University of South Florida Bayamon, PR, United States
Fabiola Rios de Choudens, MD1, Jonathan Hilal, MD2, David Metter, MD3, Carolina Martinez, MD4 1University of South Florida, Bayamon, Puerto Rico; 2University of South Florida Morsani College of Medicine, Tampa, FL; 3Tampa General Hospital / Ruffolo, Hooper & Associates / University of South Florida, Tampa, FL; 4University of South Florida, Tampa, FL
Introduction: Primary gastrointestinal angiosarcomas are extremely rare aggressive tumors arising from endothelial cells of vascular or lymphatic origin. Very few cases are documented in the literature, most involving the stomach or small bowel. Here we present a unique case of a primary colonic epithelioid angiosarcoma.
Case Description/Methods: A 60-year-old man presented to our hospital with recurrent hematochezia and symptomatic anemia. Eight months prior, he had undergone a screening colonoscopy with removal of a large 22mm sessile polyp in the transverse colon, pathology for that polyp was unavailable to us. Post procedure, the patient developed intermittent hematochezia. There was delay in his care due to the COVID-19 pandemic, but 7 months after his initial colonoscopy he underwent a repeat colonoscopy with finding of a bleeding post polypectomy site. The region was tattooed, and site cauterized however bleeding recurred. Twenty days later, due to recurrent hematochezia and anemia he was admitted to our facility. CT abdomen showed eccentric colonic wall thickening of the distal transverse colon with adjacent mesenteric nodules concerning for a neoplasm. A colonoscopy was repeated showing an ulcerated oozing lesion opposite to the tattooed region, the area was biopsied with pathology showing only ulcerated colonic tissue but no malignancy. Two clips were applied endoscopically for hemostasis however bleeding recurred two days later, and he was taken to surgery for laparoscopic transverse colectomy. Gross pathology showed epithelioid angiosarcoma with submucosal extension but clean margins and no lymphovascular invasion- pathologic stage of the tumor was pT2pN0Mx. Staging imaging including CT thorax and PET CT showed no evidence of metastatic disease therefore this was diagnosed as a primary colonic epithelioid angiosarcoma. There are no current plans for adjuvant chemotherapy for our particular patient as repeat CT and colonoscopy 6 months after surgical resection show no evidence of recurrence of malignancy.
Discussion: Angiosarcomas as a subtype of soft tissue sarcomas account for less than 1% of all soft tissue sarcomas. Colorectal angiosarcomas constitute less than o.oo1% of all colorectal cancers. Survival rate for intestinal angiosarcoma are usually very poor and most cases progress rapidly. Most of the data in literature is collected from case reports. Radical surgery with complete resection is the treatment of choice. The benefit of adjuvant chemotherapy is unclear and data seems to be limited.
Figure: Figure 1: a-b, Endoscopic appearance of transverse colon lesion. c-d, Pathology of gross specimen consistent with epithelioid angiosarcoma.
Fabiola Rios de Choudens indicated no relevant financial relationships.
Jonathan Hilal indicated no relevant financial relationships.
David Metter indicated no relevant financial relationships.
Carolina Martinez indicated no relevant financial relationships.
Fabiola Rios de Choudens, MD1, Jonathan Hilal, MD2, David Metter, MD3, Carolina Martinez, MD4. P1254 - Post Polypectomy Bleeding Gone Wrong; A Rare Case of Primary Colonic Epithelioid Angiosarcoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.