Bahk Won Jong, Na Sae Jung, Whang In Yong, Kim Yongju, Seo Kyung Jin
Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Diagnostics (Basel). 2024 Apr 11;14(8):805. doi: 10.3390/diagnostics14080805.
Aortic angiosarcomas are rare. Due to its rarity and metastatic presentation, it is difficult to diagnose metastatic aortic angiosarcoma. We describe the clinicopathological and radiologic features of a metastatic aortic angiosarcoma presenting as musculoskeletal metastases. A 59-year-old male patient presented with left thigh pain. Plain radiographs revealed multifocal osteolytic lesions in the left femur shaft. Abdominopelvic computed tomography showed a lobulated osteolytic lesion in the left iliac bone. Magnetic resonance images revealed multifocal soft tissue lesions in the thigh musculature. A positron emission tomography/computed tomography (PET/CT) scan demonstrated multiple foci of increased uptake in the left femur bone, pelvis, left thigh, and calf musculature. Focal increased uptake in the lower abdominal aorta was newly detected. Pelvis biopsy showed tumor cell nests of epithelioid cells. The tumor cells showed vasoformative features. Immunohistochemically, the tumor cells showed positivity for vimentin, CD31, and ERG. The pathologic diagnosis of epithelioid angiosarcoma was established. The origin of the tumor was presumed to be the aorta. This case underscores the importance of PET scans in identifying primary lesions. In terms of the histopathologic diagnosis of biopsy samples with tumor cells exhibiting epithelioid neoplastic morphology, employing appropriate ancillary techniques such as immunocytochemistry with vascular markers may assist in accurately diagnosing metastatic angiosarcoma.
主动脉血管肉瘤较为罕见。由于其罕见性及转移表现，转移性主动脉血管肉瘤难以诊断。我们描述了一例表现为肌肉骨骼转移的转移性主动脉血管肉瘤的临床病理及影像学特征。一名59岁男性患者因左大腿疼痛就诊。X线平片显示左股骨干有多处溶骨性病变。腹盆腔计算机断层扫描显示左髂骨有一个分叶状溶骨性病变。磁共振成像显示大腿肌肉组织有多处软组织病变。正电子发射断层扫描/计算机断层扫描（PET/CT）显示左股骨、骨盆、左大腿和小腿肌肉组织有多个摄取增加灶。新发现下腹部主动脉有局灶性摄取增加。骨盆活检显示上皮样细胞的肿瘤细胞巢。肿瘤细胞表现出血管形成特征。免疫组化显示肿瘤细胞波形蛋白、CD31和ERG呈阳性。确诊为上皮样血管肉瘤。推测肿瘤起源于主动脉。该病例强调了PET扫描在识别原发灶方面的重要性。对于肿瘤细胞表现出上皮样肿瘤形态的活检样本进行组织病理学诊断时，采用适当的辅助技术，如使用血管标志物的免疫细胞化学，可能有助于准确诊断转移性血管肉瘤。
