Angiosarcoma with Pulmonary Metastasis Presenting with Spontaneous Bilateral Pneumothorax in an Elderly Man

Abstract

Cutaneous angiosarcoma is a rare and invasive endothelial-derived sarcoma that occurs most frequently in the scalp and facial skin of elderly men. It is frequently accompanied by thin-walled cavitary pulmonary metastasis, and is often obscure on chest radiograph. We report a case of angiosarcoma of the scalp with cystic metastasis to the lung in a 63-year-old man, presenting as recurrent bilateral spontaneous pneumothorax. Lung metastasis was missed at the first episode of pneumothorax because the lung-expanded chest radiograph showed no significant abnormality. Two months later, bilateral pneumothorax recurred, and high-resolution computed tomography revealed multiple cystic, cavitary and nodular lesions. Pulmonary metastasis was confirmed by video-assisted thoracoscopic surgery, and pleurodesis was performed. After the operation, the patient received chemotherapy; no recurrence of pneumothorax was found during 6 months of follow-up. Pneumothorax in the elderly should be differentiated from malignant metastatic lung tumors.

Diffuse alveolar hemorrhage due to metastatic angiosarcoma of the lung: A case report

“…Patients with angiosarcoma usually present with metastatic disease at the time of diagnosis, and the lung is the most common site of metastatic involvement, followed by the liver, cervical lymph nodes, spleen, and rarely by the heart and brain (3). The patient in the present study presented with coughing and hemoptysis as the first symptom, but rapidly deteriorated, exhibiting progressive anemia and dyspnea.…”

“…Although it has been detected in all regions of the body, lung involvement is the most common site of metastasis (2,3). Diffuse alveolar hemorrhage (DAH) is a clinicopathological syndrome that results from a variety of conditions and is considered as a life-threatening event, however, it is rare as the presentation of pulmonary angiosarcoma (4).…”

Simultaneous bilateral spontaneous pneumothorax following high-dose chemotherapy and bone marrow transplantation for mantle cell lymphoma without evidence of pulmonary disease

“…The presence of residual subclinical microfoci of lymphoma in the lung parenchyma is possible; however, the lack of a positron emission tomography (PET) finding or histological evidence of tumor necrosis speaks against this. Of note, a case of SP in which pulmonary lesions subsequently developed has been reported [3]. If this patient had survived, pulmonary lesions may have developed, supporting the presence of residual subclinical microfoci of lymphoma when SBSP occurred.…”

“…The majority of cases had known lung lesion metastases or had a detectable lung lesion noted shortly after the SBSP occurred. The phenomenon has been reported in cases of metastatic sarcoma, trophoblastic tumor, non-seminomatous testicular cancer, and non-Hodgkin lymphoma [3][4][5][6][7][8][9][10] Sarcoma is most commonly associated with SBSP. One review examining 15 cases of SP after treatment with chemotherapy found an average time to develop SP after initiation of chemotherapy was 2-23 days [7].…”

Spontaneous Pneumothorax as the Initial Presentation in an Osteosarcoma Patient: A Case Report

“…[1,[7][8][9] Many sporadic case reports also describe SP due to lung metastases from angiosarcoma, metastatic thyroid (papillary, medullary) carcinoma, teratomas, Wilms' tumors, melanomas, carcinomas of the kidney and pancreas, metastatic ovarian granulosa cell tumor, testicular cancer, lymphomas, choriocarcinomas, and lymphangiomatosis. [6,[13][14][15][16] Sensitivity of detection of lung metastasis was 57% by chest x-ray and 88% by chest computed tomography. [8] Chest X-ray upright PA view is not 100% sensitive in diagnosing pneumothorax.…”