High-Grade Undifferentiated Pleomorphic Sarcoma of the Aortic Arch: A Case of Endovascular Therapy for Embolic Prophylaxis and Review of the Literature
Restricted accessReview articleFirst published online July, 2010
High-Grade Undifferentiated Pleomorphic Sarcoma of the Aortic Arch: A Case of Endovascular Therapy for Embolic Prophylaxis and Review of the Literature
Primary malignant tumors of the aorta (PMTAs) are an extremely rare clinical entity. In most cases, the diagnosis is made either postmortem or late in the course of disease due to a low index of clinical suspicion and presenting symptoms that mimic far more common athero-embolic processes. Due to the intravascular origin of these tumors, peripheral and mesenteric embolic events represent a major source of morbidity and mortality. We present the first reported case of a patient with a diagnosed PMTA treated with an endovascular aortic stent for the purpose of embolic prophylaxis. The presentation, diagnosis, classification, and management of PMTAs in the world literature are also reviewed.
Brodowski W.Primäres sarkom der aorta thoracica mit verbreitung des neugebildes in der unteren körperhälfte. Johresb Leistung Fortschr Med. 1873;8:243-246.
2.
Chiche L., Mongredien B., Brocheriou I., Kieffer E.Primary tumors of the thoracoabdominal aorta: surgical treatment of 5 patients and review of the literature. Ann Vasc Surg. 2003;17(4):354-364.
3.
Seelig MH, Klingler PJ, Oldenburg WA, Blackshear JLAngiosarcoma of the aorta: report of a case and review of the literature. J Vasc Surg. 1998;28(4):732-737.
4.
Thalheimer A. , Fein M., Geissinger E., Franke S.Intimal angiosarcoma of the aorta: report of a case and review of the literature. J Vasc Surg. 2004;40(3):548-553.
5.
Van Putte BP , Bollen TL, Schepens MABleeding sarcoma of the aorta mimicking a symptomatic aneurysm. J Thorac Cardiovasc Surg. 2007;133(6):1643-1644.
6.
Tucci M., Quatraro C., Calvani N., et al. Primary intimal sarcoma of the thoracic aorta. J Exp Clin Cancer Res. 2005;24(1):139-142.
7.
Sparsa A., Liozon E., Wechsler J., et al. Aortic angiosarcoma clinically mimicking polyarteritis nodosa . Scand J Rheumatol. 2006; 35(3):237-240.
8.
Böhner H., Luther B., Braunstein S., Beer S., Sandmann W.Primary malignant tumors of the aorta: clinical presentation, treatment, and course of different entities. J Vasc Surg. 2003;38(6): 1430-1433.
9.
Hagspiel KD, Hunter YR, Ahmed HK, et al. Primary sarcoma of the distal abdominal aorta: CT angiography findings. Abdom Imaging. 2004;29(4):507-510.
10.
Sánchez-Muñoz A., Hitt R., Artiles V., et al. Primary aortic sarcoma with widespread vascular embolic metastases. Eur J Intern Med. 2003;14(4):258-261.
11.
Shuster TA, Dall’Olmo CA, Spadone D., Silver D.Abdominal aortic sarcoma: report of a case with long-term survival and review of the literature. Ann Vasc Surg. 2002;16(5):545-549.
12.
Higgins R., Posner MC, Moosa HH, Staley C., Pataki KI, Mendelow H.Mesenteric infarction secondary to tumor emboli from primary aortic sarcoma: guidelines for diagnosis and management. Cancer. 1991;68(7):1622-1627.
13.
Rhee MY, Myong NH, Park YBPrimary intimal sarcoma of the aorta: role of transesophageal echocardiography . Circ J. 2002; 66(1):111-113.
14.
Salm R.Primary fibrosarcoma of aorta. Cancer. 1972 ;29(1): 73-83.
15.
Wright EP, Glick AD, Virmani R., Page DLAortic intimal sarcoma with embolic metastases. Am J Surg Pathol. 1985;9(12): 890-897.
16.
Sebenik M., Ricci A. Jr, DiPasquale B., et al. Undifferentiated intimal sarcoma of large systemic blood vessels: report of 14 cases with immunohistochemical profile and review of the literature . Am J Surg Pathol. 2005;29(9):1184-1193.
17.
Lin JSDiagnostic application of immunohistochemistry in pleomorphic sarcomas. Zhonghua Bing Li Xue Za Zhi. 1990;19(1): 67-70.
18.
Burke A., Virmani R.Sarcomas of the great vessels: a clinicopathologic study. Cancer. 1993;71(5):1761-1773.
19.
Abularrage CJ, Weiswasser JM, White PW, Arora S., Sidawy ANAortic angiosarcoma presenting as distal arterial embolization. Ann Vasc Surg. 2005;19(5):744-748.
20.
Tulsyan N., Valentin MD, Ombrellino M., Moritz M., Agis H., Kabnick L.. Recurrentaortic angiosarcoma: a case report and review of the literature. Angiology. 2006;57(1):123-125.
21.
Kim SH, Jeong JY, Kim YI, Choi YH, Chung JW, Hyung Park J.SCVIR 2002 Film Panel case 3: aortic occlusion secondary to intimal sarcoma . J Vasc Interv Radiol.2002;13(5):537-541.
22.
Osei-Agyemang T., Geks J., Wagner HJ, Feek U., Gerdes B.High-grade intimal sarcoma in an aneurysm of the infrarenal aorta. Chirurg. 2004;75(8):823-827.
23.
Muehlstedt S., Mallery S., Joyce L., Van Camp J.Myxoid leiomyosarcoma of the descending thoracic aorta. J Thorac Cardiovasc Surg. 2001;121(3):590-592.
24.
Utsunomiya D., Ikeda O., Ideta I., Hirayama T., Yamashita Y., Kamio T.Malignant fibrous histiocytoma arising from the aortic wall mimicking a pseudoaneurysm with ulceration. Circ J. 2007; 71(10):1659-1661.
25.
Ramjee V., Ellozy S.Aortic angiosarcoma masquerading as a thoracic aortic aneurysm: A case report and literature. J Vasc Surg.2009;50(6):1477-1480.
26.
Shames ML, Rubin BG, Sanchez LA, Thompson RW, Sicard GATreatment of embolizing arterial lesions with endoluminally placed stent grafts . Ann Vasc Surg. 2002;16(5):608-612.
27.
Ishigami N. , Suzuki K., Takahashi T., Neyatani H., Bashar AH, Kazui T.Intimal sarcoma of aortic arch treated with proton therapy following surgery. Asian Cardiovasc Thorac Ann. 2008; 16(2):e12-e14.
28.
Pompilio G. , Tartara P., Varesi C., Biglioli P.Intimal-type primary sarcoma of the thoracic aorta: an unusual case presenting with left arm embolization. Eur J Cardiothorac Surg. 2002; 21(3):574-576.
