Aortic Angiosarcoma Manifesting as Multiple Musculoskeletal Metastases: A Case Report

Area of Science:

• Oncology
• Radiology
• Pathology

Background:

• Aortic angiosarcomas are exceptionally rare vascular tumors.
• Their metastatic presentation often mimics other musculoskeletal conditions, complicating diagnosis.
• Early identification is critical for effective patient management.

Purpose of the Study:

• To detail the clinicopathological and radiologic features of a metastatic aortic angiosarcoma.
• To highlight the diagnostic utility of advanced imaging in identifying primary lesions.
• To emphasize the role of immunohistochemistry in confirming angiosarcoma diagnosis.

Main Methods:

• Case report of a 59-year-old male with metastatic aortic angiosarcoma.
• Utilized plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT).
• Performed pelvic biopsy with histopathological examination and immunohistochemistry (vimentin, CD31, ERG).

Main Results:

• Patient presented with thigh pain and multifocal osteolytic lesions.
• Imaging revealed extensive bone and soft tissue metastases.
• PET/CT identified increased uptake in the lower abdominal aorta, presumed primary site.
• Biopsy confirmed epithelioid angiosarcoma with characteristic vasoformative features and immunoprofile.

Conclusions:

• Metastatic aortic angiosarcoma can present insidiously with musculoskeletal symptoms.
• PET/CT is invaluable for detecting the primary aortic tumor and staging metastatic disease.
• Immunohistochemistry is essential for diagnosing epithelioid angiosarcoma in metastatic biopsies.