Severe Intestinal Bleeding caused by Intestinal Metastases of a Primary Angiosarcoma of the Thyroid Gland

Abstract

A 75 year old male presented with gastrointestinal bleeding after resection of both upper lobes of the lungs because of metastases. One year ago an angiosarcoma was the reason for a complete removal of the thyroid gland. In esophago-gastro-duodenoscopy we found multiple hemorrhagically stained polyploids lesions in the postbulbar duodenum and jejunum. Colonoscopy showed isolated polyploid lesions of the right flexura. Because of persistent gastrointestinal bleeding a diagnostic laparotomy was done. Intraoperative intestinoscopy demonstrated multiple bleeding metastasis. To remove many of the bleeding lesions two longer intestinal segments of the jejunum and ileum were resected. The histology of the metastases showed arrangements of polygonal cells with prominent nucleoli and atypical mitosis. Immunohistochemistry identified CD 31, vimentin and factor VIII associated antigen. There was an erosion of the superficial intestinal mucosal cells with resulting hemorrhage; same histology had been found in the thyroid gland and the right upper lobe of lung. Eight days after surgery the patient died because of respiratory and circulatory insufficiency.

Nonalpine Thyroid Angiosarcoma in a Patient with Hashimoto Thyroiditis

“…However, there are considerable controversy about the true existence of thyroid angiosarcomas. Although it is histologically defined as cleft-like anastomosing spaces lined by large, atypical cells of endothelial lineage [7], some authors believe that most of the reported cases are anaplastic or undifferentiated carcinomas with angiomatoid features [3, 4]. Many authors believe that thyroid angiosarcoma is a variant of sarcomatoid carcinoma, in view of their nearly constant cytokeratin positivity in the neoplastic elements.…”

“…In Southern Italy, no case of thyroid angiosarcoma has been described. Thyroid angiosarcoma is also a very aggressive tumor that can rapidly spread to the cervical lymph nodes, lungs, and brain or can metastasize to the duodenum, small bowel, and large bowel and induce severe bleeding [1, 4–6]. …”

A Case of Hemangiosarcoma in Thyroid with Severe Anemia due to Bone Marrow Metastasis

“…Tumors can also metastasize to the duodenum, small and large bowel and can cause severe bleeding [6]. In the present case, anemia and mild splenomegaly was determined pre- operatively.…”

“…Aggressive tumors can rapidly spread to the lungs, lymph nodes and the brain [1,[6][7][8]. Tumors can also metastasize to the duodenum, small and large bowel and can cause severe bleeding [6].…”

“…Metastatic disease is associated with poor prognosis and limits the mean survival time to a few months after diagnosis and surgical treatment [1,6,8,10,11]. Recently, better survival rates have been reported in the literature [7,12].…”