Angiosarcoma of the abdominal aorta after endovascular aneurysm repair

Yu, Patrick C.; Aplin, Brett; Reed, Amy B.

doi:10.1016/j.jvscit.2019.07.003

Cited by 13 publications

(16 citation statements)

References 5 publications

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“…Widespread metastasis were present in many cases, either at the time of the diagnosis or occurring during follow-up (mostly within 12 months), confirming the clinical aggressiveness and metastatic potential characterizing AS [7,25]. In particular, five patients presented with spine metastasis at the time of the diagnosis [7,22,23,25,28], and three patients developed vertebral metastasis within seven months from the first symptoms [17,30,31].This case presented with a symptomatic vertebral involvement that needed surgical percutaneous arthrodesis and raised an initial clinical suspicion for a primary/secondary spine tumor, osteonecrosis and septic spondylitis rather than an infiltrating AS originating from the nearby aortic wall. In fact, primary AS of the bone is uncommon, accounting for less than 1% of angiosarcomas, and its primary occurrence in the spine is exceedingly rare, being documented only in few reports.…”

Section: Review Of the Literaturementioning

confidence: 87%

“…Another hypothesis for the vascular graft-associated cases might be the alteration of blood flow with creation of turbulence, as reported in rare cases of arteriovenous fistulae associated AS in absence of foreign material [16]. In the literature, 17 cases of aortic graft-related AS are described (Table 1) [7,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31], 12 of which associated with a polyester prosthesis (Dacron) [7, 17-23, 25, 26, 28, 31], and two linked to a PTFE graft [29,30], while three cases do not mention the graft material [24,27]. According to this review, male gender was predominant (15 cases over 17) and the mean age of disease manifestation was 64.6 years, ranging from 50 to 84 years.…”

Section: Review Of the Literaturementioning

confidence: 99%

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Bleeding “sarcomatosis” as a rare presentation of vascular graft-related angiosarcoma: case report and review of the literature

et al. 2020

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Background Angiosarcoma is a rare malignant tumor, originating from vascular endothelial cells, accounting for approximatively 1–2% of soft tissue sarcomas. It is characterized by a rapid proliferation and high metastatic potential. Some cases of angiosarcoma are described in association with vascular prosthesis, orthopedic devices and foreign bodies. Hereby, we report a case of a patient treated with the endovascular placement of a PTFE aorto bis-iliac prosthesis for aortic aneurysm, who developed a graft-related angiosarcoma with bone and peritoneal localizations. The peritoneal “sarcomatosis” led to an acute presentation with hemoperitoneum and anemia. We perform a thorough review of the literature summarizing the description of similar cases, their epidemiology and the possibilities for treatment. Case presentation An 84-year-old male with a history of abdominal aortic aneurysm endovascular repair presented to our emergency department complaining with low back pain radiating to the left limb. He underwent a type II endoleak embolization of the aneurysmal sac nine days before. During hospitalization he underwent a spine MRI which documented a vertebral alteration of non-univocal interpretation. Vertebral biopsy was performed revealing groups of cells of uncertain nature. He lately underwent percutaneous L2–L4 arthrodesis. Forty-two days after admission, he developed acute anemia. Emergency laparotomy revealed a massive hemoperitoneum and actively bleeding peritoneal nodules. Abdominal packing was performed, and several nodules were sent for definitive histological examination. After surgery, he developed progressive and severe hypovolemic shock and expired on postoperative day 5. Conclusions Angiosarcoma associated with foreign bodies, especially vascular prosthesis, is a very rare entity. In patients who have a history of prosthetic vascular graft placement that present with lumbar pain, osteolytic changes at radiologic imaging or the development of ascites, angiosarcoma should be considered in the differential diagnosis. Despite the poor prognosis, a prompt diagnosis might give access to an adequate treatment planning, with the aim for disease control and increased survival.

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Section: Review Of the Literaturementioning

confidence: 87%

Section: Review Of the Literaturementioning

confidence: 99%

Bleeding “sarcomatosis” as a rare presentation of vascular graft-related angiosarcoma: case report and review of the literature

et al. 2020

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“…After endograft implantation, the diagnosis of an angiosarcoma is challenging as graft-related complications such as graft infection, endoleak or pseudoaneurysm may being mimicked [10][11][12]. Since these complications are more common, the diagnosis of an angiosarcoma is often delayed.…”

Section: Discussionmentioning

confidence: 99%

Angiosarcoma after endovascular aneurysm repair: case report and literature review

Pecceu

Deolet

Dorpe

et al. 2022

Acta Chirurgica Belgica

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Introduction: Epithelioid angiosarcoma is a rare soft tissue sarcoma with a poor prognosis. We report two cases of patients who presented with a history of lower back pain, inflammatory signs and weight loss 5 and 6 years after endovascular aortic repair (EVAR) of an elective infrarenal abdominal aortic aneurysm (AAA). Imaging suggested graft infection but tissue samples revealed an epithelioid angiosarcoma. The objective is to report the clinical presentation, investigative modalities and immunohistochemical findings of an angiosarcoma after EVAR. Patients and methods: Two cases are described of an angiosarcoma of the aorta after EVAR. A literature search using PubMed, Embase and Web of Science was performed in English about angiosarcoma after EVAR published between 2007 and 2021. Relevant reports were selected and analysed. Results: Fifteen case reports were identified, including the current two cases. Time to tumour detection after EVAR ranged from 6 to 120 months with a mean interval of 68 months. Most patients underwent endovascular repair of an AAA (13/15). Males (13 male/2 female patients) were predominant with a median age of 72 years (IQR 68-78 years). Over half of the patients had metastases at the time of diagnosis (9/15), most frequently in bones and liver. Conclusion: Diagnosis of angiosarcoma after EVAR remains challenging due to indistinctive clinical and radiological findings mimicking graft infection or endoleak. Angiosarcoma should be included in the differential diagnosis in patients previously treated with EVAR presenting with unintended weight loss, abdominal back pain and contrast enhancement of the aortic wall. Conclusion:

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“…[11] AS has also been reported to occur at sites of or adjacent to endovascular and bypass grafts. [12,13] There is an increased incidence in those with prior radiation therapy, appreciable vinyl chloride or arsenic exposure, or prolonged lymphedema, usually as a sequela to axillary lymph node dissection for breast cancer. [3,14,15] Our patient had an aortic graft and axillary-femoral bypass however the possibility of this location as a primary site was excluded by performing a thorough gross and microscopic examination.…”

Section: Discussionmentioning

confidence: 99%

Epithelioid angiosarcoma of the small intestine presenting with intractable gastrointestinal bleeding: An uncommon tumor with diagnostic challenge and poor prognosis

Onyenekwu

Singh

Miller

et al. 2021

CRCP

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Introduction: Angiosarcoma of the gastrointestinal tract is a rare, aggressive malignant neoplasm of vascular origin. Commonly, this tumor occurs due to metastases from other sites like the head and neck region and the soft tissue. When occurring as a primary tumor of the intestines, this entity poses a diagnostic dilemma due to its non-specific clinical presentation, coupled to its infiltrative features that may occur without an obvious lesion amenable to routine gastrointestinal interventions. The findings from an autopsy and surgical case with a brief review of its diagnostic features and relevant literature are discussed.Methods: We present a 73-year-old male with a history of a recent onset of gastrointestinal bleeding who was referred to our facility for persisting bleeding. He underwent endoscopy without an identifiable source of bleeding and subsequently received a colectomy at our facility, with repeated blood transfusions for persisting gastrointestinal bleeding. He was eventually transitioned to hospice and died shortly after presentation. A complete autopsy was performed.Results: There was anasarca with hemoperitoneum and intestinal intraluminal blood. Present in the small intestinal mucosa were three hemorrhagic nodules. Histologically, the nodules demonstrated medium to large epithelioid vasoformative neoplastic cells infiltrating through the wall of the small intestine and extending to the omentum. The findings from the gross and histology examination, as well as the immunohistochemical stains were consistent with an epithelioid angiosarcoma.Conclusion: Primary epithelioid angiosarcoma of the intestine is an uncommon aggressive tumor that poses a diagnostic challenge. Although rare, this diagnosis needs to be considered in patients with intractable gastrointestinal bleeding. Due to its morphologic overlap with other benign and malignant neoplasms, the use of ancillary testing during histologic examination is key in arriving at an accurate diagnosis.

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Angiosarcoma of the abdominal aorta after endovascular aneurysm repair

Cited by 13 publications

References 5 publications

Bleeding “sarcomatosis” as a rare presentation of vascular graft-related angiosarcoma: case report and review of the literature

Bleeding “sarcomatosis” as a rare presentation of vascular graft-related angiosarcoma: case report and review of the literature

Angiosarcoma after endovascular aneurysm repair: case report and literature review

Epithelioid angiosarcoma of the small intestine presenting with intractable gastrointestinal bleeding: An uncommon tumor with diagnostic challenge and poor prognosis

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