A rare case of epithelioid angiosarcoma

Authors

  • Ana Margarida Correia Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal https://orcid.org/0000-0003-0112-7401
  • Rafael Ribas Fernandes General Surgery Department, Hospital das Forças Armadas – Pólo do Porto, Portugal https://orcid.org/0000-0001-6469-5401
  • José Carlos Vidoedo Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal https://orcid.org/0000-0002-5061-4145
  • Jorge Guimarães Surgical Oncology Department, Instituto Português de Oncologia do Porto Francisco Gentil (IPO-Porto), Porto, Portugal
  • João Almeida Pinto Vascular Surgery Department, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal https://orcid.org/0000-0001-6519-6591

DOI:

https://doi.org/10.48729/pjctvs.301

Keywords:

Surgical Oncology, Vascular surgery, Diagnosis, Differential, Angiosarcoma

Abstract

Epithelioid angiosarcoma is a rare high-grade vascular neoplasm with a poor prognosis.

We present an anticoagulated 77-year-old man, with a history of popliteal/soleal vein thrombosis in the previous month, complaining of ipsilateral persistent lower limb pain and claudication. Absent popliteal/distal pulses prompted an arterial doppler ultrasound (DUS), revealing thrombosis of the distal superficial femoral artery and a popliteal mass. As the arterial wall’s integrity could not be appropriately evaluated by DUS, adventitial cystic disease of the popliteal artery was suspected. Computed tomography angiography and magnetic resonance imaging findings were also suggestive. Due to refractory pain, he was submitted to a popliteal mass excision along with a femoral-posterior tibial bypass. Pathology revealed an epithelioid angiosarcoma. He was referred to a Sarcoma Center, requiring hospitalization for agitation and fever. A positron emission tomography (PET) scan revealed extensive lower limb disease persistence and distant metastases. He died on the 56th day after surgery.

To our knowledge, there are only 15 cases of angiosarcoma of the popliteal artery described in the literature. Ours stands out as the first one unrelated to a popliteal aneurysm.

Being a highly-aggressive tumor, an early diagnosis is challenging but essential to a successful treatment, warranting the need for suspicion of this neoplasm. An early core biopsy or surgical sample may expedite the diagnosis.

Downloads

Download data is not yet available.

References

Kogon B, Kabeer M, Sawchuk AP, Dalsing M, Billings S, “Angiosarcoma presenting as an occluded popliteal artery pseudo-aneurysm,” J Vasc Surg, 1998 May; 27(5):970-3. doi: 10.1016/ s0741-5214(98)70280-0.

Mitchell RN, Halushka MK. Blood Vessels. In: Kumar V, Abbas AK, Aster JC, editors, Robbins & Cotran Pathologic Basis of Disease, 10th ed. Philadelphia, PA: Elsevier; 2021. p. 485-525.

Arts L, Roesti A, Haller C, Danzer D, “Angiosarcoma after Popliteal Aneurysm Exclusion Surgery. A Systematic Review,” Ann Vasc Surg, 2022 Jul; S0890-5096(22)00331-4. doi: 10.1016/j. avsg.2022.06.012.

Hart J, Mandavilli S, “Epithelioid angiosarcoma: a brief diagnostic review and differential diagnosis,” Arch Pathol Lab Med, 2011; 135(2):268-72. doi: 10.5858/135.2.268.

Cristaudo A, Steffen C, “Not Just a Popliteal Aneurysm: A Case of Metastatic Epithelioid Angiosarcoma,” EJVES Extra, 2012 May; 23(5): e50-2. doi: 10.1016/j.ejvsextra.2012.03.002.

Werra UEM, Petzold PT, “Epithelioid Angiosarcoma of the Popliteal Artery-Primary or Secondary? A Rare Disease Entity Difficult to Diagnose and Easily Overlooked-Literature Research and Case report,” Ann Vasc Surg, 2021 Jul; 74:524.e1-7. doi: 10.1016/j.avsg.2021.02.010.

Ko JS, Billings SD, “Diagnostically Challenging Epithelioid Vascular Tumors,” Surg Pathol Clin, 2015 Sep; 8(3):331-51. doi: 10.1016/j.path.2015.05.001.

Chen TW, Burns J, Jones RL, Huang PH, “Optimal Clinical Management and the Molecular Biology of Angiosarcomas,” Cancers, 2020 Nov; 12(11): 3321. doi:10.3390/cancers12113321.

Morris R, Lee CJ, “Development of Angiosarcoma in a Saphenous Vein Graft after Femoral to Above-Knee Popliteal Artery Bypass,” Ann Vasc Surg, 2018 Jul; 50:299.e9-13. doi: 10.1016/j. avsg.2018.01.087.

Nocturne G, Sellam J, Miquel A, M'Bappé P, Berenbaum F, “Is sarcoma a complication of arterial femoro-popliteal bypass?,” Joint Bone Spine, 2010 Jul; 77(4):358-60. doi: 10.1016/j.jbspin.2010.03.018.

Catalán J, Martín I, Cobo M, “Popliteal Angiosarcoma after Bypass with Autologous Saphenous Vein,” Ann Vasc Surg, 2019 Feb; 55:308.e1-4. doi: 10.1016/j.avsg.2018.06.034.

Downloads

Published

13-05-2024

How to Cite

1.
Correia AM, Ribas Fernandes R, Vidoedo JC, Guimarães J, Almeida Pinto J. A rare case of epithelioid angiosarcoma. Rev Port Cir Cardiotorac Vasc [Internet]. 2024 May 13 [cited 2024 Jul. 2];31(1):47-51. Available from: https://pjctvs.com/index.php/journal/article/view/301

Issue

Section

Clinical Cases

Categories

Most read articles by the same author(s)