Hemorrhage in cerebral metastasis from angiosarcoma of the heart: case report

Abstract

-The purpose of this article is to describe the clinical and pathological features of metastatic angiosarcoma in the central nervous system. Only a few cases of cerebral metastasis from angiosarcoma of the heart have been recorded in the literature; particulary related to intracerebral hemorrhage. A case of secondary cerebral angiosarcoma of the heart in a 33 years old man is presented. The initial symptoms were headache, vomiting, lethargy and aphasia. There was a mass in the left temporal lobe with hemorrhage and edema on the computerized tomography (CT). After 24 hours the neurological status worsened and another CT scan showed rebleeding on the tumor area. He underwent an emergency craniotomy but died two days after. Considering the longer survival of sarcoma patients with new modalities of treatment, the incidence of brain metastasis may increase, demanding a bether preventive and more aggressive approach. Besides, due to the hemorrhagic nature of such lesions, we suggest the imediate surgery to prevent a fast and lethal evolution because rebleeding.KEY WORDS: brain neoplasm, metastasis, angiosarcoma, heart tumor.Hemorragia em metástase cerebral de angiossarcoma cardíaco: relato de caso RESUMO -O propósito deste artigo é descrever os achados clínicos e patológicos das metástases de angiossarcoma no sistema nervoso central. Apenas poucos casos de metástases cerebrais de angiossarcoma cardíaco foram relatados na literatura, menos ainda relacionados a hemorragia intracerebral. Relatamos o caso de um tumor cerebral secundário a angiossarcoma cardíaco em um paciente masculino de 33 anos. Os sintomas iniciais foram: cefaléia, vômitos, letargia e afasia. A tomografia computadorizada mostrou massa no lobo temporal esquerdo associada a hemorragia e edema. Após 24 horas houve piora do estado neurológico e nova tomografia demonstrou ressangramento no leito tumoral. .oi submetido a uma craniotomia de urgência mas faleceu dois dias após. Considerando a longa sobrevida dos pacientes com sarcoma devido às novas modalidades terapêuticas, poderá aumentar a incidência de metástases cerebrais, necessitando, assim, de melhores métodos preventivos e abordagens cirúrgicas agressivas. PALAVRAS-CHAVES: neoplasia cerebral, metástase, angiossarcoma, tumor cardíaco.

Acidente vascular cerebral em cão – Relato de caso

“…Existiu também a suspeita de tumor cerebral, devido este poder comprimir o parênquima cerebral, levando a uma isquemia, provocando lesão neurológica 9 .…”

Metastatic angiosarcoma: a vascular tumour or an intracranial haemorrhage?

“…There have been brief accounts of primary congenital angiosarcoma of the brain 13 , 14. A few case reports of angiosarcoma with primary lesions of the heart, pericardium and spleen leading to metastatic brain involvement show the characteristics of rapid deterioration and adverse outcome 15 – 17. Scalp angiosarcoma causing brain metastasis is an extremely rare and lethal disease.…”

Intracranial Invasion From Recurrent Angiosarcoma of The Scalp

“…In addition, angiosarcoma metastasizing to the brain is also highly unlike to occur comparing with metastases to the other organs such as lungs, bones, liver, lymph nodes, adrenal glands, spleen, and pleuras 7,10) . Only a few cases of cerebral metastasis from angiosarcoma of the heart have been described in the literature, with particular relevance to intracerebral hemorrhage 4) . Irrespective of specific cerebral location, we suggest that immediate surgery is mandatory to prevent lethal evolution as a result of frequent rebleeding and aggressive local recurrence.…”