Intimal sarcoma of the superficial femoral artery with osteosarcomatous differentiation

Abstract

Sarcomas of the large vessels usually present centrally in the aorta, pulmonary artery, and inferior vena cava. Peripheral arterial sarcomas are exceptionally rare. They have been reported in the iliac and common or profunda femoral arteries, and are frequently undifferentiated. In this study, we describe a differentiated intimal sarcoma of the superficial femoral artery with abundant osteosarcoma within the specimen. Before knowing the diagnosis, treatment was for a presumed pseudoaneurysm using excision and bypass. Postoperatively, the patient received palliative radiation therapy. The tumor's location and histopathology are unique. A differentiated intimal sarcoma has never been reported in the superficial femoral artery, and it represents the second peripheral arterial intimal sarcoma reported with osteosarcomatous differentiation.

Intimal sarcomas of the aorta and iliofemoral arteries: a clinicopathological study of 26 cases

“…21 Only one osteosarcoma occurred in the aorta. One osteosarcoma of the femoral artery has been previously reported.…”

Treatment of intimal sarcoma of peripheral veins

“…Over 60% of reported sarcomas of the aorta and its branches are intimal sarcomas, arising from the tunica intima, rather than from endothelial, medial or adventitial cells [2] . In adults, the most common subtypes are undifferentiated pleomorphic sarcomas including the historically defined malignant fibrous histiocytoma.…”

“…Many are centrally located, and can present as an asymptomatic thoracic aneurysm, or with dyspnea, sudden death, or distal embolization. Aortic intimal sarcomas have also been reported at the site of prior vascular anastomoses [2] . The differential diagnosis of Intimal sarcomas should include benign lesions as well other soft tissue sarcoma (STS).…”

“…History and physical examination are an essential element of the workup, contrary to other STS, this type of tumor must never been biopsied. Diagnostic approach should have a high degree of suspicious, the clinical manifestations are unspecific, symptomatic thoracic aneurysm, dyspnea, distal embolization or sudden death for tumors at the aorta, this mistaken diagnosis can lead to inappropriate therapy, such as anticoagulation or thrombolysis [2] , [3] , [4] or local pain, claudication, motor or sensory loss, or as a mass in peripheral localization [5] , [8] . Imaging should include an adequate and high-quality imaging studies, an MRI preoperative of the extremity in compromise to determine resectability as well an IV contrast CT scan of the chest, abdomen and pelvis to exclude secondary tumors or metastatic disease.…”

“…The differential diagnosis of Intimal sarcomas should include benign lesions as well other soft tissue sarcoma (STS), diagnostic approach should have a high degree of suspicious, clinical manifestations are unspecific. Imaging should include an adequate and high-quality studies such as a Magnetic resonance imaging (MRI) preoperative to determine resectability as well as a CT scan of the chest, abdomen and pelvis to exclude metastatic disease [2] , [3] , [4] , [5] , [6] , [7] , [8] .…”