Paciente de 82 aos que consulta en

febrero de 2015 por dolor lumbar crnico,

gonalgia izquierda y deambulacin limitada
por dolor en EI izq.
AP importantes de cncer de mama izq en
marzo 2005 tratado con mastectoma +QT.
Primero se le realiza una RX

Angiosarcoma

Generalidades
Tumor agresivo que se origina en estructuras
vasculares.
>
Edad: 20-70 aos
Localizaciones:
Piel 33%
Partes blandas 24 %
Hueso 6% - huesos largos 60%

La mayora solitarios (33% son multifocales)

Mal pronstico (66% presentan M1
pulmonares y otros rganos)

Rx simple
Lesiones predominantemente lticas,
destructivas.
No margen esclertico.
Zona amplia de transicin
Puede haber insuflacin sea, si bajo
grado.
Rotura de la cortical y masa de
partes blandas si es de alto grado.

AP radiograph in the same case shows a femoral lesion with a fairly wide zone of transition & thinning of the endosteal cortex (white
solid arrow). Like the rib lesion, this appears moderately aggressive. These 2 lesions should prompt consideration of metastasis or
multiple myeloma, though the patient is only in their 30s.

AP radiograph shows multiple lytic lesions involving various bones of the midfoot (white solid arrow). The lesions appear permeative,
without sclerotic margin. Joint spaces remain normal, ruling out arthritic or septic process. The pattern might suggest disuse
osteoporosis, but metatarsals show normal density.

Lateral radiograph shows honeycomb pattern (white solid arrow). Multiple lesions, especially when in contiguous bones and in the
lower extremity, should prompt consideration of angiosarcoma, proven in this case.

TC
Hallazgos similares a Rx.
Varios grados de agresividad.
Sospechar tumor seo de estirpe vascular
cuando:
- Afectacin multifocal de una nica regin
anatmica.
- Predomina en extremidades inferiores.
- Difcil diferenciar entre: angiosarcoma,
hemangioendotelioma y hemagiopericitoma los 3
presentan multifocalidad.
El angiosarcoma puede ser el ms agresivo.
*

AP radiograph shows a "naked" sacroiliac joint. Note the clearly visible right sacroiliac joint (white solid arrow). This indicates that
the posterior iliac wing is missing. The posterior iliac wing is easily seen superimposed over the SI joint on the normal left side (white
curved arrow). This naked SI joint is an important diagnostic finding, indicating a large posterior destructive iliac lesion, but can be

Axial NECT confirms destruction of the posterior iliac wing (white solid arrow) and adjacent sacral ala by proven angiosarcoma.

AP radiograph in the same case shows a much more aggressive iliac wing lesion, with a wide zone of transition, cortical
breakthrough, & pathologic fracture (white solid arrow).

Axial NECT in the same patient confirms destruction of the iliac wing with fragments of bone carried to the periphery (white open
arrow) and a large soft tissue mass (white solid arrow) making metastasis or myeloma unlikely. Vascular tumor such as this proven
angiosarcoma should also be considered. Polyostotic lesions tend to involve the lower extremities.

RM
T1: hipointenso
T2: hiperintenso, inhomognea
C+: captacin heterognea de
contrate: centro necrtico
hipointenso.
Puede tener vasos perifricos
prominentes.

Sagittal T1WI MR in the same case shows multiple focal lesions involving, to some extent, nearly every bone of the foot and ankle
(white solid arrow). The marrow replacement is seen as low signal intensity on these T1WIs. Polyostotic lesions, especially isolated to
the lower extremities, should lead to consideration of vascular osseous tumors. In this case, angiosarcoma was proven.

Diagnstico diferencial

Metstasis
Mieloma mltiple
Hemangioendotelioma
Hemangiopericitoma

Sndrome de Stewart-Treves
Linfangiosarcoma desarrollado sobre linfedema crnico, ms
frecuente secundario a mastectoma.
Se presenta en 0,45% en pacientes que sobreviven ms de 5 aos.
Intervalo entre tratamiento cncer y diagnstico: 11-21 aos
Aparicin de ndulos violceos sobre la piel edematoso del brazo
afectado.