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1
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Velez Torres JM, Kryvenko ON. Common Diagnostic Challenges in Genitourinary Mesenchymal Tumors: A Practical Approach. Adv Anat Pathol 2024; 31:429-441. [PMID: 39311437 DOI: 10.1097/pap.0000000000000461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2024]
Abstract
Mesenchymal neoplasms within the genitourinary tract include a wide spectrum of tumors, ranging from benign to malignant, and tumors of uncertain malignant potential. Except for stromal tumors of the prostate, which originate from the specific prostatic stroma, these neoplasms generally resemble their counterparts in other body sites. The rarity of these neoplasms and the limitation associated with small biopsy samples present unique diagnostic challenges for pathologists. Accurate diagnosis is paramount, as it significantly influences prognosis and guides management and treatment strategies. This review addresses common diagnostic scenarios, discusses key differential diagnoses, and sheds light on potential diagnostic pitfalls.
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Affiliation(s)
- Jaylou M Velez Torres
- Department of Pathology and Laboratory Medicine
- Sylvester Comprehensive Cancer Center
| | - Oleksandr N Kryvenko
- Department of Pathology and Laboratory Medicine
- Sylvester Comprehensive Cancer Center
- Desai Sethi Urology Institute
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL
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2
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Wagner C, Alfattal R, Mallick J. Radiation-Induced Intraosseous Malignant Peripheral Nerve Sheath Tumor: A Case Report. Int J Surg Pathol 2024:10668969241286061. [PMID: 39370901 DOI: 10.1177/10668969241286061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
INTRODUCTION The significance of radiation therapy in cancer treatment comes with associated complications, including fibrosis, osteonecrosis, and the development of secondary malignancies, such as malignant peripheral nerve sheath tumors (MPNSTs). We emphasize the importance of understanding these complications for an effective patient management. METHODS We report a 47-year-old man with a history of squamous cell carcinoma of the tongue, treated with surgery, chemotherapy, and radiation therapy. The patient later presented with symptoms that led to the discovery of an intraosseous MPNST. RESULTS Histopathological examination revealed characteristic features of MPNST, including spindle cells arranged is sweeping fascicles with contrasting hypercellular and hypocellular areas, producing a marble-like pattern, with atypical wavy, buckled, hyperchromatic nuclei, and brisk mitotic activity. Immunohistochemical analysis showed patchy positive staining for S100 and SOX10, and a complete loss of H3K27me3 expression. This report underscores the challenge of diagnosing secondary malignancies post-radiation therapy and the importance of careful histological examination to differentiate them from other conditions. CONCLUSIONS In conclusion, radiation-induced secondary malignancies are a significant late side effect of radiation therapy that can profoundly impact treatment decision-making and requires a high index of suspicion during post radiation surveillance. Malignant peripheral nerve sheath tumor serves as a pertinent example, highlighting the importance of considering long-term risks when developing optimal management plans for cancer patients.
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Affiliation(s)
- C Wagner
- Department of Pathology and Laboratory Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - R Alfattal
- Department of Molecular Genetic Pathology, MD Anderson Cancer Center, Houston, TX, USA
| | - J Mallick
- Department of Pathology and Laboratory Medicine, University of Texas Medical Branch, Galveston, TX, USA
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3
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Peyrottes A, Bodard S, Timsit MO, Méjean A, Panthier F, Audenet F. Primary angiosarcoma of the kidney: A challenging diagnosis. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102609. [PMID: 38460936 DOI: 10.1016/j.fjurol.2024.102609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/14/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
Angiosarcoma is a rare malignancy derived from endothelial cells, which behaves aggressively. Primary angiosarcoma of the kidney is even rarer, and its clinical and radiological presentations do not differ from clear cells renal cell carcinoma (ccRCC). Management protocols are not standardized, although nephrectomy is usually performed. Subsequent treatments (chemotherapy, radiotherapy, and lately, targeted therapies) vary considerably. Herein, we report the case of a middle-aged patient harboring primary angiosarcoma of the left kidney and discuss its presentation and management in light of current guidelines. The case is described for its rarity and masquerading nature.
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Affiliation(s)
- Arthur Peyrottes
- Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, 20, rue Leblanc, 75015 Paris, France.
| | - Sylvain Bodard
- Service d'Imagerie Adulte, Hôpital Necker-Enfants-Malades, AP-HP Centre, Université Paris Cité, Paris, France; Sorbonne Université, CNRS UMR 7371, Inserm U 1146, Laboratoire d'Imagerie Biomédicale (LIB), 75006 Paris, France
| | - Marc-Olivier Timsit
- Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, 20, rue Leblanc, 75015 Paris, France
| | - Arnaud Méjean
- Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, 20, rue Leblanc, 75015 Paris, France
| | - Frederic Panthier
- Service d'Urologie, Hôpital Tenon, AP-HP, Sorbonne Université, Paris, France
| | - François Audenet
- Service d'Urologie, Hôpital Européen Georges-Pompidou, AP-HP Centre, Université Paris Cité, 20, rue Leblanc, 75015 Paris, France
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4
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Liao X, Lai J, Lin J, Zhang D. Primary and secondary angiosarcomas of the liver: a multi-institutional study of 32 cases. Hum Pathol 2023; 137:10-17. [PMID: 37054784 DOI: 10.1016/j.humpath.2023.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Angiosarcomas involving the liver can be hepatic primary or metastasis from another anatomic site, which have not been systematically compared. We analyzed a series of liver biopsy or resection specimens carrying a diagnosis of angiosarcoma collected between 2005 and 2022 at 3 tertiary medical centers. The cohort included 32 patients (20 M and 12 F) with a median age of 64 years. Nineteen were primary hepatic angiosarcoma (PHA) and 13 metastatic angiosarcoma to liver (MA). Males were predominant in PHA (15/19, 78%) compared to MA (5/13, 38%, P = .025). There was no age difference between the 2 groups. Five cases had background hepatic cirrhosis, which more likely harbored PHA (4/5, 80%). Multifocality and multiorgan involvement were common in both groups. Tumor size was significantly larger in PHA than in MA (10.4 versus 4.7 cm, P < .01). Histologically, there were no differences in terms of tumor morphology (spindled versus epithelioid) and growth patterns (vasoformative versus solid) between the 2 groups. Immunohistochemically, all tumor cells were positive for CD31 (28/28, 100%) and ERG (18/18, 100%). Molecular analysis in 5 cases demonstrated different mutation profiles involving different genes, including MTOR, PIK3CA, ARID1A, CDKN2A, PTEN, TP53, ATRX, KDR/VEGFR2, and so forth. On follow-up, 30 patients (93%) died of disease, with a median survival of 114 days. Univariate and multivariate analyses revealed PHA and epithelioid morphology to be associated with worse survival (P < .05), while treatment was associated with better survival (P < .001). Our results confirmed that angiosarcoma, particularly PHA, is extremely aggressive. Epithelioid morphology is an adverse prognosticator and may be used for tumor subclassification.
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Affiliation(s)
- Xiaoyan Liao
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA.
| | - Jinping Lai
- Department of Pathology, Kaiser Permanente Sacramento Medical Center, Sacramento, CA, 95825, USA
| | - Jingmei Lin
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Dongwei Zhang
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
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5
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Yang J, Dong A, Nian S, Peng Y, Zuo C. FDG PET/CT in a Case of Primary Angiosarcoma of the Kidney. Clin Nucl Med 2023; 48:370-372. [PMID: 36716457 DOI: 10.1097/rlu.0000000000004586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
ABSTRACT Primary angiosarcoma of the kidney is a rare aggressive malignancy. We describe MRI and FDG PET/CT findings in a case of primary renal angiosarcoma with hepatic, pulmonary, and bony metastases. The large primary tumor showed extensive necrosis and increased FDG uptake in the nonnecrotic components. Multiple metastatic lesions in the liver, lung, and bones were detected by FDG PET/CT. Most of the hepatic metastases seen on MRI were missed on FDG PET/CT due to low FDG avidity.
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Affiliation(s)
- Jian Yang
- From the Departments of Nuclear Medicine
| | | | | | - Yonghan Peng
- Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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6
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Kamitani R, Matsumoto K, Takeda T, Mizuno R, Oya M. Evaluation of prognostic factors and treatment options for renal angiosarcoma: A retrospective analysis of 113 reported cases. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:263-270. [PMID: 36116986 DOI: 10.1016/j.ejso.2022.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Primary renal angiosarcoma (PRA) is an extremely rare and aggressive neoplasm. Indeed, due to its rarity, established clinical guidelines for PRA have not yet been established. In this study, we attempted to investigate its prognostic factors and treatment options. METHODS We systematically searched for articles describing PRA that had been published up until December 2021. The final cohort included 113 patients in 103 articles. The starting point of this study was the time of diagnosis and the end point was the time of recurrence and disease-specific mortality. RESULTS Metastasis at diagnosis was associated with poorer disease-specific survival (DSS) (p = 0.001). Tumors of more than 5 cm had poorer DSS than tumors of 5 cm or less (p < 0.001). Multivariate analysis demonstrated that primary metastatic status, and tumor size were independent prognostic factors. In cases of localized PRA, tumor sizes exceeding 5 cm had also prognostic significance for recurrence-free survival (RFS) and DSS. Surgical margins, postoperative radiation, and postoperative systemic therapy were not associated with prognoses. However, in a subgroup analysis of tumors exceeding 5 cm, postoperative radiation therapy improved RFS and DSS (p = 0.022 and p = 0.031, respectively). In cases of metastatic PRA, systemic therapy improved DSS (p < 0.001). CONCLUSION We identified several prognostic factors for PRA. Among them, primary metastatic status and tumor size exceeding 5 cm were selected as independent prognostic factors. Postoperative radiation therapy for large, localized PRA and systemic therapy for recurrent and metastatic PRA might be a treatment option.
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Affiliation(s)
- Rei Kamitani
- Keio University School of Medicine, Department of Urology, Japan
| | | | - Toshikazu Takeda
- Keio University School of Medicine, Department of Urology, Japan
| | - Ryuichi Mizuno
- Keio University School of Medicine, Department of Urology, Japan
| | - Mototsugu Oya
- Keio University School of Medicine, Department of Urology, Japan
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7
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Zhang J, Gong H, Wang Y, Zhang G, Hou P. Angiosarcoma of the visceral organs: A morphological, immunohistochemical, and C-MYC status analysis. Pathol Res Pract 2022; 238:154118. [PMID: 36087414 DOI: 10.1016/j.prp.2022.154118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/10/2022] [Accepted: 09/02/2022] [Indexed: 12/01/2022]
Abstract
Visceral angiosarcomas are rare malignant tumors with poor prognosis. The pathogenesis remains unclear. Herein, we describe the morphological, immunohistochemical, and C-MYC status of a series of visceral angiosarcomas. We evaluated the clinicopathologic and C-MYC status of visceral angiosarcomas (n = 12) and compared them to a control series of angiosarcomas arising in cutaneous (n = 15) and soft tissue structures (n = 15). Clinical follow-up data were obtained for all patients and exhibited high metastasis and mortality rates. Malignant endothelial cells displayed a range of morphological features including nonepithelioid, epithelioid, and mixed features, forming vasoformative (n = 6), solid (n = 4) or mixed (n = 2) architectures. Epithelioid morphology was present in 4/12 tumors. Mitoses ranged from 3 to 60 per 10 high-power fields. Necrosis was observed in 10/12 tumors. By immunohistochemistry, all angiosarcomas expressed at least 2 markers of endothelial differentiation, including CD31, CD34, vWF, ERG, and Fli-1. Eight cases of C-MYC amplification and 5 cases of C-MYC translocation were detected. Our data showed that visceral angiosarcoma is more common in women, and the clinical presentations of patient age and tumor size were significantly different between the study and control groups. No significant difference in staining between the visceral angiosarcoma and control groups was observed for endothelial markers, while different C-MYC statuses were detected.
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Affiliation(s)
- Jiaojiao Zhang
- Department of Pathology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Huilin Gong
- Department of Pathology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuanyuan Wang
- Department of Pathology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Guanjun Zhang
- Department of Pathology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Peng Hou
- Key Laboratory for Tumor Precision Medicine of Shaanxi Province and Department of Endocrinology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
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8
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Gao X, Liu H, Wang F, Xu Z, Han Y, Liu S. Angiosarcoma of breast and chest wall complicated with tuberculous empyema: A case report. Thorac Cancer 2022; 13:2078-2081. [PMID: 35615878 PMCID: PMC9284151 DOI: 10.1111/1759-7714.14482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 12/02/2022] Open
Abstract
Angiosarcoma is a highly malignant endothelial tumor, accounting for 1% to 2% of soft tissue sarcomas. The most common site of the disease is the skin, accounting for approximately 60% of cases, especially the skin of the head. It can also occur in soft tissue, bone, and retroperitoneum. However, angiosarcomas of the breast and chest wall are rare. Here, we report a 44‐year‐old woman who was admitted to hospital with encapsulated empyema. She was subsequently diagnosed with angiosarcomas of the breast and chest wall with tuberculous empyema. At the same time, we also reviewed the current research progress in angiosarcoma of the breast and chest wall to explore better treatment options for these patients.
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Affiliation(s)
- Xingchen Gao
- Thoracic Surgery Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Haiyan Liu
- Thoracic Surgery Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Feng Wang
- Thoracic Surgery Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Ziwei Xu
- Thoracic Surgery Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Yi Han
- Thoracic Surgery Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
| | - Shuku Liu
- Thoracic Surgery Beijing Tuberculosis and Thoracic Tumor Research Institute, Beijing Chest Hospital, Capital Medical University, Beijing, China
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9
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Omiyale AO. Primary vascular tumours of the kidney. World J Clin Oncol 2021; 12:1157-1168. [PMID: 35070735 PMCID: PMC8716994 DOI: 10.5306/wjco.v12.i12.1157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/01/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Primary vascular tumours of the kidney are rare and may pose diagnostic difficulties because of their similar clinical, morphological, and immunohistochemical features. This article summarizes the clinical and pathological features of primary renal angiosarcoma and anastomosing haemangioma of the kidney including epidemiology, genetics, and prognosis. Renal anastomosing haemangiomas are benign neoplasms characterized by anastomosing capillary-sized vascular channels. These tumours are rare, with about 75 cases reported in the literature. Most anastomosing haemangiomas are found incidentally on ultrasound, computed tomography, or magnetic resonance imaging. Common symptoms include abdominal pain, haematuria, and abdominal mass. Renal anastomosing haemangiomas are characterized by recurrent mutations in GNAQ and GNA14 genes. The prognosis of anastomosing haemangioma is excellent. Primary renal angiosarcomas are malignant tumours showing endothelial differentiation. To date, 76 cases have been described in the literature. Primary renal angiosarcomas are frequently symptomatic. The clinical features of renal angiosarcomas are similar to those of renal anastomosing haemangiomas, including abdominal pain, haematuria, and abdominal mass. Angiogenesis-related genes and vascular-specific receptor tyrosine kinases such as KDR, TIE1, SNRK, TEK, and FLT1 are upregulated in angiosarcomas. Primary renal angiosarcomas are highly aggressive neoplasms with a poor prognosis despite surgical treatment, chemotherapy, radiotherapy, or targeted therapy.
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Affiliation(s)
- Ayo O Omiyale
- Department of Cellular Pathology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, United Kingdom
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10
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Carr R, Moreland H, Hsia MHC. Late-stage primary renal angiosarcoma: an extremely rare cancer complicated by COVID-19 post-operatively. J Surg Case Rep 2021; 2021:rjab562. [PMID: 34987758 PMCID: PMC8711261 DOI: 10.1093/jscr/rjab562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/22/2021] [Indexed: 12/02/2022] Open
Abstract
Primary renal angiosarcoma (AS) encompasses only 1% of soft tissue sarcomas, and it is seldom seen in literature. Because of its rarity, few risk factors for its development have been established. Due to lack of screening guidelines for kidney cancer, it is often found late when patients become symptomatic. We present the case of a male patient who presented with gross hematuria and flank pain and was discovered to have a large renal mass. Following successful resection, pathology showed it to be AS. The patient had a post-operative course complicated by two separate COVID-19 infections and expired 200 days after surgery. This case not only highlights an extremely rare renal cancer but also illustrates the challenges patients with complex medical issues faced in the era of COVID-19.
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Affiliation(s)
- Reilly Carr
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Hannah Moreland
- University of South Carolina School of Medicine, Columbia, SC, USA
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11
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Komoto H, Kitajima K, Kawanaka Y, Yoshimura N, Kunimoto R, Yokoyama H, Shinkai Y, Kaizuka Y, Yamamoto S, Kihara T, Kimura N, Hirota S, Yamakado K. CT Findings of Primary Renal Angiosarcoma. Case Rep Oncol 2021; 14:212-216. [PMID: 33776706 PMCID: PMC7983682 DOI: 10.1159/000512015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Primary angiosarcomas of the kidney are very rare but highly aggressive tumors showing poor prognosis. We present a case of primary renal angiosarcoma occurring in a 60-year-old man with left flank pain. CT images depicted a huge exophytic mass (14 cm in diameter) in the left kidney, exhibiting central extensive hemorrhage or necrosis without contrast enhancement. The mass showed centripetal peripheral nodular enhancement on dynamic contrast-enhanced CT images. We suggest its inclusion in the differential diagnosis of cases of hemorrhagic renal tumors with prominent vasculature.
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Affiliation(s)
- Hisashi Komoto
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yusuke Kawanaka
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Nahomi Yoshimura
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryo Kunimoto
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Hiroyuki Yokoyama
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukako Shinkai
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yohei Kaizuka
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Shingo Yamamoto
- Department of Urology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Takako Kihara
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Neinei Kimura
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Seiichi Hirota
- Department of Surgical Pathology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Japan
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12
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Kazaz IO, Ersoz S, Colak F, Teoman AS, Kazaz SN, Karaguzel E, Kutlu O. Primary renal angiosarcoma: A case report and a short review of literature. INDIAN J PATHOL MICR 2020; 63:S44-S46. [PMID: 32108626 DOI: 10.4103/ijpm.ijpm_66_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Primary renal angiosarcomas (AS) are uncommon tumors with poor prognosis. Aetiology is unknown but some unproven risk factors have been described. It is difficult to discriminate these masses from renal cell carcinomas or other renal masses with imaging modalities. Immunohistochemistry plays an important role in the diagnosis. Main treatment protocol for primary renal AS is still controversial and nephrectomy with chemotherapy and/or radiotherapy seems the only treatment option. We state a primary renal angiosarcoma case for its rareness and contribution to literature.
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Affiliation(s)
- Ilke Onur Kazaz
- Department of Urology and Pathology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Safak Ersoz
- Department of Urology and Pathology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Fatih Colak
- Department of Urology and Pathology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | | | - Seher Nazli Kazaz
- Department of Medical Oncology, Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Ersagun Karaguzel
- Department of Urology and Pathology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Omer Kutlu
- Department of Urology, Akdeniz University Faculty of Medicine, Antalya, Turkey
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13
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Chang CW, Chien CC, Juan YS, Chueh KS. Primary renal angiosarcoma mimicking urothelial carcinoma - A case report and literature reviews. Urol Case Rep 2020; 34:101407. [PMID: 33145170 PMCID: PMC7596193 DOI: 10.1016/j.eucr.2020.101407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/08/2020] [Indexed: 01/01/2023] Open
Abstract
Angiosarcoma (AS) is a rare aggressive tumor originating from endothelial cells. We reported a 66-year-old female with primary renal angiosarcoma (PRA) who presented as urothelial carcinoma with hematuria and dysuria. Based on ureterorenoscopic tumor biopsy, the initial diagnosis suggested low-grade non-invasive urothelial carcinoma. However, the specimen retrieved from nephroureterectomy confirmed the diagnosis of primary renal angiosarcoma. Primary renal angiosarcoma could uncommonly present as urothelial carcinoma in renal pelvis. Surgical resection remains to be the most effective therapy but there is no consensus about adjuvant therapies. The overall prognosis of primary renal angiosarcoma is dismal.
Primary renal angiosarcoma is a rare disease that could mimic urothelial carcinoma. Surgical resection is considered to be main treatment. The effectiveness osf adjuvant therapies remain to be clarified.
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Affiliation(s)
- Che-Wei Chang
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan.,Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chu-Chun Chien
- Department of Pathology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuang-Shun Chueh
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
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14
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Zhang C, Fu B, Xu S, Zhou XC, Cheng XF, Fu WQ, Wang GX. Robot-assisted retroperitoneal laparoscopic excision of perirenal vascular tumor: A case report. World J Clin Cases 2020; 8:2050-2055. [PMID: 32518800 PMCID: PMC7262712 DOI: 10.12998/wjcc.v8.i10.2050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/01/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A vascular tumor is a benign tumor with unique clinical and pathological features. Perirenal vascular tumor is extremely rare and has not yet been reported. Clinically, it manifests as soreness and swelling. Color ultrasound and renal angiography illustrated the perirenal mass, which was closely connected with the kidney and the surrounding tissues and organs. Histology showed extensive embedded perirenal fat, and thin-walled vascular tissue displayed a pink stain due to red blood cells.
CASE SUMMARY Herein, a case of robot-assisted retroperitoneal laparoscopic excision of a perirenal vascular tumor is reported. Analysis of the clinical, biological, and histological features of the perirenal vascular tumor can provide an in-depth understanding of the disease, which provides a theoretical and practical basis for better diagnosis and treatment.
CONCLUSION This study contributes to a practical basis for the diagnosis and treatment of perirenal hemangiom.
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Affiliation(s)
- Cheng Zhang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Bin Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Song Xu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Xiao-Chen Zhou
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Xiao-Feng Cheng
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Wen-Qing Fu
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
| | - Gong-Xian Wang
- Department of Urology, The First Affiliated Hospital of Nanchang University, Nanchang 330000, JiangXi Province, China
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15
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Heo SH, Shin SS, Kang TW, Kim GE. Primary renal angiosarcoma with extensive hemorrhage: CT and MRI findings. Int Braz J Urol 2019; 45:402-405. [PMID: 30735338 PMCID: PMC6541118 DOI: 10.1590/s1677-5538.ibju.2018.0375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 08/19/2018] [Indexed: 12/24/2022] Open
Abstract
Primary angiosarcomas of the kidney are very rare, but highly aggressive tumors showing poor prognosis. Patients frequently complain of flank pain, hematuria, or a palpable mass. We present a case of primary renal angiosarcoma occurring in a 61-year-old man. CT images depicted a huge exophytic mass (16 cm in diameter) in the right kidney, exhibiting extensive hemorrhage. The mass showed centripetal peripheral nodular enhancement on dynamic contrast-enhanced images. Furthermore, MR imaging revealed a tangled mesh of tumor vessels in the periphery of the mass. We suggest its inclusion in the differential diagnosis of cases of hemorrhagic renal tumors with prominent vasculature.
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Affiliation(s)
- Suk Hee Heo
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Sang Soo Shin
- Department of Radiology, Chonnam National University Medical School, Gwangju, South Korea
| | - Taek Won Kang
- Department of Urology, Chonnam National University Medical School, Gwangju, South Korea
| | - Ga Eon Kim
- Department of Pathology, Chonnam National University Medical School, Gwangju, South Korea
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16
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Drosos E, Kalyvas A, Komaitis S, Skandalakis GP, Kalamatianos T, Liouta E, Neromyliotis E, Alexiou GA, Stranjalis G, Koutsarnakis C. Angiosarcoma-related cerebral metastases: a systematic review of the literature. Neurosurg Rev 2019; 43:1019-1038. [PMID: 31165296 DOI: 10.1007/s10143-019-01127-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/01/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
Abstract
Angiosarcoma-related cerebral metastases have only been recorded in a few case reports and case series and have not been systematically reviewed to date. Our objective was therefore to perform a systematic literature review on cases of angiosarcomas metastasizing to the brain to inform current practice. All three major libraries-PubMed/MEDLINE, Embase, and Cochrane-were systematically searched, until January 2019. Articles in English reporting angiosarcoma-related cerebral metastases via hematogenous route were included. Our search yielded 45 articles (38 case reports, 5 retrospective studies, 1 case series and 1 letter to the editor), totaling 48 patients (mean age 47.9 years). The main primary site was the heart. The mean time of diagnosis of cerebral metastases following primary tumor identification was 4.9 months. In 15 cases, the brain was the only metastatic site. In cases of multiple extracerebral metastases, the most common sites were the lung and bone. Acute intracerebral supratentorial hemorrhage was the most common presenting radiological feature. Treatment strategies were almost equally divided between the surgical (with or without adjuvant treatment) and the medical arm. Mean overall survival was 7.2 months while progression-free survival was 1.5 months. To our knowledge, this is the first systematic literature review on angiosarcoma-related cerebral metastases. This pathology proves to be an extremely rare clinical entity and carries a poor prognosis, and no consensus has been reached regarding treatment.
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Affiliation(s)
- Evangelos Drosos
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece
| | - Aristotelis Kalyvas
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Spyridon Komaitis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | | | - Theodosis Kalamatianos
- Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Evangelia Liouta
- Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Eleftherios Neromyliotis
- Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece
| | - George A Alexiou
- Neurosurgery Department, University of Ioannina, Leof. Stavrou Niarchou, Ioannina, Greece
| | - George Stranjalis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece.,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece.,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece
| | - Christos Koutsarnakis
- Athens Microneurosurgery Laboratory, Ploutarhou 3, Athens, Greece. .,Department of Neurosurgery, Evangelismos Hospital, National and Kapodistrian University of Athens, Ypsilantou 45-47, Athens, Greece. .,Hellenic Center for Neurosurgical Research "Petros Kokkalis", Ploutarxhou 3, Athens, Greece.
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17
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Samadi K, Arellano RS. Primary perirenal angiosarcoma: A rare presentation of a perirenal mass. Radiol Case Rep 2018; 14:28-29. [PMID: 30305861 PMCID: PMC6174842 DOI: 10.1016/j.radcr.2018.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 11/19/2022] Open
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18
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Lodhi HT, Inayat F, Munir A, Ilyas G. Primary renal angiosarcoma: a diagnostic and therapeutic challenge. BMJ Case Rep 2018; 2018:bcr-2018-225484. [PMID: 30244222 DOI: 10.1136/bcr-2018-225484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Primary renal angiosarcoma is an exceedingly rare and aggressive neoplasm. Although it may occur in youth, this tumour is frequently reported in the sixth and seventh decades of life. The clinical presentation is frequently varied. Pathogenesis remains largely unknown and it has overlapping features with other tumours of the kidney. Current treatment options include variable combinations of surgery, chemotherapy and radiotherapy. Reports regarding the disease prognosis and natural history are limited. In this article, we chronicle the case of a patient with primary renal angiosarcoma presenting at an advanced stage as a widely metastasised tumour. Additionally, we undertake here a brief literature review highlighting the rarity and aggressiveness of this condition, its poor prognosis, and the lack of specific management guidelines.
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Affiliation(s)
| | | | - Ahmed Munir
- Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
| | - Ghulam Ilyas
- SUNY Downstate Medical Center, Brooklyn, New York, USA
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