Abstract
Angiosarcoma is a rare type of soft-tissue sarcoma, constituting only 1% out of all soft-tissue sarcomas pathologically originating from lymphatic or vascular endothelial cells. Angiosarcomas are reported to be very aggressive with a high incidence of metastases to different sites; therefore, it is very important to determine disease extension and detect local recurrence and/or distant metastases for appropriate management. We report a case of a 55-year-old Indian male who presented with soft-tissue thickening of the left cheek for which biopsy revealed angiosarcoma and was referred for fludeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) to assess the extent of disease highlighting the potential role of FDG PET/CT in rare malignancies like angiosarcomas.
Keywords: Facial angiosarcoma, fludeoxyglucose positron emission tomography/computed tomography, liver and spleen metastasis, rare metastases
Figure 1.
A 55-year-old male, who is a known case of histopathologically proven angiosarcoma, was referred for an 18F-fludeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan to assess the extent of disease [Figure 1]. (a) The maximum intensity projection of the patient showed intense FDG uptake involving right cervical lymph nodes and hepatosplenomegaly with metastasis to the liver and spleen. (b-e) Transverse images of the PET/CT fusion and the attenuation CT images demonstrated cutaneous tissue thickening overlying the left maxilla with increased FDG uptake, (f,g) shows metastases with increased FDG uptake to the liver and spleen. Angiosarcomas are known to be a rare type of sarcomas, accounting for only 1.6% of all soft-tissue sarcomas.[1] The most common anatomical sites of location are the head, neck, and breast, followed by other extremities.[2] The incidence among males is more common than among females, showing a 2:1 distribution.[3] Although there are few case reports of primary splenic angiosarcomas,[4] primary liver angiosarcomas,[5] and primary splenic angiosarcomas metastasizing to the liver,[6] to the best of our knowledge, there is no reported case of cutaneous angiosarcoma with metastasis to the cervical lymph nodes, liver, and spleen
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
References
- 1.Yang KF, Li Y, Wang DL, Yang JW, Wu SY, Xiao WD. Primary splenic angiosarcoma with liver metastasis: A case report and literature review. World J Gastroenterol. 2016;22:3506–10. doi: 10.3748/wjg.v22.i12.3506. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Rujeerapaiboon N, Wetwittayakhlang P. Primary hepatic angiosarcoma: A rare liver malignancy – Varying manifestations but grave prognosis. Case Rep Gastroenterol. 2020;14:137–49. doi: 10.1159/000506928. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Neuhauser TS, Derringer GA, Thompson LD, Fanburg-Smith JC, Miettinen M, Saaristo A, et al. Splenic angiosarcoma: A clinicopathologic and immunophenotypic study of 28 cases. Mod Pathol. 2000;13:978–87. doi: 10.1038/modpathol.3880178. [DOI] [PubMed] [Google Scholar]
- 4.Wang L, Lao IW, Yu L, Wang J. Clinicopathological features and prognostic factors in angiosarcoma: A retrospective analysis of 200 patients from a single Chinese medical institute. Oncol Lett. 2017;14:5370–8. doi: 10.3892/ol.2017.6892. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ. Angiosarcoma. Lancet Oncol. 2010;11:983–91. doi: 10.1016/S1470-2045(10)70023-1. [DOI] [PubMed] [Google Scholar]
- 6.Rouhani P, Fletcher CD, Devesa SS, Toro JR. Cutaneous soft tissue sarcoma incidence patterns in the U.S: An analysis of 12,114 cases. Cancer. 2008;113:616–27. doi: 10.1002/cncr.23571. [DOI] [PubMed] [Google Scholar]