DOI QR코드

DOI QR Code

Undifferentiated Pleomorphic Sarcoma of the Thoracic Aorta Presenting with Ruptured Saccular Aneurysm: A Case Report

소낭성 동맥류 파열로 발현된 흉부 대동맥에서 기원한 미분화성 다형성 육종: 증례 보고

  • Do Woo Kim (Department of Radiology, Daegu Catholic University College of Medicine) ;
  • Young Hwan Kim (Department of Radiology, Daegu Catholic University College of Medicine) ;
  • Ung Rae Kang (Department of Radiology, Daegu Catholic University College of Medicine) ;
  • Jun Woo Cho (Department of Thoracic Surgery, Daegu Catholic University College of Medicine) ;
  • Jae Seok Jang (Department of Thoracic Surgery, Daegu Catholic University College of Medicine)
  • 김도우 (대구가톨릭대학교 의과대학 영상의학교실) ;
  • 김영환 (대구가톨릭대학교 의과대학 영상의학교실) ;
  • 강웅래 (대구가톨릭대학교 의과대학 영상의학교실) ;
  • 조준우 (대구가톨릭대학교 의과대학 흉부외과학교실) ;
  • 장재석 (대구가톨릭대학교 의과대학 흉부외과학교실)
  • Received : 2019.06.11
  • Accepted : 2020.01.16
  • Published : 2020.09.01

Abstract

Cases of undifferentiated pleomorphic sarcoma of the thoracic aorta are rare, and usually present with embolic events, renovascular hypertension, or back pain. Mural-based undifferentiated pleomorphic sarcomas that present as ruptured saccular aneurysms are extremely rare and are difficult to differentiate from mycotic aneurysms or penetrating atherosclerotic ulcers. Herein, we report a case of histopathologically proven undifferentiated pleomorphic sarcoma arising from the wall of the descending thoracic aorta that manifested as a mass after thoracic endovascular aortic repair for the treatment of a ruptured saccular aneurysm. We present findings obtained by CT and PET to provide helpful information for the accurate diagnosis and appropriate treatment of future cases.

흉부 대동맥 미분화성 다형성 육종은 매우 드문 질환으로 색전 사례, 신혈관성 고혈압, 등 통증 등의 증상을 보일 수 있다. 특히 대동맥 벽에서 기원하여 소낭 동맥류 파열로 보고된 경우는 극히 드물며 진균성 동맥류나 관통성 죽상경화 궤양과 감별이 어렵다. 이에 저자들은 소낭성 동맥류 파열로 혈관 내 흉부 대동맥 치료를 시행한 후 종괴가 발생하여 수술적 생검으로 확진된 미분화성 다형성 육종의 전산화단층촬영과 양전자방출단층촬영 소견을 보고하고자 하며 이를 통해 정확한 진단과 적절한 치료에 도움을 주고자 한다.

Keywords

References

  1. Bohner H, Luther B, Braunstein S, Beer S, Sandmann W. Primary malignant tumors of the aorta: clinical presentation, treatment, and course of different entities. J Vasc Surg 2003;38:1430-1433  https://doi.org/10.1016/S0741-5214(03)00935-2
  2. Rusthoven C, Shames ML, Bui MM, Gonzalez RJ. High-grade undifferentiated pleomorphic sarcoma of the aortic arch: a case of endovascular therapy for embolic prophylaxis and review of the literature. Vasc Endovascular Surg 2010;44:385-391  https://doi.org/10.1177/1538574410369711
  3. Moradi A, Afsharfard A, Atqiaee K. Undifferentiated pleomorphic sarcoma presenting as abdominal pain with a pulsatile mass. Case Rep Surg 2016;2016:8251043 
  4. Utsunomiya D, Ikeda O, Ideta I, Hirayama T, Yamashita Y, Kamio T. Malignant fibrous histiocytoma arising from the aortic wall mimicking a pseudoaneurysm with ulceration. Circ J 2007;71:1659-1661  https://doi.org/10.1253/circj.71.1659
  5. Shuster TA, Dall'Olmo CA, Spadone D, Silver D. Abdominal aortic sarcoma: report of a case with long-term survival and review of the literature. Ann Vasc Surg 2002;16:545-549  https://doi.org/10.1007/s10016-001-0270-x
  6. Burke AP, Virmani R. Sarcomas of the great vessels. A clinicopathologic study. Cancer 1993;71:1761-1773  https://doi.org/10.1002/1097-0142(19930301)71:5<1761::AID-CNCR2820710510>3.0.CO;2-7
  7. Seelig MH, Klingler PJ, Oldenburg WA, Blackshear JL. Angiosarcoma of the aorta: report of a case and review of the literature. J Vasc Surg 1998;28:732-737  https://doi.org/10.1016/S0741-5214(98)70104-1
  8. Heo SY, Park CS, Kim SJ, Park NH, Heo JH, Lee JJ. Undifferentiated pleomorphic sarcoma of the thoracic aorta: a case report. J Korean Soc Radiol 2016;75:304-308  https://doi.org/10.3348/jksr.2016.75.4.304
  9. Lee WK, Mossop PJ, Little AF, Fitt GJ, Vrazas JI, Hoang JK, et al. Infected (mycotic) aneurysms: spectrum of imaging appearances and management. Radiographics 2008;28:1853-1868  https://doi.org/10.1148/rg.287085054
  10. Mader MT, Poulton TB, White RD. Malignant tumors of the heart and great vessels: MR imaging appearance. Radiographics 1997;17:145-153 https://doi.org/10.1148/radiographics.17.1.9017805