department of Radiology, Allegheny Health Network, Pittsburgh, PA, USA
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17
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Wang H, Shi J, Liu H, Chen Y, Wang Y, Wang W, Zhang L. Clinical and diagnostic features of angiosarcoma with pulmonary metastases: A retrospective observational study. Medicine (Baltimore) 2017; 96:e8033. [PMID: 28885371 PMCID: PMC6392612 DOI: 10.1097/md.0000000000008033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Angiosarcoma with pulmonary metastasis is a rare, fatal disease that often presents with multiple pulmonary nodules and diffuse alveolar hemorrhage. We herein review the detailed clinical characteristics of pulmonary metastatic angiosarcoma and determine a reasonable diagnostic strategy.The medical records of 11 patients with pulmonary angiosarcoma were reviewed.The mean age of the patients was 45.7 years (range, 30-71 years). All patients were male. The most common symptom was hemoptysis (8/11). Common initial misdiagnoses were tuberculosis (5/11), vasculitis (2/11), nontuberculous infectious disease (1/11), and constrictive pericarditis (1/11). Chest computed tomography (CT) of patients with hemoptysis showed bilateral, randomly distributed, variably shaped, and differently sized nodules, as well as ground-glass opacities (GGO) (8/11). The right heart was the most common primary tumor site (8/11), but the sensitivity of echocardiography was limited; CT angiography and cardiac magnetic resonance imaging (MRI) revealed more atrial masses. CT-guided needle biopsy was difficult to perform in most patients because of the small size of the nodules. The diagnosis was made by surgical biopsy of either the lung (3/9) or heart (6/9). The median overall survival of patients who underwent lung biopsy and those who underwent cardiac/pericardiac biopsy was 4.1 and 1.4 months, respectively (P = .098). The median overall survival of the 9 available patients was 5.0 months (95% confidence interval, 0.500-8.544).Angiosarcoma with pulmonary metastases should be considered in patients with hemoptysis and concurrent GGO and nodules on their chest CT scan. Careful cardiologic monitoring is necessary for these patients, even without any cardiac symptoms or signs, and enhanced cardiac MRI is the first recommendation. Surgical biopsy is reliable for histological diagnosis, but the safety of the lung biopsy should be carefully assessed. When primary cardiac tumors are identified, heart biopsy should be preferentially considered.
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Affiliation(s)
| | | | | | | | - Yining Wang
- Radiology Department, Peking Union Medical College Hospital, Dong Cheng District, Beijing, China
| | | | - Li Zhang
- Department of Respiratory Medicine
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18
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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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19
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Yogi A, Miyara T, Ogawa K, Iraha S, Matori S, Haranaga S, Murayama S. Pulmonary metastases from angiosarcoma: a spectrum of CT findings. Acta Radiol 2016; 57:41-6. [PMID: 25711232 DOI: 10.1177/0284185115571789] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/16/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Though a few reports have summarized the computed tomography (CT) findings of pulmonary metastases from angiosarcoma, the detailed CT findings of cysts are not well known, except for their characteristic thin walls. PURPOSE To retrospectively summarize the CT findings of pulmonary metastases from angiosarcoma, focusing mainly on the CT findings of cysts. MATERIAL AND METHODS Thirty-three patients with pulmonary metastases from angiosarcoma were selected retrospectively. Two radiologists reviewed and assessed patients' chest CT images on a consensus basis for nodules, cysts, the CT halo sign, pneumothorax, pleural effusion, and enlarged lymph nodes. Cysts were also evaluated by wall thickness and smoothness, air-fluid levels, and vessels or bronchi penetrating the cysts. The relationship between cysts and pneumothorax was assessed using the Chi-square test. RESULTS Nodules were found in 28 (85%) patients. Cysts were found in 19 (58%) patients; 17 had thin and smooth walls, 10 had thin and irregular walls, and four had thick and irregular walls. In addition, 12 patients showed vessels or bronchi penetrating the cysts, and six showed air-fluid levels. The CT halo sign, pneumothorax, pleural effusion, and mediastinal lymphadenopathy were seen in 19 (58%), 16 (48%), 26 (78.8%), and five (15.2%) patients, respectively. Pneumothorax occurred significantly more frequently in patients with cysts (P = 0.002). CONCLUSION Cysts showed variability in their walls, and air-fluid levels and vessels or bronchi penetrating the cysts appeared to be characteristic findings, which may be useful for detection and accurate diagnosis in patients with pulmonary metastases from angiosarcoma.
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Affiliation(s)
- Akira Yogi
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Tetsuhiro Miyara
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
- Department of Radiology, Okinawa Prefectural Yaeyama Hospital, Okinawa, Japan
| | - Kazuhiko Ogawa
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shiro Iraha
- Department of Radiology, Okinawa Prefectural South Medical Center / Pediatric Medical Center, Okinawa, Japan
| | - Shigetaka Matori
- Departments of Dermatology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
| | - Shusaku Haranaga
- Department of Infections, Respiratory and Digestive Medicine Control and Prevention of Infectious Diseases (The First Department of Internal Medicine), Faculty of Medicine, University of the Ryukyus
| | - Sadayuki Murayama
- Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan
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20
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Primary Left Cardiac Angiosarcoma with Mitral Valve Involvement Accompanying Coronary Artery Disease. Case Rep Surg 2015; 2015:810306. [PMID: 26649221 PMCID: PMC4663746 DOI: 10.1155/2015/810306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/04/2015] [Indexed: 11/17/2022] Open
Abstract
We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation.
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21
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Pan Z, An Z, Li Y, Zhou J. Diffuse alveolar hemorrhage due to metastatic angiosarcoma of the lung: A case report. Oncol Lett 2015; 10:3853-3855. [PMID: 26788222 DOI: 10.3892/ol.2015.3820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 09/24/2015] [Indexed: 11/06/2022] Open
Abstract
Angiosarcoma is a rare, heterogeneous malignant tumor that derives from endothelial cells, and it has aggressive characteristics with a marked tendency for distant metastasis. Diffuse alveolar hemorrhage (DAH) is a catastrophic clinical syndrome, however, it is rare as the presentation of pulmonary angiosarcoma. To increase awareness with regard to angiosarcoma and DAH, the current study presents a case of angiosarcoma that originated from the subcutaneous soft tissue of the mastoid process, but was subject to a delayed diagnosis and rapid invasion into the brain and lung. The metastatic angiosarcoma of the lung presented with DAH as the initial manifestation. The pathological examination of a biopsy of the subcutaneous mass and pulmonary lesions confirmed the diagnosis of angiosarcoma. The patient succumbed to respiratory failure at 1 month post-diagnosis.
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Affiliation(s)
- Zhijie Pan
- Department of Respiratory Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Zhou An
- Department of Respiratory Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Yanyuan Li
- Department of Pathology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
| | - Jianying Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China
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22
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Lee WJ, Lim JS, Lee YS. Multiple cerebral hemorrhages associated with Friend leukemia integration 1 (FLI1) positive cardiac angiosarcoma and left atrial thrombi. Int J Stroke 2015; 10:E19-20. [PMID: 25598032 DOI: 10.1111/ijs.12407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
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23
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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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24
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Giaj Levra M, Novello S, Scagliotti GV, Papotti M, Le Cesne A. Primary pleuropulmonary sarcoma: a rare disease entity. Clin Lung Cancer 2012; 13:399-407. [PMID: 22673623 DOI: 10.1016/j.cllc.2012.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 02/06/2023]
Affiliation(s)
- Matteo Giaj Levra
- University of Torino, Department of Clinical and Biological Sciences, Division of Thoracic Oncology, S. Luigi Hospital, Orbassano, Italy.
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25
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Kotton DN, Muse VV, Nishino M. Case records of the Massachusetts General Hospital. Case 2-2012. A 63-year-old woman with dyspnea and rapidly progressive respiratory failure. N Engl J Med 2012; 366:259-69. [PMID: 22256809 DOI: 10.1056/nejmcpc1109274] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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26
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Rai S, Barthwal M, Bhattacharya P, Bhargava S, Pethe M. Metastatic angiosarcoma presenting as diffuse alveolar hemorrhage. Lung India 2011; 25:14-6. [PMID: 20396655 PMCID: PMC2853041 DOI: 10.4103/0970-2113.44131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Angiosarcoma is a rare malignant neoplasm of the vascular or lymphatic endothelium. Diffuse alveolar hemorrhage is a rare presenting manifestation of angiosarcoma. We describe a case of pulmonary metastasis of angiosarcoma who presented with diffuse alveolar hemorrhage as initial manifestation.
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Affiliation(s)
- Sp Rai
- Department of Respiratory Medicine, Military Hospital (Cardio-Thoracic Centre), Pune., India
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27
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Chen YB, Guo LC, Yang L, Feng W, Zhang XQ, Ling CH, Ji C, Huang JA. Angiosarcoma of the lung: 2 cases report and literature reviewed. Lung Cancer 2010; 70:352-6. [DOI: 10.1016/j.lungcan.2010.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/02/2010] [Accepted: 09/06/2010] [Indexed: 01/18/2023]
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28
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Carillo GAO, Carretero MAC, Vazquez JER, Fontan EG, Ramos MB, Ventura JA, Rodriguez AP, Salmon AS, Tejedor JLG. Epithelioid Angiosarcoma of the Lung with Pleural Metastases: A Rare Cause of Haemoptysis. Heart Lung Circ 2010; 19:624-8. [DOI: 10.1016/j.hlc.2010.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 04/07/2010] [Accepted: 05/03/2010] [Indexed: 01/18/2023]
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29
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Fonseca V, Reis G, Lourenço C, Alves C, Vasconcelos AP, Martelo F, Bravio I, Lousinha A, Timóteo AT, Pinto E, Granadeiro J, Pinto Saraiva A. [Pulmonary metastasis in a cardiac angiosarcoma - case report and discussion]. REVISTA PORTUGUESA DE PNEUMOLOGIA 2010; 15:1175-84. [PMID: 19859633 DOI: 10.1016/s0873-2159(15)30199-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a case report of a 35 year-old male without any relevant former pathology admitted to the emergency room with atypical chest pain, cough and sputum with ECG changes suggesting pericarditis. He was initially admitted to the cardiology ward and experienced clinical improvement after initiating anti- inflammatory treatment. As intercurrence he had bacterial origin pneumonia complicated by pleural effusion (PE). After discharge patient was referred to a pulmonology appointment where aetiological investigation of the PE was instigated. Investigation revealed changes in the cardiac cavities and multiple lung nodules, suggesting subacute endocarditis with septic pulmonary embolism. Admitted to the pulmonology unit patient underwent videothoracsopy which diagnosed cardiac angiosarcoma with pulmonary metastisation. Within a few days there was a rapid evolution of the clinical picture, with cardiac failure and death of the patient without radiotherapy or adjuvant chemotherapy being started.
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30
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Saitoh JI, Sakurai H, Suzuki Y, Katoh H, Takahashi T, Nakano T. Metastatic angiosarcoma of the lung with alveolar hemorrhage. Jpn J Radiol 2009; 27:381-4. [PMID: 19943151 DOI: 10.1007/s11604-009-0352-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Accepted: 07/06/2009] [Indexed: 12/13/2022]
Abstract
A case of metastatic angiosarcoma of the lung with alveolar hemorrhage was experienced. A 76-year-old woman was diagnosed as stage IIb uterine cervical cancer. The cancer disappeared after radiotherapy. Five years later, she was readmitted because of severe pain around the right hip joint. Fracture of the neck of the right femur was found on roentgenogram. On chest CT and roentgenogram, spotted or restiform shadows with uncertain margins were found in the peripheral regions of the bilateral lung field. The lesions reached just underneath the pleura, and interstitial shadows such as ground-glass-like shadows and thickening of the interlobular walls were also found. These lesions were rapidly aggravated in the course of 1-2 weeks. She died after a short period of hospitalization (2 months) with pathological fracture. In autopsy, metastases of the tumor were found to bones, lungs, heart, and other organs that mainly occurred hematogenously. No recurrence of the uterine cervical cancer was detected. Tumor cells were polymorphic or ovoid, and occurred scattered individually or showed growth-forming small aggregates. By immunohistochemical staining, CD31, CD34 and Factor VIII were found to be positive, and the tumor was diagnosed as epithelioid angiosarcoma. The main findings in the lungs were intraalveolar hemorrhage consequent to tumor embolization.
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Affiliation(s)
- Jun-ichi Saitoh
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, 371-8511, Japan.
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31
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32
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Hui C. An unusual cause of diffuse pulmonary haemorrhage. CLINICAL RESPIRATORY JOURNAL 2008; 2:183-6. [PMID: 20298327 DOI: 10.1111/j.1752-699x.2008.00061.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Diffuse pulmonary haemorrhage is a potentially life-threatening complication of a variety of conditions. Tumours, including angiosarcoma lung metastases, are an unusual cause of pulmonary haemorrhage. METHODS Report of a case. RESULTS This case describes a 38-year-old previously healthy male who presented with chest wall bruising followed by haemoptysis and a cerebellar haemorrhage. The patient developed diffuse pulmonary haemorrhage. A biopsy of the chest wall lesion indicated a haematoma and an open-lung biopsy suggested the diagnosis of vasculitis. The patient died within 3 months after initial presentation and an autopsy revealed a chest wall angiosarcoma with pulmonary and cerebellar metastases. CONCLUSION Pulmonary angiosarcoma metastases should be included in the differential diagnosis of diffuse pulmonary haemorrhage, especially in a young, previously healthy patient with normal renal function, particularly as the pathological diagnosis may be difficult and even misleading.
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Affiliation(s)
- Cathryn Hui
- Department of Radiology, Faculty of Medicine, Vancouver General Hospital, Vancouver, BC, Canada.
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33
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Kurian KC, Weisshaar D, Parekh H, Berry GJ, Reitz B. Primary cardiac angiosarcoma: case report and review of the literature. Cardiovasc Pathol 2006; 15:110-2. [PMID: 16533700 DOI: 10.1016/j.carpath.2005.10.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 09/16/2005] [Accepted: 10/03/2005] [Indexed: 11/25/2022] Open
Abstract
We report of a young man who was referred for evaluation of the right atrial mass. He had presented outside the hospital with shortness of breath. A transthoracic echocardiogram (TTE) done there showed a bright echodensity in the right atrium with moderate pericardial effusion. He was treated for presumed viral pericarditis. Pericardiocentesis showed a bloody effusion. Four weeks after this initial presentation, a repeat TTE was done to evaluate for recurrent pericardial effusion due to shortness of breath. The right atrial mass had increased in size and no effusion was noted. He was referred to us for further evaluation. The tumor was successfully resected during surgery, and the pathological examination revealed primary cardiac angiosarcoma. The case highlights the misdiagnosis in initial clinical presentation, current diagnostic modalities, and treatment options for cardiac angiosarcoma.
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Affiliation(s)
- Kizhake C Kurian
- Department of Cardiovascular Medicine, UFSHC at Jacksonville, Jacksonville, FL 32209, USA.
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Abstract
Abstract
Diffuse lung involvement by metastatic tumor from an unknown primary site often constitutes a diagnostic dilemma. Although cytologic features and pattern of metastatic spread can guide in narrowing the list of possible primary neoplasms, immunohistochemistry remains pivotal in determining the phenotype of metastatic disease. We report a case with extensive involvement of lung parenchyma by a metastatic epithelioid neoplasm exhibiting a variety of distinctive patterns with a predominance of intra-arterial and lymphangitic spread. Immunohistochemical studies showed no evidence of epithelial, melanocytic, or lymphoid differentiation. The neoplastic cells were strongly positive for vimentin and CD31 but negative for CD34 and factor VIIIR:Ag. Electron microscopy of formalin-fixed tissue revealed multiple Weibel-Palade bodies and pinocytosis, supporting the diagnosis of epithelioid angiosarcoma. Doppler studies performed after pathologic diagnosis was rendered demonstrated 2 discrete hypoechoic masses within the medial aspect of the left proximal calf musculature, suggestive of solid soft tissue neoplasm—a possible source of pulmonary metastatic disease.
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Affiliation(s)
- Lidiya Lund
- From the Department of Pathology, St. Luke's-Roosevelt Hospital Center, New York, NY
| | - Ramila Amre
- From the Department of Pathology, St. Luke's-Roosevelt Hospital Center, New York, NY
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López L, Iriberri M, Cancelo L, Gómez A, Uresandi F, Atxotegui V. Persistent Hemoptysis Secondary to Extensive Epithelioid Angiosarcoma. ACTA ACUST UNITED AC 2004; 40:188-90. [PMID: 15030735 DOI: 10.1016/s1579-2129(06)60213-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pulmonary angiosarcoma is an unusual cause of diffuse pulmonary hemorrhage. Angiosarcomas are rare malignant vascular tumors accounting for 1% to 2% of all sarcomas. Angiosarcomas have been detected in nearly all organs, but lung involvement is unusual, accounting for less than 7%. The literature describes approximately 10 isolated cases of primary pulmonary angiosarcoma as opposed to the more common metastatic type. Given that primary and metastatic types are clinicopathologically similar, the presence of a distant primary sarcoma must be ruled out before a diagnosis of primary pulmonary angiosarcoma can be made. A pathological diagnosis requires a finding of polygonal or oval cells with atypical irregular nuclei and vascular spaces lined with such cells surrounded by hemorrhagic phenomena. Immunohistochemical analysis is positive for specific endothelial cell markers such as CD31 and factor VIII, and coexpression of keratin is a frequent finding.
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Affiliation(s)
- L López
- Unidad de Patología Respiratoria, Hospital de Cruces, Baracaldo, Vizcaya, Spain
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Tateishi U, Hasegawa T, Kusumoto M, Yamazaki N, Iinuma G, Muramatsu Y, Moriyama N. Metastatic angiosarcoma of the lung: spectrum of CT findings. AJR Am J Roentgenol 2003; 180:1671-4. [PMID: 12760941 DOI: 10.2214/ajr.180.6.1801671] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to summarize the CT features of pulmonary metastases in angiosarcoma in 24 patients. CONCLUSION A variety of CT features were associated with metastatic angiosarcoma of the lung. The common CT manifestations of metastatic angiosarcoma were multiple solid nodular lesions and multiple thin-walled cysts that were often accompanied by hemorrhagic change.
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Affiliation(s)
- Ukihide Tateishi
- Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
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