Spyridon Zouridis, MD, Umer Ejaz Malik, MD, Stephen Hasak, MD Albany Medical Center, Albany, NY
Introduction: GI bleeds are frequent causes of hospitalization. Small bowel malignancies are uncommon causes of these bleeds. Primary angiosarcomas of small intestine are extremely rare and are often associated with poor outcomes. We present a case of small intestine angiosarcoma diagnosed during GI work up for anemia of unclear origin.
Case Description/Methods: An 80-year-old male with PMH of hypertension, CAD and obesity was referred to our hospital by his PCP for evaluation of severe anemia. Patient reported having chronic fatigue, dyspnea on exertion and limitation of his activities in the preceding months. Physical exam was unremarkable other than conjunctival pallor. Lab work showed normocytic anemia. Patient received a blood transfusion for correction of anemia. Gastroenterology service was consulted to rule out occult GI losses as the cause of his anemia. An EGD was performed which revealed multiple duodenal nodular plaques with oozing. Biopsies were collected and APC was performed (Fig. 1-2). Biopsy revealed focal cluster of highly atypical cells in lamina propria and fragments of adenoma (low grade dysplasia). Definite diagnosis was not established from these biopsies. He then required three further admissions with episodes of recurrent GI bleeds and anemia. Repeat EGD with an EUS was performed. EGD showed a non-bleeding infiltrative mass in duodenal bulb along with nodular mucosa. Biopsies were collected. EUS showed a hypoechoic mass in duodenal bulb measuring 16 x 6 mm extending to submucosa (SM) with poorly defined borders. A localized wall thickening was also found in 2nd and 3rd portion of duodenum, primarily in SM measuring 5 mm. (Fig. 3) Biopsies identified epithelioid angiosarcoma (tubular adenoma with vascular proliferation). Oncology referral was made as outpatient. Unfortunately, patient was found to have metastatic disease on workup and even though chemotherapy was offered patient passed away a few months later.
Discussion: Epithelioid angiosarcomas are highly aggressive mesenchymal sarcomas of endothelial cell origin, primarily occurring in 7th decade of life. Occurrence in small intestine is exceedingly rare. Presenting symptoms are usually nonspecific leading to a delay in diagnosis. Median survival time is usually 150 days. Treatment options may include surgery and/or chemotherapy, however these malignancies, by demonstrating early nodal and solid organ metastasis, are usually fatal within 2-3 years after diagnosis.
Figure: Figure 1: Duodenal bulb Figure 2: 2nd portion of duodenum Figure 3: Duodenal bulb mass (2nd EGD)
Disclosures: Spyridon Zouridis indicated no relevant financial relationships. Umer Ejaz Malik indicated no relevant financial relationships. Stephen Hasak indicated no relevant financial relationships.
Spyridon Zouridis, MD, Umer Ejaz Malik, MD, Stephen Hasak, MD. P1992 - Epithelioid Angiosarcoma Presenting as Gastrointestinal Bleeding, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.