J Korean Neurosurg Soc.  2012 Jan;51(1):47-50. 10.3340/jkns.2012.51.1.47.

Rapid Clinical Course of Cerebral Metastatic Angiosarcoma from the Heart

• Jung SH
• Jung TY
• Joo SP
• Kim HS

• KMID: 2190471
• DOI: http://doi.org/10.3340/jkns.2012.51.1.47

Abstract

We report here one case of rapid and aggressive course of cerebral metastatic angiosarcoma from the heart. A 36-year-old man presented with 10-days history of headache. Magnetic resonance imaging demonstrated subacute hemorrhage with a small region of enhancement in right parietal region and the pathological diagnosis was angiosarcoma. Transthoracic echocardiography demonstrated 3.2x3 cm sized mass on right atrial wall. Newly developed lesion was reoperated, three and four weeks later respectively, and whole brain radiotherapy of total 30 Gy was done. With the interval of two months, gamma knife surgery was done for new lesions two times, which were well controlled. Newly developed lesions rapidly happened even in the adjuvant treatment. He died 9 months after the diagnosis because of the aggravation of primary cancer. The cerebral metastatic angiosarcoma from the heart showed the rapid aggressive behavior and the closed follow-up could be needed for the adjuvant treatment.

Keyword

Angiosarcoma; Cerebral; Heart; Metastasis

MeSH Terms

Adult
Brain
Echocardiography
Headache
Heart
Hemangiosarcoma
Hemorrhage
Humans
Magnetic Resonance Imaging
Neoplasm Metastasis

Figure

• 

  Fig. 1 Initial radiologic findings. CT showed the intracerebral hemorrhage of subacute stage on right parietal area (A). MRI demonstrates a heterogeneous mixed signal intensity lesion on T1 and T2-weighted images (B and C) with a small region of enhancement in right parietal region (D). CT: computed tomography, MRI: magnetic resonance imaging.

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  Fig. 2 Pathologic findings. A: Highly cellular with cellular atypia and frequent mitosis (H&E, original magnification ×400). B: Immunopositive for CD34 (original magnification ×400). C: Immunopositive for actin (original magnification ×400). D: Immunopositive for CD31 (original magnification ×400). E: Ki-67 labeling index at 80% (original magnification ×400).

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  Fig. 3 Follow-up radiologic findings. A and B: Three weeks later, CT and MRI show another intracerebral hemorrhage associated with enhancing lesion of right parietal area. C: Four weeks later, MRI shows the marginal enhanced lesion on post-resection cavity associated with perilesional edema. D: After WBRT two months later, MRI shows less than 1 cm-sized, four newly enhancing lesions. E: Two months later, there are newly developed lesions; 2.3 cm sized hemorrhagic mass lesion with heterogeneous enhancement in right cerebellar hemisphere. F: Six weeks later, MRI shows that the new multiple lesions are detected. CT: computed tomography, MRI: magnetic resonance imaging, WBRT: whole brain radiotherapy.

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