Case of Rapidly Progressing Angiosarcoma after Total Hip Arthroplasty

Abstract

The occurrence of malignant tumor in proximity to an arthroplasty prosthesis has been a matter of debate since it was first reported in 1978. Upon considering the number of orthopedic implants used, the occurrence of malignancy is rare. Especially in case of angiosarcoma, only a few cases have been reported worldwide. In this case, we report an extremely rare case of angiosarcoma arising at the site of a revision total hip arthroplasty. A 69-year-old female had received total hip replacement on her left hip due to osteoarthritis 8 months ago. Four months later, she complained pain on her operated area, X-ray showed loosening of implanted cup on her left hip. Thereafter, erythematous and purpuric papules and nodules were developed and spread around on her left hip. Through the skin biopsy she was diagnosed with angiosarcoma, and then she died of a sharp deterioration. Herein, we report a rare case of angiosarcoma occurred after total hip replacement with a review of the literature.

Osteosarcoma Around a Ceramic-on-Ceramic Total Hip Arthroplasty

“…Most studies followed bimodality therapy involving surgery (resection, internal fixation, or THA revision) and chemotherapy or radiation therapy [ [14] , [15] , [16] , [17] , [18] , 21 , 23 ], including our case. Other studies used unimodal therapy with either chemotherapy or radiation therapy to treat the sarcoma [ 19 , 22 , 24 ]. The prognosis for the patients in this literature review is poor with survival being less than 1 year after diagnosis in 92.3% of patients.…”

Angiosarcoma of the caecum

“…It may be related to long-term exposure to radiation, chemical agents such as polyvinylchloride, thorotrast and arsenic, as well as a consequence of chronic lymphedema and amyloidosis [9,10,11]. Angiosarcoma has also been reported in association with implanted foreign material such as vascular (Dacron) grafts and orthopedic joint prostheses [12,13,14], breast implants [15,16], or in patients with arteriovenous fistulas. [12,13,17] According to the findings of recent studies, protracted use of calcium channel blockers may lead to colorectal angiosarcoma [1].…”

Etiology, pathogenesis, and management of angiosarcoma associated with implants and foreign body: Clinical cases and research updates

“…These retained foreign materials could belong to either of the categories, such as metallic objects (Shell splinter, bullet, surgical sponge/gauze, or non-arthroplasty implants), orthopedic and vascular prosthetic implants. [12][13][14][15]17] Diagnostic differentiation of angiosarcoma from other malignant carcinomas presents a challenging situation due to nonspecific clinical presentations and disease rarity. The multifocal ubiquitous clinical presentation with symptoms such as vomiting, abdominal discomfort, nausea, and bowel distension adds to the difficulty in early diagnostics.…”

“…Alive with disease 7 mo after surgery Terrando et al [61] Terrando et al [61] Terrando et al [61] Terrando et al [61] Lee et al [14] Biomedical implant tumorigenesis: orthopedic prosthesis linked to angiosarcoma Orthopedic prosthesis have been used extensively as implants for joint replacement after osteoarthritis or post-traumatic fractures. Various biomaterials have been used to construct orthopedic prostheses to provide nontoxic and inert characteristics.…”

“…[9][10][11] These cases were related to the development of AS at sites where vascular grafts, and orthopedic implants, such as prosthesis and metallic plates were present. [12][13][14] Other reports also described the presence of metallic objects (shell splinter and bullet), surgical sponge/gauze, bone wax, cardiac defibrillator, and biomaterials at sites presenting AS proliferation. [15][16][17] Chronic inflammation around these foreign materials could probably potentiate the pathogenic progression to the malignant transformation of surrounding soft tissues.…”