Imaging features of soft tissue epithelioid angiosarcoma in the lower extremity: A case report

Abstract

Abstract. Epithelioid angiosarcomas are extremely rare malignant tumors formed from endothelial cells. The majority of studies reporting these tumors have been concerned with the clinical and pathological aspects, with limited reporting of radiological diagnosis. The aim of the present study was to provide a reference to improve understanding of diagnosis, treatment choice and prognosis assessment of epithelioid angiosarcoma. The current study reports the case of a 44-year-old woman with epithelioid angiosarcoma located in the deep soft tissue of the lower extremities. Physical examination of the right thigh revealed a palpable hard mass and movement was clearly restricted and painful. X-ray, computed tomography (CT) scans and magnetic resonance imaging (MRI) were used to evaluate the imaging features of the tumor. Using X-ray and CT scanning, an inhomogenous tumor with osteolytic osseous destruction was observed. MRI revealed that the bordering skeletal muscles were infiltrated. The patient was treated with palliative surgery and chemotherapy, but succumbed to disease 1 year later. IntroductionAngiosarcoma accounts for ~2% of soft tissue sarcomas (1). Epithelioid angiosarcoma is a rare type of angiosarcoma that was first reported by Ng et al in 1996 (2). Epithelioid angiosarcoma occurs in various sites, including the skin, head and neck, lungs, breasts, adrenal glands, bones and deep soft tissue in the extremities (3-8). Epithelioid angioma has a male predilection and typically occurs in adults, with the highest incidence being in the seventh decade of life (4). Treatment modalities include surgical resection of the primary tumor, radiation therapy and chemotherapy (4-6). Within 2-3 years of diagnosis, ~50% of patient succumb to disease, however, 20-30% of patients are free of disease (4,9). Advanced age, increased tumor size and a retroperitoneal primary site are considered to be adverse prognostic factors (9). Although pathological examination is the gold standard of diagnosis, radiological studies may provide assistance for determining the treatment choice and assessing the prognosis (10). Magnetic resonance imaging (MRI) reveals the infiltration of the lesion, and computed tomography (CT) angiography (CTA) reveals the involvement of the arteries in the lower extremities, which determines whether or not thrombosis is present (3,4). The current study presents the imaging analysis of a patient with epithelioid angiosarcoma that occurred in the deep soft tissue of the lower extremities. Written informed consent was obtained from the patient. Case reportA 44-year-old woman presented at the Department of Radiology, The Affiliated Hospital of Xuzhou Medical College (Jiangsu, China) on September 16, 2012 with soreness in the medial side of the right thigh, which had developed over 2 months. Almost 1 month later, a mass had evolved at the painful site; however, the pain was not associated with exertion. A physical examination revealed an increased temperature on the medial side, at the mid-shaft of the femur. The ma...

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“…9 Sarcomas appear hypodense to isodense in comparison to surrounding musculature on CT. 10 CT angiography of the lower extremities helps in the evaluation of masses and associated arteries as well as identification of the tumor’s origin and surgical planning. 7 According to Subhawong et al, 11 CT imaging can provide useful clues for the characterization of soft tissue tumors; they describe four distinguishing CT characteristics that include mineralization pattern, lesion density, bone involvement, vascular malformations, and/or vascular involvement.…”

“…CT is used in cases where there is a contraindication for MRI or where CT may be better at delineating areas of periosteal bone formation, microcalcifications, and cortical destruction. 7 CT is a faster examination compared to MRI, and it may be better tolerated by claustrophobic patients due to the use of more confined space with MRI. There are limitations and contraindications such as ionizing radiation exposure, contrast reactions, and cost.…”

Primary Angiosarcoma of Humerus – A Case Report and Literature Review

“…Angiosarcoma of bone rarely shows calcifications. Lv et al explained the aggressiveness of angiosarcoma in the lower extremity as an osteolytic destructive lesion with an ill-defined cortico-medullary junction [ 1 ]. In our case, a large expansile lytic soft- tissue mass in the right proximal humerus involving both cortex and medulla with a wide zone of transition without sclerotic margins was observed.…”

“…The tumor biology exhibits an aggressive natural course with rapid malignant transformation and marked anaplasia . [ 1 ] Osseous angiosarcoma has a propensity for recurrences and distant metastasis. At a glance, about 6% of all angiosarcomas develop in the bone [ 2 , 3 ].…”

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