Case and Research Letters
Abdominal Wall Angiosarcoma in a Patient With Drug-Induced Immunosuppression Following Renal Transplantation
Angiosarcoma de pared abdominal en paciente con inmunosupresión farmacológica por trasplante renal
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(B) Scar of the primary site of a malignant melanoma is clearly identifiable after a double M-plasty.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Agorio, J. Magliano, J.D. Brewer, C.I. Bazzano" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Agorio" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Magliano" ] 2 => array:2 [ "nombre" => "J.D." "apellidos" => "Brewer" ] 3 => array:2 [ "nombre" => "C.I." 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Proliferation of spindle cells arranged in fascicles (original magnification, hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100). B, Irregular pseudovascular spaces surrounded by multinucleated giant cells (original magnification, hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100).<span class="elsevierStyleHsp" style=""></span>C, Involvement of full thickness of the dermis with extension into the subcutaneous tissue (original magnification, hematoxylin-eosin<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>20). D, Spindle cells expressing CD34 (×<span class="elsevierStyleHsp" style=""></span>20).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Jubert, L.J. del Pozo, C. Saus, A. Martín-Santiago" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." 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"apellidos" => "Martín-Santiago" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731015003488" "doi" => "10.1016/j.ad.2015.06.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731015003488?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016000111?idApp=UINPBA000044" "url" => "/15782190/0000010700000002/v2_201703220318/S1578219016000111/v2_201703220318/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case and Research Letters</span>" "titulo" => "Abdominal Wall Angiosarcoma in a Patient With Drug-Induced Immunosuppression Following Renal Transplantation" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "162" "paginaFinal" => "163" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "P. Martín, A. Pulpillo, R. Cabrera, J. Conejo-Mir" "autores" => array:4 [ 0 => array:4 [ "nombre" => "P." "apellidos" => "Martín" "email" => array:1 [ 0 => "Pablo_ronda@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Pulpillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "R." "apellidos" => "Cabrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "J." "apellidos" => "Conejo-Mir" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Angiosarcoma de pared abdominal en paciente con inmunosupresión farmacológica por trasplante renal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 723 "Ancho" => 1000 "Tamanyo" => 119052 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large bruise-like reddish-purple plaque covering nearly the entire lower half of the abdomen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">An 80-year-old woman with a history of hypertension and type 2 diabetes mellitus had been under treatment with ciclosporin (75<span class="elsevierStyleHsp" style=""></span>mg/d) and mycophenolate (1500<span class="elsevierStyleHsp" style=""></span>mg/d) since a 2004 kidney transplant for chronic renal failure. An infiltrating ductal carcinoma led to left mastectomy and axillary clearance in 2006 without adjuvant chemotherapy or radiotherapy. She was referred to the dermatologist for a lesion that had appeared on her abdomen 2 months earlier. The only symptom was a pulling sensation. The lesion formed a large reddish-purple bruise-like plaque covering almost the entire lower half of the abdomen. Nodular structures were also present (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). No signs of adenopathy, ascites, or other cutaneous lesions were found. Histology revealed neoplastic endothelial cells forming channels that dissected collagen fibers. The cells exhibited atypia with loss of nuclear-cytoplasmic ratio, pleomorphism, and abundant mitoses (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Immunohistochemistry was positive for CD31 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and CD34 markers in tumor cells and negative for human herpes virus 8. A diagnosis of angiosarcoma was established. A computed tomography scan of the abdomen revealed dermal tumors infiltrating the subcutaneous tissue as far as the abdominal wall below the umbilicus and mild ascites possibly related to peritoneal carcinomatosis. The patient was referred to the oncology department, where she declined the recommended chemotherapy. One month after diagnosis, she was admitted. Her general condition had declined, she had edema in the lower extremities and evident ascites. Paracentesis confirmed peritoneal infiltration of ascitic fluid secondary to the angiosarcoma. She died 2 weeks later from kidney failure.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Angiosarcoma, or malignant angioendothelioma, is an uncommon tumor of endothelial cells that accounts for only 2% of all sarcomas.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> It is an aggressive tumor with a 5-year survival rate of 50% to 60%.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Mean survival after diagnosis ranges from 18 to 28 months.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Three types of angiosarcoma are traditionally described. The first is idiopathic cutaneous angiosarcoma, which appears on the head and scalp of older patients.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> The second and third are angiosarcoma secondary to chronic lymphedema (Stewart-Treves syndrome) and a type that appears in skin exposed to radiotherapy. This tumor generally presents as a lesion that resembles bruising, with erythematous-violaceous nodules. The various types of angiosarcoma have similar histologic features. They are poorly defined tumors that trace irregular paths across large networks of dilated vascular channels, infiltrating dermal and subcutaneous layers. Tumor cells have large, hyperchromatic, pleomorphic nuclei and show a high degree of mitotic activity. CD31 positivity is the most sensitive immunohistochemical finding for establishing a diagnosis. Factor VIII and CD34 are secondary markers.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> The pathogenesis of these tumors is not clearly defined. Some have suggested that elevated serum concentrations of vascular endothelial growth factor or angiopoietin 2, or a decrease in cadherins in the vascular endothelium, may play a role.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> c-Myc amplification has also been detected in angiosarcomas secondary to radiotherapy or lymphedema.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,7</span></a> The role of drug-induced immunosuppression in the development of these tumors is unclear. Treatment requires surgical excision and radiotherapy. No evidence yet suggests that chemotherapy improves the prognosis, but chemotherapy with anthracyclines and taxanes would be the first line of treatment when the disease has metastasized. Twenty cases of angiosarcoma have been described to date in kidney transplant recipients on immunosuppressants. The tumor usually appears in an arteriovenous fistula. Only 5 other cutaneous angiosarcomas have been reported.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,8–10</span></a> The case we describe is highly unusual, similar only to one reported in 2011, in which an abdominal angiosarcoma appeared 8 years after a kidney transplant in an immunosuppressed patient.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Our patient's tumor did not follow the traditional etiological pattern for this type of tumor. Although she had had a mastectomy, she had never undergone radiotherapy. Moreover, lymphedema was absent from the tumor site. The etiology of angiosarcomas in kidney transplanted patients on long-standing immunosuppressant therapy remains unclear, given the few known cases described. Impaired immune vigilance seems to be implicated, but further study is needed to establish the precise relationship between immunosuppression, kidney transplantation, and this rare tumor.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín P, Pulpillo A, Cabrera R, Conejo-Mir J. Angiosarcoma de pared abdominal en paciente con inmunosupresión farmacológica por trasplante renal. Actas Dermosifiliogr. 2016;107:162–163.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 723 "Ancho" => 1000 "Tamanyo" => 119052 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large bruise-like reddish-purple plaque covering nearly the entire lower half of the abdomen.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 749 "Ancho" => 1000 "Tamanyo" => 228838 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Anomalous proliferation of blood vessels forming structures that resemble channels (hematoxylin-eosin, original magnification<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>200).</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 752 "Ancho" => 1000 "Tamanyo" => 147030 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Positivity for CD31 markers in tumor cells (CD31, original magnification <span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Angiosarcoma" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.J. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 3 | 6 | 9 |
| 2024 Octubre | 66 | 42 | 108 |
| 2024 Septiembre | 67 | 17 | 84 |
| 2024 Agosto | 82 | 52 | 134 |
| 2024 Julio | 66 | 41 | 107 |
| 2024 Junio | 75 | 23 | 98 |
| 2024 Mayo | 69 | 32 | 101 |
| 2024 Abril | 75 | 17 | 92 |
| 2024 Marzo | 71 | 26 | 97 |
| 2024 Febrero | 56 | 28 | 84 |
| 2024 Enero | 44 | 30 | 74 |
| 2023 Diciembre | 63 | 19 | 82 |
| 2023 Noviembre | 77 | 32 | 109 |
| 2023 Octubre | 79 | 13 | 92 |
| 2023 Septiembre | 82 | 27 | 109 |
| 2023 Agosto | 38 | 18 | 56 |
| 2023 Julio | 43 | 39 | 82 |
| 2023 Junio | 58 | 23 | 81 |
| 2023 Mayo | 49 | 23 | 72 |
| 2023 Abril | 45 | 28 | 73 |
| 2023 Marzo | 51 | 20 | 71 |
| 2023 Febrero | 47 | 17 | 64 |
| 2023 Enero | 33 | 32 | 65 |
| 2022 Diciembre | 35 | 46 | 81 |
| 2022 Noviembre | 19 | 22 | 41 |
| 2022 Octubre | 22 | 23 | 45 |
| 2022 Septiembre | 21 | 31 | 52 |
| 2022 Agosto | 24 | 58 | 82 |
| 2022 Julio | 24 | 63 | 87 |
| 2022 Junio | 12 | 21 | 33 |
| 2022 Mayo | 33 | 44 | 77 |
| 2022 Abril | 32 | 21 | 53 |
| 2022 Marzo | 33 | 48 | 81 |
| 2022 Febrero | 27 | 17 | 44 |
| 2022 Enero | 28 | 29 | 57 |
| 2021 Diciembre | 32 | 30 | 62 |
| 2021 Noviembre | 33 | 37 | 70 |
| 2021 Octubre | 48 | 42 | 90 |
| 2021 Septiembre | 38 | 38 | 76 |
| 2021 Agosto | 25 | 27 | 52 |
| 2021 Julio | 27 | 27 | 54 |
| 2021 Junio | 36 | 29 | 65 |
| 2021 Mayo | 30 | 26 | 56 |
| 2021 Abril | 79 | 59 | 138 |
| 2021 Marzo | 60 | 40 | 100 |
| 2021 Febrero | 57 | 29 | 86 |
| 2021 Enero | 27 | 22 | 49 |
| 2020 Diciembre | 31 | 18 | 49 |
| 2020 Noviembre | 25 | 29 | 54 |
| 2020 Octubre | 36 | 16 | 52 |
| 2020 Septiembre | 39 | 8 | 47 |
| 2020 Agosto | 23 | 25 | 48 |
| 2020 Julio | 19 | 14 | 33 |
| 2020 Junio | 34 | 26 | 60 |
| 2020 Mayo | 23 | 18 | 41 |
| 2020 Abril | 31 | 19 | 50 |
| 2020 Marzo | 33 | 16 | 49 |
| 2020 Febrero | 4 | 0 | 4 |
| 2020 Enero | 0 | 1 | 1 |
| 2019 Diciembre | 4 | 3 | 7 |
| 2019 Septiembre | 1 | 0 | 1 |
| 2019 Agosto | 2 | 0 | 2 |
| 2019 Julio | 4 | 0 | 4 |
| 2019 Junio | 0 | 10 | 10 |
| 2019 Mayo | 4 | 3 | 7 |
| 2019 Abril | 0 | 2 | 2 |
| 2019 Marzo | 0 | 3 | 3 |
| 2019 Febrero | 4 | 0 | 4 |
| 2018 Diciembre | 1 | 0 | 1 |
| 2018 Noviembre | 5 | 0 | 5 |
| 2018 Octubre | 5 | 0 | 5 |
| 2018 Septiembre | 5 | 0 | 5 |
| 2018 Abril | 0 | 1 | 1 |
| 2018 Marzo | 2 | 1 | 3 |
| 2018 Febrero | 18 | 5 | 23 |
| 2018 Enero | 24 | 9 | 33 |
| 2017 Diciembre | 28 | 7 | 35 |
| 2017 Noviembre | 26 | 5 | 31 |
| 2017 Octubre | 14 | 9 | 23 |
| 2017 Septiembre | 26 | 12 | 38 |
| 2017 Agosto | 26 | 15 | 41 |
| 2017 Julio | 19 | 7 | 26 |
| 2017 Junio | 24 | 11 | 35 |
| 2017 Mayo | 27 | 10 | 37 |
| 2017 Abril | 17 | 12 | 29 |
| 2017 Marzo | 12 | 30 | 42 |
| 2017 Febrero | 16 | 8 | 24 |
| 2017 Enero | 13 | 6 | 19 |
| 2016 Diciembre | 20 | 13 | 33 |
| 2016 Noviembre | 17 | 14 | 31 |
| 2016 Octubre | 27 | 19 | 46 |
| 2016 Julio | 1 | 1 | 2 |
| 2016 Junio | 0 | 3 | 3 |
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