Metastatic angiosarcoma: a vascular tumour or an intracranial haemorrhage?

Abstract

A 64-year-old man presented with weakness of his right arm and leg. He had previously had mitral valve replacement, tricuspid annuloplasty, leg deep vein thrombosis (DVT) and femoral embolism. Computed tomography (CT) scan of the brain showed an acute left thalamic haemorrhage. Repeat CT brain showed resolution of the original haemorrhage, but the apparent development of new areas of haemorrhage. Warfarin continued due to high risk of thromboembolism. He was readmitted with the rapid development of a visible swelling at the sternum and on the scalp. Ultrasound scan of the sternum revealed a vascular tumour. Suspected haemorrhages in the past were reported as the metastatic deposits. Biopsy and immunohistochemical staining confirmed angiosarcoma of the scalp. Being vascular tumours, angiosarcoma can mimic a brain haemorrhage. Our case illustrates a clinical conundrum. Diagnosing metastatic angiosarcoma of the brain proved difficult without visible primary and histology. The rapid clinical course of the disease and problems with anticoagulation therapy made treatment options limited and the prognosis worse.

Pyothorax-associated angiosarcoma metastasized to the brain with multiple and progressively expanding hematomas: Case report and literature review

“…[ 36 ] To the best of our knowledge, 34 cases of metastatic brain angiosarcoma have been reported, half of which were metastases from the heart [ Table 1 ]. [ 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 ] Metastatic lesions of the brain are usually multiple at diagnosis, and differentiation from intracerebral hemorrhages[ 26 ] or cavernous angiomas[ 23 27 ] based only on radiological findings is difficult. Only two previous cases had a history of expanding hematoma in a short period as was observed in our case.…”

“…[36] To the best of our knowledge, 34 cases of metastatic brain angiosarcoma have been reported, half of which were metastases from the heart [Table 1]. Metastatic lesions of the brain are usually multiple at diagnosis, and differentiation from intracerebral hemorrhages [26] or cavernous angiomas [23,27] based only on radiological findings is difficult.…”

Metastatic Cardiac Angiosarcoma to the Lung, Spine, and Brain: A Case Report and Review of the Literature

“…1, [5][6][7][8] In published case reports of angiosarcoma of the CNS, the clinical presentation is often rapid onset of neurologic deficits with intracranial hemorrhage. [9][10][11][12][13] The propensity of angiosarcomas to hemorrhage is underscored by a report of surgical resection that required 12 units of packed red blood cell and plasma transfusions. 4 Systemic angiosarcomas originate from endothelial cell of arteries, veins, or lymphatic channels.…”

“…[7][8][9]12,19,[28][29][30][31][32][33][34][35][36][37][38][39][40] The most common primary site of angiosarcomas with CNS metastasis is the right atrium of the heart (35% of reported cases). 8,9,12,13,28,30,35,40 The most common metastasis sites are the cervical lymph nodes, lung, liver and spleen. 7,41 In our patient, we suspect that the primary site was the right atrial mass, with metastatic spread to the lung and brain.…”