Management of intracranial angiosarcoma metastasis to the right lateral ventricle choroid plexus by radiotherapy: A case report

Abstract

Angiosarcomas are a type of rare malignant endothelial tumor. While its most common metastasis site is the scalp, cerebral metastases are rare. A 46-year-old woman came with a headache. A cranial magnetic resonance imaging (MRI) showed a hemorrhagic lesion within the right lateral choroid plexus and T1 contrast-enhancing lesions in the falx cerebri and right frontal dura. We used mini-craniotomy and neuronavigation to remove a purple-colored extradural lesion in the right frontal region. Histopathological analysis later confirmed the diagnosis of angiosarcoma. Cardiac MRI demonstrated the presence of a left atrial mass, which led to the decision to operate on the patient by the cardiovascular surgery team. After the surgery, the patient underwent radiotherapy and chemotherapy, as there was no cranial metastasis necessitating surgical resection. The cranial metastases responded to the treatment on follow-up, and there was no evidence of recurrence on the three-year follow-up. Although they are uncommon, pathology that indicates the presence of angiosarcoma requires cardiac screening. These patients may not require aggressive surgery as they respond well to adjuvant therapies.

Keywords

• angiosarcoma
• metastasis
• radiotherapy
• case report

References

1. Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ. Angiosarcoma. Lancet Oncol. 2010 Oct;11(10):983–91.
2. Jung S-H, Jung T-Y, Joo S-P, Kim H-S. Rapid clinical course of cerebral metastatic angiosarcoma from the heart. J Korean Neurosurg Soc. 2012 Jan 31;51(1):47–50.
3. Drosos E, Kalyvas A, Komaitis S, Skandalakis GP, Kalamatianos T, Liouta E, et al. Angiosarcoma-related cerebral metastases: a systematic review of the literature. Neurosurg Rev. 2020 Aug;43(4):1019–38.
4. Schlemmer M, Reichardt P, Verweij J, Hartmann JT, Judson I, Thyss A, et al. Paclitaxel in patients with advanced angiosarcomas of soft tissue: a retrospective study of the EORTC soft tissue and bone sarcoma group. Eur J Cancer. 2008 Nov;44(16):2433–6.
5. Ravi V, Subramaniam A, Zheng J, Amini B, Trinh VA, Joseph J, et al. Clinical activity of checkpoint inhibitors in angiosarcoma: A retrospective cohort study. Cancer. 2022 Sep 15;128(18):3383–91.
6. Florou V, Rosenberg AE, Wieder E, Komanduri KV, Kolonias D, Uduman M, et al. Angiosarcoma patients treated with immune checkpoint inhibitors: a case series of seven patients from a single institution. J Immunother Cancer. 2019 Aug 8;7(1):213.