Soft Tissue Sarcoma at a Dialysis Access Site in a Transplant Recipient

Abstract

Soft tissue sarcomas typically present as soft, painless masses on an extremity. Here, we present a patient with metastatic soft tissue sarcomas at his dialysis access site. This association with dialysis access has not been documented previously.A 62-year-old man presented with a nonhealing wound on his left upper extremity after excision of a pseudoaneurysmal arteriovenous fistula. The patient had received a second kidney transplant that was functioning well. Immunosuppression included tacrolimus, mycophenolate mofetil, and prednisone. He was induced with thymoglobulin twice.A biopsy was performed showing a high-grade pleomorphic sarcoma. A magnetic resonance image of his left upper extremity showed an 11 × 5.5 × 3 cm mass abutting the biceps and brachialis muscles. Also, we discovered several lesions in the axilla and the left side of the neck, which were suspicious for metastases. A positron emission tomographycomputed tomography scan confirmed a left upper extremity soft tissue mass, with marked fluorodeoxyglucose uptake, in abnormally enlarged axillary, and supraclavicular lymph nodes of the left thorax, consistent with metastases. The patient underwent chemotherapy and radiation therapy.Soft tissue sarcomas are rare. A high index of suspicion is needed to make a diagnosis. This is the first reported case of a soft tissue sarcoma discovered at a dialysis access site. As with all malignancies, early diagnosis is key to patient survival. Thorough physical examinations and increased vigilance by physicians caring for immunosuppressed patients is invaluable.

Angiosarcoma in arteriovenous fistula after kidney transplantation

“…According to our review of the reported data [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] (Table ), 23 cases of angiosarcoma occurring from vascular access had been described in 20 English language reports. Most of the patients were men (83.3%), and their mean age Only five patients had received a second KT.…”

Review on Arteriovenous Fistula Techniques and Complications

“…Malignancy: Angiosarcoma has been reported at the site of AV access to be rare. Symptoms include pain with or without a swelling that may ulcerate or bleed [70][71][72].…”

Soft Tissue Sarcomas in Disused Arteriovenous Fistulae

“…We read with interest the recent paper describing a soft tissue sarcoma associated with a dialysis access site (arteriovenous fistula [AVF]) in a heavily immunosuppressed patient. 1 We refer to a series of similar malignancies in disused arteriovenous fistulae in immunosuppressed transplant patients at our institution. 2 This series included 3 angiosarcomas and a lymphoma; all presented over a 2-year period.…”