Fine‐Needle aspiration cytology of primary renal angiosarcoma with histopathologic and immunocytochemical correlation

Grapsa, Dimitra; Sakellariou, Stratigoula; Politi, Ekaterini

doi:10.1002/dc.23051

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…Additionally, CT imaging was valuable for acute assessment of complications. Moreover, fine-needle aspiration cytology appeared advantageous in early diagnosis when there was a consideration of PSA without laparotomy [25,26]. Collectively, PSA should be considered in the differential diagnosis of patients with splenomegaly, especially when there is anemia of unknown etiology.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognostic Factors of Primary Splenic Angiosarcoma: A Retrospective Clinical Analysis from China

Zhang

et al. 2018

Cell Physiol Biochem

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Background/Aims: Primary splenic angiosarcoma is an aggressive malignancy originating from endothelial cells with a particularly poor outcome despite radical therapy. Owing to its extremely low incidence, available data for splenic angiosarcoma are limited. The present study aimed to address this limitation by presenting a thorough retrospective analysis of Chinese primary splenic angiosarcoma patients over a 53-year period (1963-2016). Methods: To determine the characteristics of Chinese primary splenic angiosarcoma and identify factors that impact the outcomes of this histology, we retrospectively retrieved reports of 110 Chinese primary splenic angiosarcoma cases published between 1963-2012. Results: In total, 61 males and 49 females diagnosed with primary splenic angiosarcoma were included in the present study. The median age at diagnosis was 50 years (range 2.5–76 years). Of these patients, 25.5% had received prior radiotherapy. The rate of splenic rupture was 59.11%. The 1-year overall survival rate was 19.1% with a median overall survival time of 8.1 months. Age, gender, and radiation history showed no correlation with survival rate. However, by univariate analysis, we found that significant adverse predictors of survival were splenic rupture before surgery and large tumor size (> 5 cm), while adjuvant chemotherapy was a favorable predictor. Furthermore, multivariate analysis revealed that splenic rupture and adjuvant chemotherapy were independent adverse and favorable predictors, respectively. Conclusion: Our large series describes and confirms the characteristics and poor prognosis of Chinese primary splenic angiosarcoma, thus indicating a critical role for early diagnosis and surgical intervention (prior to rupture) in management, and highlights the promising potential of adjuvant chemotherapy for improving the outcome in these cases.

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Prognostic Factors of Primary Splenic Angiosarcoma: A Retrospective Clinical Analysis from China

Zhang

et al. 2018

Cell Physiol Biochem

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“…However, Singh et al classified this neoplasm as classic PRA or epithelioid renal angiosarcoma (ERA), depending on the predominance of a spindle or epithelioid pattern of cells, respectively (22,23). ERA has been described by many case reports as a divergent and infrequent manifestation of PRA, based on the exhibition of fundamental cell morphological and immunohistochemical discrepancies (10,12,18,22,24,25). Co-existence of PRA with other renal tumors and pathologies can modify the conventional histological features.…”

Section: Histopathology and Classificationmentioning

confidence: 99%

“…In the poorly differentiated phenotype, endothelial cells create a less obvious vasoformative configuration, becoming atypical and spindle or epithelioid in shape (18). These cells are arranged in multiple layers, occasionally forming intraluminal papillary projections (3,10). On the other hand, the welldifferentiated phenotype includes distinct vascular channels lined by a single layer of neoplastic cells with pleomorphic and hyperchromatic nuclei, immiscible cytoplasm and prominent nucleoli (10).…”

Section: Histopathology and Classificationmentioning

confidence: 99%

“…These cells are arranged in multiple layers, occasionally forming intraluminal papillary projections (3,10). On the other hand, the welldifferentiated phenotype includes distinct vascular channels lined by a single layer of neoplastic cells with pleomorphic and hyperchromatic nuclei, immiscible cytoplasm and prominent nucleoli (10). Classic PRA, which concerns the majority of cases, consists predominantly of spindle and elongated cells.…”

Section: Histopathology and Classificationmentioning

confidence: 99%

“…Furthermore, features such as multilayering, hyperchromatic nuclei, atypical mitotic figures, irregular nuclear outline and spindle or polygonal cell appearance reflect the malignant behavior of PRA (10). In contrast, renal angiomyolipoma and hemangioma, lack these features as benign entities (13,45).…”

Section: Histopathological Examination and Immunohistochemistrymentioning

confidence: 99%

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Primary Angiosarcoma of the Kidney: Literature Review of a Rare Nosologic Entity

et al. 2020

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Primary angiosarcoma of the kidney is a rare tumor, hence little is known concerning its diagnostic features and therapeutic management. We conducted this survey to present a complete literature review with emphasis on clinicopathological features, diagnosis and therapy. A thorough search was conducted in MEDLINE/PubMed. All relevant studies concerning primary renal angiosarcomas in adults were thoroughly reviewed. Primary renal angiosarcoma is characterized by an overall poor prognosis, is of unknown etiology and occurs most commonly in males between 60 and 70 years old. Presence of distant metastasis at the time of diagnosis is prevalent. Histopathological examination and immunohistochemical studies are the most important diagnostic tools. Treatment options include surgery, chemotherapy, radiotherapy and immunotherapy. Conclusion: Primary renal angiosarcoma is a rare but aggressive malignancy with low response to available therapeutic regimens and dismal survival rates.Angiosarcoma is an extremely rare and aggressive malignant tumor occurring in fewer than 2% of all soft-tissue sarcomas (1). Primary angiosarcoma arises most commonly from the skin, superficial soft tissue, liver, spleen, bone, and breast (2, 3). An exceedingly infrequent location is the kidney, which accounts for 1% of the total of angiosarcomas diagnosed (4). Primary renal angiosarcoma (PRA) has an overall dismal prognosis, with an estimated average life expectancy of 6 months. It is also referred to as renal hemangiosarcoma and was first described in 1942, with few reported cases since then. Its etiology is still unknown and its predisposing factors remain ill-defined (5, 6). However, case reports show development of PRA in patients with pre-existing renal angiomyolipoma or multicystic kidney disease (7,8). White males between 60-70 years old are most commonly affected (9). Presenting symptoms in the majority of patients include flank pain, hematuria, anemia and palpable mass (3).Initial diagnostic approach involves abdominal computed tomography (CT) and magnetic resonance imaging which may reveal a solitary renal mass. Further total body scan, which is indicated for TNM staging, may unveil distant metastatic lesions in the lungs, liver, bone, spleen, abdominal lymph nodes, peritoneum, or soft tissues (3). Histopathologically, it is defined by an angiomatous structure composed of atypical proliferation of endothelial cells, with epithelioid, spindle or histiocytoid characteristics, and anastomotic vascular channels (10). Biopsy and cytological characteristics combined with a positive immunohistochemical staining for CD31, CD34, factor VIII, vimentin, and friend leukemia integration 1 (FLI1) are the gold standard methods for the definitive diagnosis of PRA (6, 10).

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Primary angiosarcoma of the kidney: case report and comprehensive literature review

et al. 2019

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AbstractPurposeAngiosarcoma (AS) is an aggressive malignant tumour of endothelial origin, most frequently compelling the skin. The kidney is a rare site of primary occurrence of AS with a quite challenging diagnosis and poor prognosis, mainly due to its raw metastasising power. We described our first case of AS treatment. A comprehensive literature review in this field is also carried out.Patients and methodsWe report the case of a 56-years-old man with radiological appearance of an 11 cm poor vascularised left renal mass. The pre-operative imaging ruled out distant metastases and inferior vena cava thrombosis. Thus, after radioembolization, we performed a transperitoneal open radical nephrectomy with regional lymphadenectomy with the removal of the middle portion of the ileo-psoas muscle, followed by two lines of adjuvant chemotherapy. We analysed all the papers concerning primary kidney AS until December 2018.ResultsEstimated intraoperative blood loss was 200 mL with an operative time of 100 minutes. No postoperative complications were recorded, with the patient discharge in the 8th postoperative day. The pathological assessment showed a pT3a N0, M0 tumour compatible with AS of the kidney. An immune-histochemical study showed a vascular positive for CD31, CD34, Fli-1 with a Ki-67/Mib 1 of 50%. One month after surgery the patient began adjuvant chemotherapy with gemcitabine. After 45 days from surgery, a Computed Tomography scan showed lung and liver metastases with disease relapse in the left kidney lodge. The response to the first-line treatment was excellent, unlike the second-line, encountering a chemo-refractory disease. The cancer-specific survival was of 15 months. We included 66 cases in our review.ConclusionThis is the first case of treatment of kidney AS performed at our Institute. Our findings added new information about the unclear biology and progression of this subset of tumours, demonstrating an abysmal prognosis.

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Fine‐Needle aspiration cytology of primary renal angiosarcoma with histopathologic and immunocytochemical correlation

Cited by 5 publications

References 14 publications

Clinical Characteristics and Prognostic Factors of Primary Splenic Angiosarcoma: A Retrospective Clinical Analysis from China

Clinical Characteristics and Prognostic Factors of Primary Splenic Angiosarcoma: A Retrospective Clinical Analysis from China

Primary Angiosarcoma of the Kidney: Literature Review of a Rare Nosologic Entity

Primary angiosarcoma of the kidney: case report and comprehensive literature review

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