A Rare Case of Peritoneal Disseminated Angiosarcoma 20 Years after Ovarian Cancer Diagnosis

Abstract

Angiosarcoma is a rare form of sarcoma which may be either a primary tumor or it may result from previous irradiation because of another tumor. In this paper, we present a case of a female patient diagnosed as having peritoneal disseminated angiosarcoma 20 years after ovarian cancer treatment (surgery, chemotherapy and radiotherapy). The case was very atypical because of an extremely rare peritoneal location and disseminated nature of the changes. Based on the initial histological picture, poorly differentiated cancer metastasis was diagnosed, suggesting a recurrence of the ovarian cancer that had been diagnosed earlier. The time elapsed from the ovarian cancer diagnosis, history of the previous irradiation and concentration of tumor markers were the only additional clinical data provided to the pathologists, which ultimately contributed to a correct diagnosis. The case we present herein shows and emphasizes the importance of proper communication between a clinician and a pathologist, which is a prerequisite for a correct diagnosis and, consequently, for proper treatment of patients. It also confirms the high specificity of the HE4 (human epididymis protein 4) marker in the monitoring of ovarian cancer, which was within normal limits in spite of peritoneal tumor dissemination.

Gynecological radio-induced secondary malignancy after a gynecological primary tumor: a rare entity and a challenge for oncologists

“…While the initial results led to 85 publications, after the screening process, only 20 publications met the inclusion criteria (Figure 1). Overall, six retrospective,17–22 two population-based cohort,23 24 and 12 case reports25–36 were included. Key characteristics of the analyzed population are summarized in Online Supplemental Tables 2 and 3.…”

“…Similarly, the clinical data on survival were not always described, as highlighted in Online Supplemental Table 3. Data on overall survival were available in 11 studies19 20 22 25–27 31–34 36 and ranged between 7 and 57 months. Only three articles reported data on progression-free survival on angiosarcomas that ranged between 1 month and 3 years for bones, soft tissue and/or local progression after treatment 26 32 34.…”

Radiation-associated peritoneal angiosarcoma

“…One such case report was of disseminated peritoneal angiosarcoma that occurred 20 years after treatment for ovarian cancer with RT 9. Other such case reports include that of small bowel angiosarcoma and greater omentum angiosarcoma 7 10.…”

Radiation‑induced angiosarcoma of the omentum diagnosed by laparoscopy: A case report

“…All cases presented with advanced disease, which were complicated with massive hemorrhagic ascites and peritoneal dissemination. While the cases receiving palliative care described the rapidly progressing character of the disease ( 3 , 5 ), Chudecha-Glaz et al reported the achievement of partial response by platinum-based chemotherapy, which lead to cytoreductive surgery and control of the disease at least temporarily ( 4 ). Swiftly making the diagnosis and enabling chemotherapy administration seems to be the key in controling the disease.…”