A case of primary angiosarcoma of the chest wall with early postoperative lymph node metastasis controlled by radiotherapy

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  • 術後早期に発生したリンパ節転移を放射線治療で制御し得た胸壁原発血管肉腫の一例

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Abstract

<p>A 75-year-old male patient presented to our hospital with abdominal distension and anorexia. Computed tomography (CT) revealed left pleural effusion and a mass showing suspicious involvement with the seventh rib. On thoracic drainage, bloody pleural effusion was observed: primary lung cancer was suspected. Thoracoscopic partial resection of the left lung and needle biopsy of the ribs were performed for diagnosing primary lung cancer. Although the pulmonary mass was found to be a hematoma, needle biopsy of the rib lesion revealed angiosarcoma. Positron emission tomography (PET) -CT showed 18F-fluorodeoxyglucose (FDG) accumulation due to the tumor in the chest wall and left axillary lymph node. Radical surgery was performed, comprising resection of the tumor in the left chest wall and axillary lymph node dissection. Histological examination revealed an epithelioid angiosarcoma with a maximum diameter of 2.1 cm in the chest wall and numerous metastases in the left axillary lymph node. Postoperatively, the left axillary and supraclavicular lymph nodes were irradiated with 50 Gy of additional radiotherapy. Three months after surgery, PET-CT showed FDG accumulation in the left parasternal lymph node, which was determined to be due to metastasis. Therefore, 50 Gy of radiotherapy was also administered to the left internal sternal region. The patient has been under observation for 5 years without signs of recurrence since then. Radiotherapy was considered an effective treatment for the patient with lymph node metastasis from hemangiosarcoma.</p>

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