Angiosarcoma and Vascular Surgery: A Case Report and Review of Literature

Abstract

Introduction: Angiosarcomas (AS) are rare and aggressive neoplasms originating from the endothelium: they represent less than 2% of all soft tissue sarcomas and usually have a poor prognosis. Although more often primary, different risk factors have been described and some cases are associated with vascular surgery. Materials and Methods: We present the case of an 84-year-old man who developed an AS on his thigh 3 years after a popliteal bypass with autologous saphenous vein. We performed a thorough review of the literature describing the main characteristics of the 25 cases (including ours) of AS associated with vascular surgery reported from 1981 to 2022. Results: Most of the patients were males (21 men vs 4 women) with a range age of 50-84 years. Most of AS are associated with Dacron grafts (12 cases), the overall mean time to onset is 7.8 years after surgery. The most common presenting symptoms are pain (20 cases) and weight loss (10 cases), while cutaneous presentation is uncommon; indeed, violaceous and painful papules, plaques, nodules, and skin ulceration have been found in 3 cases only. Due to unspecific symptoms, differential diagnosis is often difficult and a biopsy for histological confirmation is mandatory. Conclusion: Even if it seems to be a very rare complication, AS should always be considered in patients with compatible symptoms and who have undergone vascular surgery in the past.

Primary ovarian angiosarcoma: Two case reports and review of literature

“…When well-differentiated, they form lumps, and when poorly-differentiated, only single-cell lacunae can be observed. The diagnosis of primary oAS should be combined with the results of routine pathological examinations and immunohistochemistry panels, especially positive endothelial cell markers (mainly CD31, CD34, FV, and vimentin)[ 6 ]. Therefore, oAS may present a challenge for intraoperative frozen section diagnosis of an ovarian mass[ 7 ].…”

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

“…These retained foreign materials could belong to either of the categories, such as metallic objects (Shell splinter, bullet, surgical sponge/gauze, or non-arthroplasty implants), orthopedic and vascular prosthetic implants. [12][13][14][15]17] Diagnostic differentiation of angiosarcoma from other malignant carcinomas presents a challenging situation due to nonspecific clinical presentations and disease rarity. The multifocal ubiquitous clinical presentation with symptoms such as vomiting, abdominal discomfort, nausea, and bowel distension adds to the difficulty in early diagnostics.…”

“…Left femur Metastasized to lung and bone Surgery, radiotherapy Died 3 mo after surgery Villaescusa Catalan et al [93] Hartvigson et al [94] Werra et al [95] Veterano et al [96] May Lee et al [13] and involvement of metallic foreign body or biomedical implants-mediated tumorigenesis. These cases indicates that the pathogenic progression of AS in patients with synthetic biomedical implants or metallic foreign body could be multifactorial.…”

“…These retained foreign materials could belong to either of the categories, such as metallic objects (Shell splinter, bullet, surgical sponge/gauze, or non-arthroplasty implants), orthopedic and vascular prosthetic implants. [12–15,17]…”

“…[9][10][11] These cases were related to the development of AS at sites where vascular grafts, and orthopedic implants, such as prosthesis and metallic plates were present. [12][13][14] Other reports also described the presence of metallic objects (shell splinter and bullet), surgical sponge/gauze, bone wax, cardiac defibrillator, and biomaterials at sites presenting AS proliferation. [15][16][17] Chronic inflammation around these foreign materials could probably potentiate the pathogenic progression to the malignant transformation of surrounding soft tissues.…”