Metastatic Angiosarcoma: A Rare Cause of Chylothorax

Abstract

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Metastatic angiosarcoma (MA) is a rare malignancy originating from soft tissue, and chylothorax is an even rarer manifestation of this disease. We present a unique case of MA with pulmonary and pleural involvement which presented with unilateral chylothorax and ascites. CASE PRESENTATION: A 49 year old female with a history of latent tuberculosis infection (LTBI) presented with a 2 week history of abdominal pain and dyspnea. Physical examination was significant for an ill appearance with decreased right sided breath sounds and moderate ascities. Laboratory analysis was significant for hypoalbuminemia, hyponatremia, and elevated CA 125. CT imaging revealed a large right sided pleural effusion, moderate ascities with peritoneal enhancement, and hypodense liver lesions. Paracentesis was significant for a serum ascites albumin gradient of 1.3 with negative cytology. Thoracentesis was consistent with a chylous effusion with lymphocytic predominance and a pleural adenosine deaminase of 23.7. A chest tube was placed and drained 3 liters of fluid daily. All Infectious work up was negative. Repeat CT imaging revealed right lung interstitial opacities and a wedge biopsy was consistent with angiosarcoma with pleural infiltration. The patient passed away shortly after diagnosis. DISCUSSION: Angiosarcomas are rare neoplasms originating from soft tissues, commonly heart, breast, and skin. Pulmonary involvement indicates metastatic disease, usally presenting with pulmonary nodules or diffuse alveolar hemorrhage. In these cases, the disease is aggressive with 5 year survival rates less than 20%. Only 1 case of MA presenting as a chylothorax has been reported. The rarity of these tumors makes diagnosis exceptionally difficult and requires a multidisciplinary approach. CONCLUSIONS: While this patient had risk factors for other process which can cause ascities and chylothorax (LTBI), ultimately her symptoms were related to a more rare disease process - MA. Angiosarcoma should be included in the differential of chylothorax, especially when other more common diagnoses have been excluded. Reference #1: Abraham, V. A Rare Find-Primary Pulmonary Angiosarcoma. CHEST Journal. October 2011; 140(4). Reference #2: Pan, Z et al. Diffuse alveolar hemorrhage due to metastatic angiosarcoma of the lung: a case report. Oncology Letters. December 2015; 10(6). 3853-3855. Reference #3: Vavilis, D et al. Primary ovarian angiosarcoma—review of the literature and report of a case with coexisting chylothorax. European Journal of Gynaecologic Oncology. 2007; 28(4): 287-9. DISCLOSURE: The following authors have nothing to disclose: Rishi Mehta, Jessica Johnson, Katherine Young No Product/Research Disclosure Information