Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion
Angiosarcomas are rare cancers accounting for less than 2% of all soft tissue sarcomas. We report the case of an unusual presentation of pleural epithelioid angiosarcoma in a patient with constrictive pericarditis and recurrent pleural effusion. A 62 year old smoker presented with acute chest pain....
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doaj-2aaf1e3fc52e47ca843339abab55b25d2020-11-24T21:41:28ZengElsevierRespiratory Medicine Case Reports2213-00712018-01-01247780Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusionUrshila Durani0Alice Gallo de Moraes1Joel Beachey2Darlene Nelson3Steven Robinson4Nandan S. Anavekar5Department of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Corresponding author.Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USADepartment of Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USADepartment of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USADepartment of Medicine, Division of Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USADepartment of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA; Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USAAngiosarcomas are rare cancers accounting for less than 2% of all soft tissue sarcomas. We report the case of an unusual presentation of pleural epithelioid angiosarcoma in a patient with constrictive pericarditis and recurrent pleural effusion. A 62 year old smoker presented with acute chest pain. ECG showed diffuse elevation of ST segments in the precordial leads. After extensive evaluation, he was diagnosed with viral pericarditis and treated with colchicine. Two weeks later the patient presented to the emergency department with a large right pleural effusion. Evaluation of the pleural fluid obtained from a thoracentesis revealed an exudative effusion with negative microbial studies and no evidence of malignant cells. His pleural effusion re-accumulated rapidly, requiring repeated thoracenteses over several weeks. Medical thoracoscopy was performed and pleural biopsy revealed primary pleural epithelioid angiosarcoma. Staging PET scan revealed malignant enhancement of right pleura, pericardium, right iliac bone and right shoulder. He died suddenly within 6 weeks of diagnosis, prior to initiating palliative chemotherapy. Pleural angiosarcoma should be considered in the differential diagnosis of recurrent pleural effusions of unknown etiology. Negative cytology does not rule out the diagnosis; excisional biopsy is required. Reported risk factors include asbestos exposure, prior chest radiation, active smoking and history of complicated pleural tuberculosis. Pleural epithelioid angiosarcomas carry a very poor prognosis, with the majority of patients dying within months of diagnosis. Keywords: Epithelioid angiosarcoma, Pleural effusion, Pericarditishttp://www.sciencedirect.com/science/article/pii/S2213007117301910 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Urshila Durani Alice Gallo de Moraes Joel Beachey Darlene Nelson Steven Robinson Nandan S. Anavekar |
spellingShingle |
Urshila Durani Alice Gallo de Moraes Joel Beachey Darlene Nelson Steven Robinson Nandan S. Anavekar Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion Respiratory Medicine Case Reports |
author_facet |
Urshila Durani Alice Gallo de Moraes Joel Beachey Darlene Nelson Steven Robinson Nandan S. Anavekar |
author_sort |
Urshila Durani |
title |
Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion |
title_short |
Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion |
title_full |
Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion |
title_fullStr |
Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion |
title_full_unstemmed |
Epithelioid angiosarcoma: A rare cause of pericarditis and pleural effusion |
title_sort |
epithelioid angiosarcoma: a rare cause of pericarditis and pleural effusion |
publisher |
Elsevier |
series |
Respiratory Medicine Case Reports |
issn |
2213-0071 |
publishDate |
2018-01-01 |
description |
Angiosarcomas are rare cancers accounting for less than 2% of all soft tissue sarcomas. We report the case of an unusual presentation of pleural epithelioid angiosarcoma in a patient with constrictive pericarditis and recurrent pleural effusion. A 62 year old smoker presented with acute chest pain. ECG showed diffuse elevation of ST segments in the precordial leads. After extensive evaluation, he was diagnosed with viral pericarditis and treated with colchicine. Two weeks later the patient presented to the emergency department with a large right pleural effusion. Evaluation of the pleural fluid obtained from a thoracentesis revealed an exudative effusion with negative microbial studies and no evidence of malignant cells. His pleural effusion re-accumulated rapidly, requiring repeated thoracenteses over several weeks. Medical thoracoscopy was performed and pleural biopsy revealed primary pleural epithelioid angiosarcoma. Staging PET scan revealed malignant enhancement of right pleura, pericardium, right iliac bone and right shoulder. He died suddenly within 6 weeks of diagnosis, prior to initiating palliative chemotherapy. Pleural angiosarcoma should be considered in the differential diagnosis of recurrent pleural effusions of unknown etiology. Negative cytology does not rule out the diagnosis; excisional biopsy is required. Reported risk factors include asbestos exposure, prior chest radiation, active smoking and history of complicated pleural tuberculosis. Pleural epithelioid angiosarcomas carry a very poor prognosis, with the majority of patients dying within months of diagnosis. Keywords: Epithelioid angiosarcoma, Pleural effusion, Pericarditis |
url |
http://www.sciencedirect.com/science/article/pii/S2213007117301910 |
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