대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 487 Date 2007-02-26

  • Courtesy of Hyun Ju Lee, MD. / Seoul National University Hospital, Seoul, Korea
  • Age/Sex 63 / M
  • Chief ComplaintHemoptysis Excision of scalp tumor one year ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Cystic Metastasis of Angiosarcoma
Radiologic Findings
Chest radiograph showed cavitary nodule in right upper lung field. Multiple air cysts are shown on chest CT.
Brief Review
An angiosarcoma originate from the endothelial cells and arises most commonly from the dermis of the scalp and upper half of the facial area, and is frequently accompanied by pulmonary metastasis in which solid nodules or masses are produced. Thin-walled carvernous pulmonary metastases are rarely reported. Generally, neoplastic cavities occur in approximately nine percent of primary and four percent of metastatic pulmonary tumors.
The pathogenesis of cavitary pulmonary metastasis is controversial. It may be caused by tumor necrosis secondary to inadequate blood supply due to tumor emboli and subsequent evacuation of necrotic tissue into the airway, a mechanism which can explain the pathogenesis of rapidly growing large lesions. The cavitary lesions in the present case, however, were small and on histological examination showed no tumor emboli. As an alternative, the tumor, by extrinsic compression, can cause bronchial obstruction and thus a resulting cystic lesion, along which tumor cells can extend to form tumor cavities. Nomura et al.suggested that in angiosarcomas, the lining of the vessels tends to be incomplete and that these imperfect vessels can break down and coalesce to form thin-walled cavities.
References
1. Kim MY, Lim BS, Oh MH, et al. Metastatic Angiosarcoma of the Lung : HRCT Findings. Journal of the Korean Radiological Society 1999; 40: 493-496
2. Lanese DM, Pacht ER. Unusual presentation of metastatic scalp angiosarcoma: Diagnosis by transbronchial lung biopsy. J Natl Med Assoc 1987;79:565-568
3. Barker AF, Smith JD. Rapidly developing cavitating pulmonary metastases. Chest 1979;76:103-105
4. Aronchick JM, Palevsky HI, Miler WT. Cavitary pulmonary metastases in angiosarcoma. Diagnosis by transthoracic needle aspiration. Am Rev Respir Dis 1989;139:252-253
5. Nomura M, Nakaya Y, Sito K, et al. Hemopneumothorax secondary to multiple cavitary metastasis in angiosarcoma of the scalp. Respiration 1994;61:109-112
6. Cardozo DW, Claud PL, Chen I, et al Cystic pulmonary metastasis complicating angiosarcoma of the scalp. Calif Med 1966;105:210-214
7. Morrison WH, Byers RM, Garden AS, Evans HL, Ang KK, Peters LJ. Cutaneous angiosarcoma of the head and neck. A therapeutic dilemma. Cancer 1995;76:319-327
8. Chaudhuri MR. Cavitary pulmonary metastases. Thorax 1970;25:375-381
9. Dines DE. Cortese DA, Brennan MD, Hahn RG. Payne WS. Malignant pulmonary neoplasmas predisposing to spontaneous pneumothorax. Mayo Clin Proc 1973;48:541-544
Keywords
Lung, Malignant tumor,

No. of Applicants : 45

▶ Correct Answer : 31/45,  68.9%
  • - Vital Imaging centre, mumbai, India Ganesh Agrawal
  • - China Medical University Hospital, Taiwan Jun-Jun Yeh
  • - Hopital calmette, CHRU,lille, France Toledano manuel
  • - PGIMER, Chandigarh, India Ram Prakash Galwa
  • - China Medical University Hospital, Taiwan Sea-Harn Pan
  • - Ewha Womans University MokDong Hospital, Korea Yookyung Kim
  • - Kazipet, Warangal, A.P, India Pavankumar Vodithala
  • - Sweid a national hospital, Syria Marwan al chami
  • - Osaka University, Japan Osamu Honda
  • - John Smith
  • - Yongsan Hospital, Chung-Ang University, Korea Jae Seung Seo
  • - Annemasse, Polyclinique de SAVOIE, France Gay-Depassier Philippe
  • - CHU Grenoble, France Bing Fabrice
  • - Regional Imaging - Riverina, Australia Rashid Hashmi
  • - Annecy hospital, France Gilles genin
  • - CHR Annecy, France Segall Olivier
  • - EKH-Berlin, Germany Michael Weber
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Gyeongsang National University Hospital, Korea Kim Seok Hyun
  • - Homs National Hospital, Homs - Syria Rami Abou Zalaf
  • - Asan Medical Center, Korea Eun Jin Chae
  • - Hospital Sotiria, Athens, Greece Vasilios Tzilas
  • - IRSA, La Rochelle, France Denis Chabassiere
  • - Shinchon Severance Hospital, Korea Ho Joon Lee
  • - University of California, Los Angeles, USA Fereidoun Abtin
  • - A.S.C.S. Safwa, Saudi Arabia Kalari.Adi Narayana
  • - Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
  • - Monaldi Hospital, Naples, Italy Gaetano Rea
  • - Shree Krishna Hospital, Gujarat, India N S Harsha Vardhan
  • - Doctors Hospital, Nassau, Bahamas N.B.S.Mani
  • - ULTRA CARE, Coimbatore, India Debabrata Das
▶ Correct Answer as Differential Diagnosis : 5/45,  11.1%
  • - Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - E-Da hospital, Taiwan Yu-Feng Wei
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Kyung Hee Medical Center, Korea Su Youn Sim
▶ Semi-Correct Answer : 2/45,  4.4%
  • - KAUMS, Kashan, Iran Ebrahim Razi
  • - IRSA La Rochelle, France Jean-luc BIGOT
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