Primary angiosarcoma of the lung

Abstract

Introduction: Angiosarcoma is a malignant endothelial tumor of vascular or lymphatic origin. Primary pulmonary angiosarcoma is extremely rare and is often associated with professional factors. Materials and Methods: A 56-year-old man had been admitted on 20/10/2017 with complaints of persistent fever up to 37.5 within 2 months, dry cough and chest pain. He had reported a long-term predisposition for ammonia and silicon dioxide. Results: The paraclinical results had revealed increased sediment and C-reactive protein levels, anaemic syndrome 115 by type of Iron deficiency anaemia. The X-ray scans of the lungs had shown no signs of pneumonia. The symptoms were not affected by antibiotics and antipyretics treatment. Positive serology for `Epstein-Barr virus`, `Cytomegalovirus`, `Mycoplasma pneumoniae`, `Chlamydia pneumoniae-IgM (+)`, `Chlamydia Trachomatis IgA (+)`. Rejected infectious and haematological disease. Echocardiography - rejected endocarditis, haemocultures were negative. Results from coronary catheterization showed nonstenotic coronary atherosclerosis. History of left-sided `pneumonia` (2016). Diagnosed with bilateral radiculopathy - L4-L5-S1 (2014). Concomitant diseases - `gastritis`, `oesophagitis`, `duodenitis`, `arterial hypertension` systemically treated. Computed tomography of the thoracic cage - double-sided rounded lesions, with suspected secondary lesions in the liver. Positron Emission Tomography/Computed Tomography - disseminated malignant process in the lung, left crus of diaphragm, osteosclerotic lesions with different bone localization. Thoracic and abdominal lymphadenomegaly. Bronchoalveolar lavage - nothing abnormal detected. Fine Needle Biopsy - benign histological material. Cutting needle biopsy - morphological picture of a malignant blastoma. Histology had shown infiltration of tumor cells with hyperchromatic nuclei and formation of lumen spaces. Immunohistochemisty results had shown cells expression on CD 34 and corresponded to epithelioid angiosarcoma. Conclusion: A first course of aggressive chemotherapy had been performed. In spite of the complex therapy involving chemotherapy, antibiotics and haemostatics the patient developed massive haemoptysis. On 13.01.2018 the patient passed away due to pulmonary and cerebral oedema and hemodynamic disorder.