Carotid Intimal Sarcoma Presenting as Large Vessel Occlusion and Diagnosed by Embolus Histopathology: Case Report
Mahlon D Johnson1, Eli J Rogers1, Muhammad Waqas Khan1
1Departments of Pathology (MDJ, PDM), Neurology (EJR, MWK, SMKA, CGB), and Neurosurgery (TM, MTB), University of Rochester Medical Center, NY.
Insights
Intimal sarcoma (IS) can present as a large vessel occlusion causing ischemic stroke, even without a detectable primary tumor. Histopathology of embolectomy specimens is crucial for diagnosing this rare condition.
Area of Science:
- Cardiovascular Pathology
- Neuropathology
- Oncology
Background:
- Intimal sarcoma (IS) is a rare primary vascular tumor.
- Large vessel occlusion leading to ischemic stroke is a critical neurological event.
- Detecting the primary tumor site of vascular sarcomas can be challenging.
Observation:
- A patient presented with acute embolic ischemic stroke due to a large vessel occlusion.
- Histopathologic evaluation of the embolectomy specimen revealed intimal sarcoma (IS).
- Despite extensive investigations, including multimodal imaging, no primary tumor site was identified.
Findings:
- The embolectomy specimen confirmed intimal sarcoma (IS) as the cause of ischemic stroke.
- Comprehensive diagnostic workup failed to locate a primary tumor, suggesting an occult primary or metastatic disease.
- The patient received multidisciplinary interventions, including radiotherapy.
Implications:
- Cerebral embolectomy specimens require meticulous histopathologic analysis for diagnosing intimal sarcoma (IS).
- Histopathology plays a vital role in identifying intimal sarcoma (IS) presenting as an embolic source.
- This case highlights the importance of considering rare vascular tumors in the differential diagnosis of cryptogenic ischemic strokes.
Objective:
The objective of this study was to present the clinical, histopathologic, and radiographic findings of a unique case of intimal sarcoma (IS) embolus presenting as a large vessel occlusion causing an ischemic stroke without a detectable primary tumor site.
Methods:
Extensive examinations, multimodal imaging, laboratory testing, and histopathologic analysis were used in evaluation.
Results:
We report the case of a patient who presented with acute embolic ischemic stroke and was found to have IS based on a histopathologic evaluation of his embolectomy specimen. Subsequent comprehensive imaging studies failed to detect a primary tumor site. Multidisciplinary interventions including a course of radiotherapy were performed. The patient died of recurrent multifocal strokes 92 days after diagnosis.
Discussion:
Meticulous histopathologic analysis should be conducted on cerebral embolectomy specimens. Histopathology may be useful in diagnosing IS.
