Angiosarcoma

Paciente de 82 aos que consulta en febrero de 2015 por dolor lumbar crnico, gonalgia izquierda y deambulacin limitada por dolor en EI izq.

AP importantes de cncer de mama izq en marzo 2005 tratado con mastectoma +QT.

Primero se le realiza una RX Huguet Gibert, Maria- 1346374912Angiosarcoma3GeneralidadesTumor agresivo que se origina en estructuras vasculares. > Edad: 20-70 aosLocalizaciones:Piel 33%Partes blandas 24 %Hueso 6% - huesos largos 60%La mayora solitarios (33% son multifocales)Mal pronstico (66% presentan M1 pulmonares y otros rganos)4Rx simpleLesiones predominantemente lticas, destructivas.No margen esclertico.Zona amplia de transicinPuede haber insuflacin sea, si bajo grado.Rotura de la cortical y masa de partes blandas si es de alto grado.5

AP radiograph in the same case shows a femoral lesion with a fairly wide zone of transition & thinning of the endosteal cortex (white solid arrow). Like the rib lesion, this appears moderately aggressive. These 2 lesions should prompt consideration of metastasis or multiple myeloma, though the patient is only in their 30s.6

AP radiograph shows multiple lytic lesions involving various bones of the midfoot (white solid arrow). The lesions appear permeative, without sclerotic margin. Joint spaces remain normal, ruling out arthritic or septic process. The pattern might suggest disuse osteoporosis, but metatarsals show normal density.7

Lateral radiograph shows honeycomb pattern (white solid arrow). Multiple lesions, especially when in contiguous bones and in the lower extremity, should prompt consideration of angiosarcoma, proven in this case.8TCHallazgos similares a Rx.Varios grados de agresividad.* Sospechar tumor seo de estirpe vascular cuando:- Afectacin multifocal de una nica regin anatmica.- Predomina en extremidades inferiores.- Difcil diferenciar entre: angiosarcoma, hemangioendotelioma y hemagiopericitoma los 3 presentan multifocalidad. El angiosarcoma puede ser el ms agresivo.9

AP radiograph shows a "naked" sacroiliac joint. Note the clearly visible right sacroiliac joint (white solid arrow). This indicates that the posterior iliac wing is missing. The posterior iliac wing is easily seen superimposed over the SI joint on the normal left side (white curved arrow). This naked SI joint is an important diagnostic finding, indicating a large posterior destructive iliac lesion, but can be easily overlooked.10

Axial NECT confirms destruction of the posterior iliac wing (white solid arrow) and adjacent sacral ala by proven angiosarcoma.11

AP radiograph in the same case shows a much more aggressive iliac wing lesion, with a wide zone of transition, cortical breakthrough, & pathologic fracture (white solid arrow).12

Axial NECT in the same patient confirms destruction of the iliac wing with fragments of bone carried to the periphery (white open arrow) and a large soft tissue mass (white solid arrow) making metastasis or myeloma unlikely. Vascular tumor such as this proven angiosarcoma should also be considered. Polyostotic lesions tend to involve the lower extremities.13RMT1: hipointensoT2: hiperintenso, inhomogneaC+: captacin heterognea de contrate: centro necrtico hipointenso.Puede tener vasos perifricos prominentes.14

Sagittal T1WI MR in the same case shows multiple focal lesions involving, to some extent, nearly every bone of the foot and ankle (white solid arrow). The marrow replacement is seen as low signal intensity on these T1WIs. Polyostotic lesions, especially isolated to the lower extremities, should lead to consideration of vascular osseous tumors. In this case, angiosarcoma was proven.15Diagnstico diferencialMetstasisMieloma mltipleHemangioendoteliomaHemangiopericitoma1617Sndrome de Stewart-TrevesLinfangiosarcoma desarrollado sobre linfedema crnico, ms frecuente secundario a mastectoma.Se presenta en 0,45% en pacientes que sobreviven ms de 5 aos.Intervalo entre tratamiento cncer y diagnstico: 11-21 aosAparicin de ndulos violceos sobre la piel edematoso del brazo afectado.

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