Imaging features of primary sites and metastatic patterns of angiosarcoma

Abstract

Angiosarcomas are rare, aggressive soft tissue sarcomas originating from endothelial cells of lymphatic or vascular origin and associated with a poor prognosis. The clinical and imaging features of angiosarcomas are heterogeneous with a wide spectrum of findings involving any site of the body, but these most commonly present as cutaneous disease in the head and neck of elderly men. MRI and CT are complementary imaging techniques in assessing the extent of disease, focality and involvement of adjacent anatomical structures at the primary site of disease. CT plays an important role in the evaluation of metastatic disease. Given the wide range of imaging findings, correlation with clinical findings, specific risk factors and patterns of metastatic disease can help narrow the differential diagnosis. The final diagnosis should be confirmed with histopathology and immunohistochemistry in combination with clinical and imaging findings in a multidisciplinary setting with specialist sarcoma expertise. The purpose of this review is to describe the clinical and imaging features of primary sites and metastatic patterns of angiosarcomas utilising CT and MRI.

Lenvatinib‐associated hemoperitoneum in a patient with primary angiosarcoma of the breast

“…The incidence of primary angiosarcoma in the breast is about 0.05%, and among all breast tumors, 0.1%–0.2% 4,5 . They are usually characterized by the presence of epithelial markers like pan‐cytokeratin or endothelial markers such as CD31 and CD34 and are likely to hemorrhage due to frailty of the neovascular tissue 6,7 . With hepatocellular carcinoma, the likelihood of tumor hemorrhage is increased when it is in the caudate lobe as well as in Segments II, III, and VI of the liver.…”

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

“…Advanced metastasis may spread multifocally, infecting the liver, lymph nodes, bone, brain, spleen, and other soft tissues. [2,3,[25][26][27] In 15% of the cases, the patient is diagnosed with the disease at the metastatic state, and in ~70% to 80% of cases, local recurrences have been described posttreatment. Diagnostic imaging techniques may aid in initial preoperative diagnosis and provide definitive clinical suspicions for further course of treatment.…”

“…These imaging techniques may provide the necessary clinical assessment of treatment response, staging the metastasis of the disease and detecting the calcifications to identify bone involvement. [27,29,30] Diagnostic imaging features are relatively nonspecific, presenting challenges in the differential diagnosis of AS from other tumors. Thus, histological and immuno-histochemical identification of the tumor specimen is paramount for differential diagnosis.…”

Angiosarcoma of the lungs, liver, and bones in a 27-year-old male patient

“…Angiosarcoma can be detected on ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI); however, it is usually difficult to distinguish it from other cancer types [7,14]. Biopsy, pathology tests, and immunohistochemical analysis are required to confirm the diagnosis [15].…”