Angiosarcoma in a Chronically Immunosuppressed Renal Transplant Recipient

Abstract

Angiosarcomas are rare malignant tumors of endothelial origin that occur predominantly in the adult population. To date, only 12 cases have been described after renal transplantation. We review the literature and present an additional case of a 59-year-old patient in whom lower-extremity lesions of cutaneous angiosarcoma developed several years after transplantation. Of the 13 patients, clinical details were available in only 12 cases. There were 10 male and 2 female patients. The mean age at diagnosis was 47.6 years (age range, 28-71 years). Almost all patients were on a combination immunosuppressive regimen, and the interval between transplantation and the development of the tumor was variable in the range of 8 months to 12 years. In five patients, the tumor arose within or adjacent to an arteriovenous fistula site. Cutaneous involvement was observed in only four cases. The histologic spectrum consisted of both well-differentiated and poorly differentiated tumors. In one patient, features of the hemophagocytic syndrome were clinically present and the tumor morphologically displayed prominent erythrophagocytosis. In two of the cases, including the patient described in the current report, polymerase chain reaction was performed on lesional tissue for human herpesvirus-8 and the result was negative for the presence of viral DNA. Despite the use of multimodal aggressive therapy in most patients, death as a result of disease dissemination occurred over variable time periods (range, 1-15 months).

Transmission of Angiosarcomas From a Common Multiorgan Donor to Four Transplant Recipients

“…According to the literature, less than 20 cases have been described in patients after kidney transplantation. However, in these immunosuppressed patients, angiosarcomas were not located in transplanted organs, but tumors were observed within or adjacent to the arteriovenous fistula site in transplanted patients and tumors developed within several years after transplantation (2). To the best of our knowledge, no case of simultaneous transmission of metastatic angiosarcomas ascribed to organ transplantations from a common donor has been reported.…”

Chronic venous ulceration with associated angiosarcoma

“…3 The risk factors for angiosarcoma 4 include: chronic pyothorax, exposure to environmental toxins and drugs (Thorotrast, insecticides containing AsO3, vinyl chloride, long-term anabolic steroid and estrogen therapy), previous radiotherapy, chronic lymphoedema (Stewart-Treves syndrome), morbid obesity, 5 and renal transplantation. 6,7 Less commonly reported associations are pre-existing neoplasia (benign and malignant nerve sheath tumors, leiomyomas, plexiform neurofibromas, schwannomas, and malignant germ cell tumour), familial syndromes (Klippel-Trenaunay syndrome, Maffucci syndrome, neurofibromatosis, Aicardi syndrome, xeroderma pigmentosum, and hereditary retinoblastoma), and adjacent to foreign material (shrapnel, steel, plastic, Dacron, vascular graft material, surgical sponges, and bone wax). 8,9 Chronic skin ulceration is a rare predisposing condition for angiosarcoma.…”

Angiosarcoma of the Scalp and Face: A Hard to Treat Tumor

“…Several cases following a renal transplant have been reported [8]. Goedert et al suggested that similarly to Kaposi sarcoma, angiosarcoma and AIDS could be associated [9].…”