Metastatic angiosarcoma of the lung with alveolar hemorrhage

Saitoh, Jun‐ichi; Sakurai, Hideyuki; Suzuki, Yoshiyuki; Katoh, Hiroyuki; Takahashi, Tetsuya; Nakano, Takashi

doi:10.1007/s11604-009-0352-1

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…These imaging findings, whether solid or cystic, can generally be observed with hemorrhagic changes, which are considered to be a characteristic finding of metastatic angiosarcoma. Radiologically, these hemorrhagic complications may be characterized by gas-fluid levels in thin-walled cysts, diffuse pulmonary infiltration, hemothorax or ground-glass thinning areas ( 11 , 14 , 15 ). PET/CT can non-invasively distinguish benign and malignant lesions, search for metastatic lesions, and provide clinical decision-making ideas for diagnosis by combining patients’ clinical symptoms and related examinations, which has a high negative predictive value ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

A Rare Cause of Pulmonary Nodules Diagnosed as Angiosarcoma Was Misdiagnosed as Vasculitis and Wegener’s Granuloma in an Elderly Man: A Case Report

Wang

Yang

2021

Front. Oncol.

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BackgroundAngiosarcoma is a rare, highly malignant tumor prone to recurrence and metastasis. Angiosarcoma is insidious in the initial stage, and its clinical manifestation lacks specificity. The diagnosis is based on histopathology and immunohistochemistry findings.Case presentationA 73-year-old man was hospitalized following complaints of persistent cough 6 months and hemoptysis for 2 months. Anti-infective treatment was ineffective. A CT-guided percutaneous core needle biopsy of pulmonary lesions revealed organized pneumonia, and the removed skin of purpuric rash area on the left calf revealed vasculitis. Chest CT was used during the patient follow-up. Hormonal therapy combined with immunoglobulins did not lead to improvement, and there was rapid progression of the lung lesions. Subsequently, the patient underwent a surgery, the diseased tissue was separated and removed completely beside the left submandibular gland under local anaesthesia. The immunohistochemical staining indicated CD31 (+) and CD34 (+) confirming a diagnosis of metastatic angiosarcoma. The expression of PD-L1 was 70%, therefore, anlotinib and pembrolizumab treatments were initiated. The patient eventually died.ConclusionAngiosarcoma is a malignant tumor in the clinic that lacks typical and specific signs and symptoms. The diagnosis depends on immunohistochemistry, which requires repeated biopsies of multiple sites in highly suspected cases.

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Section: Discussionmentioning

confidence: 99%

A Rare Cause of Pulmonary Nodules Diagnosed as Angiosarcoma Was Misdiagnosed as Vasculitis and Wegener’s Granuloma in an Elderly Man: A Case Report

Wang

Yang

2021

Front. Oncol.

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“…Therefore, either diffuse alveolar hemorrhage (DAH) or pulmonary embolism (presenting as chest pain, hypoxemia, and hemoptysis) is often the presenting manifestation. [6,12] Hemoptysis, which can mimic the symptoms of pulmonary hemorrhage syndrome, pulmonary vasculitis, pulmonary infection, or parenchymal lung disease, is the most commonly reported symptom. [6,11,13] Antibiotics and steroid therapy can sometimes improve the symptoms.…”

Section: Discussionmentioning

confidence: 99%

Clinical and diagnostic features of angiosarcoma with pulmonary metastases

Wang¹,

Shi²,

Liu³

et al. 2017

Medicine

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Angiosarcoma with pulmonary metastasis is a rare, fatal disease that often presents with multiple pulmonary nodules and diffuse alveolar hemorrhage. We herein review the detailed clinical characteristics of pulmonary metastatic angiosarcoma and determine a reasonable diagnostic strategy.The medical records of 11 patients with pulmonary angiosarcoma were reviewed.The mean age of the patients was 45.7 years (range, 30-71 years). All patients were male. The most common symptom was hemoptysis (8/11). Common initial misdiagnoses were tuberculosis (5/11), vasculitis (2/11), nontuberculous infectious disease (1/11), and constrictive pericarditis (1/11). Chest computed tomography (CT) of patients with hemoptysis showed bilateral, randomly distributed, variably shaped, and differently sized nodules, as well as ground-glass opacities (GGO) (8/11). The right heart was the most common primary tumor site (8/11), but the sensitivity of echocardiography was limited; CT angiography and cardiac magnetic resonance imaging (MRI) revealed more atrial masses. CT-guided needle biopsy was difficult to perform in most patients because of the small size of the nodules. The diagnosis was made by surgical biopsy of either the lung (3/9) or heart (6/9). The median overall survival of patients who underwent lung biopsy and those who underwent cardiac/pericardiac biopsy was 4.1 and 1.4 months, respectively (P = .098). The median overall survival of the 9 available patients was 5.0 months (95% confidence interval, 0.500-8.544).Angiosarcoma with pulmonary metastases should be considered in patients with hemoptysis and concurrent GGO and nodules on their chest CT scan. Careful cardiologic monitoring is necessary for these patients, even without any cardiac symptoms or signs, and enhanced cardiac MRI is the first recommendation. Surgical biopsy is reliable for histological diagnosis, but the safety of the lung biopsy should be carefully assessed. When primary cardiac tumors are identified, heart biopsy should be preferentially considered.

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“…Our data suggest that the percentage of category major 1 of the discrepancies between antemortem clinical and autopsy diagnosis has not changed significantly over the past 30 years. [87] Malignant fibrous histiocytoma of the liver 1/0/0 43 1 1 0 Schweyer S, et al [88] Renal cell carcinoma 0/0/1 N/A 1 1 0 Katz ES, et al [89] https://doi.org/10.1371/journal.pone.0255917.t004…”

Section: Plos Onementioning

confidence: 99%

Pulmonary tumor embolism: A retrospective study over a 30-year period

Anthony

Catoni

et al. 2021

PLoS ONE

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Background Pulmonary tumor embolism (PTE) is difficult to detect before death, and it is unclear whether the discrepancy between antemortem clinical and postmortem diagnosis improves with the advance of the diagnostic technologies. In this study we determined the incidence of PTE and analyzed the discrepancy between antemortem clinical and postmortem diagnosis. Methods We performed a retrospective autopsy study on patients with the history of malignant solid tumors from 1990 to 2020 and reviewed all the slides of the patients with PTE. We also analyzed the discrepancies between antemortem clinical and postmortem diagnosis in 1999, 2009 and 2019 by using the Goldman criteria. Goldman category major 1 refers to cases in which an autopsy diagnosis was the direct cause of death and was not recognized clinically, but if it had been recognized, it may have changed treatment or prolonged survival. Results We found 20 (3%) cases with PTE out of the 658 autopsy cases with solid malignancies. Out of these 20 cases, urothelial carcinoma (30%, 6/20) and invasive ductal carcinoma of the breast (4/20, 20%) were the most common primary malignancies. Seven patients with shortness of breath died within 3–17 days (average 8.4±2.2 days) after onset of the symptoms. Pulmonary embolism was clinically suspected in seven out of twenty (35%, 7/20) patients before death, but only two patients (10, 2/20) were diagnosed by imaging studies before death. The rate of Goldman category major 1 was 13.2% (10/76) in 1999, 7.3% (4/55) in 2009 and 6.9% (8/116) in 2019. Although the rate of Goldman category major 1 appeared decreasing, the difference was not statistically significant. The autopsy rate was significantly higher in 2019 (8.4%, 116/1386) than in 2009 (4.4%, 55/1240). Conclusions The incidence of PTE is uncommon. Despite the advances of the radiological techniques, radiological imaging studies did not detect the majority of PTEs. The discrepancy between the antemortem clinical and the postmortem diagnosis has not improved significantly over the past 30 years, emphasizing the value of autopsy.

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Metastatic angiosarcoma of the lung with alveolar hemorrhage

Cited by 6 publications

References 9 publications

A Rare Cause of Pulmonary Nodules Diagnosed as Angiosarcoma Was Misdiagnosed as Vasculitis and Wegener’s Granuloma in an Elderly Man: A Case Report

A Rare Cause of Pulmonary Nodules Diagnosed as Angiosarcoma Was Misdiagnosed as Vasculitis and Wegener’s Granuloma in an Elderly Man: A Case Report

Clinical and diagnostic features of angiosarcoma with pulmonary metastases

Pulmonary tumor embolism: A retrospective study over a 30-year period

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