This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Aug 7, 2020; 26(29): 4372-4377 Published online Aug 7, 2020. doi: 10.3748/wjg.v26.i29.4372
Multifocal gastrointestinal epithelioid angiosarcomas diagnosed by endoscopic mucosal resection: A case report
You-Wei Chen, Jie Dong, Wan-Yuan Chen, Yi-Ning Dai
You-Wei Chen, Jie Dong, Department of Gastroenterology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Wan-Yuan Chen, Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou 310014, Zhejiang Province, China
Yi-Ning Dai, Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China
Author contributions: Chen YW was the patient’s doctor, who performed the gastroscopy, colonoscopy and endoscopic mucosal resection; Dong J was responsible for collecting medical history of the patient and drafting the paper; Chen WY was a pathologist who provided the pathological results; Dai YN reviewed the literature and revised the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors have declared that no conflict of interests exists.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Received: April 7, 2020 Peer-review started: April 7, 2020 First decision: April 29, 2020 Revised: May 9, 2020 Accepted: July 15, 2020 Article in press: July 15, 2020 Published online: August 7, 2020
Abstract
BACKGROUND
Epithelioid angiosarcoma is a vascular neoplasm that is among the most aggressive subtypes of sarcomas. Its involvement in the gastrointestinal tract is rare. We here report a case of multifocal gastrointestinal epithelioid angiosarcomas presenting with gastrointestinal bleeding.
CASE SUMMARY
A 77-year-old woman was admitted because of melena and dizziness for three months. Gastroscopy and colonoscopy were performed, revealing a centrally ulcerated hemorrhagic polypoid lesion in the gastric body and multiple polypoid lesions with blood clots and hemorrhagic tendency in the colon. Histopathological examination of routine endoscopic biopsy samples showed inflammation in the gastric mucosa and tubular adenomas in the colon. The polypoid lesions were removed by endoscopic mucosal resection. Immunohistochemistry suggested a final diagnosis of epithelioid angiosarcomas. The patient refused chemotherapy and died after three months.
CONCLUSION
Epithelioid angiosarcomas are characterized by highly vascular nature and tendency to cause gastrointestinal bleeding. Efforts to obtain histological findings using endoscopic mucosal resection are of great importance.
Core tip: Gastrointestinal epithelioid angiosarcoma is extremely rare, which is only described in individual case reports and case series. Most reported cases appeared as centrally ulcerated, hemorrhagic, highly erythematous or purpuric nodules. Histopathology is the golden standard for diagnosis. Endoscopic biopsy often obtains insufficient specimens, while endoscopic mucosal resection of suspected lesions is satisfactory for histopathological examination. We here report a case of gastrointestinal bleeding which was finally diagnosed as multifocal epithelioid angiosarcomas in the gastrointestinal tract.
