Angiosarcoma at the site of a Dacron vascular prosthesis: A case report and literature review

doi:10.1016/0741-5214(91)90158-Q

Journal of Vascular Surgery

Volume 14, Issue 1, July 1991, Pages 87-91

https://doi.org/10.1016/0741-5214(91)90158-Q Get rights and content

Abstract

Four of 32 reported sarcomas related to the aorta have arisen around previously placed aortic vascular prostheses suggesting that the graft may have been an etiologic factor. Our recent experience with such an angiosarcoma arising around a Dacron aortic graft prompted a review of the lesion to identify risk factors, diagnostic approaches, and treatment options. The diagnosis of these sarcomas is seldom made before operation. Animal studies have implicated plastic polymers including Dacron as carcinogenic materials capable of inducing sarcoma in 7% to 50% of exposures. Because of the rarity of these tumors and the thousands of vascular implants used over the past 30 years, it is unlikely that this degree of risk can be extrapolated to humans. However, a tumor should be included in the differential diagnosis of any mass or thromboembolic event associated with a vascular prosthesis. (J VASC SURG 1991;14:87-91.)

Section snippets

Case report

A 56-year-old white man underwent an uneventful repair of an infrarenal aortic aneurysm on Feb. 7, 1986, with placement of a bifurcated woven double-velour Dacron graft.

In late August 1989 he began to complain of left lower quadrant and lower back pain with sciatica. In September after radiologic examination of the lumbar spine was nondiagnostic for degenerative disk disease, a differential diagnosis including diverticular disease and pseudoaneurysm led to CT scanning of the abdomen because his

Discussion

After the description of Voorhees et al.⁶ of arterial replacement using flexible tubes of synthetic “Vinyon N” in 1951, the next 5 years saw the investigation of Teflon, Dacron, and Orlon as potential arterial substitutes.⁷

While carrying out studies on hypertension in 1948, Oppenheimer et al.⁸ noted that rat kidneys wrapped in cellophane caused sarcomas. Further studies in murine species have shown that plastic films embedded subcutaneously can induce malignant mesenchymal tumors in 7% to 50%

References (13)

JW Fehrenbacher et al.
Angiosarcoma of the aorta associated with a Dacron graft
Ann Thorac Surg
(1981)
TX O'Connell et al.
Sarcoma associated with Dacron prosthetic material
J Thorac Cardiovasc Surg
(1976)
KG Brand et al.
Risk assessment of carcinogenesis at implantation sites
Plast Reconstr Surg
(1980)
DS Weinberg et al.
Primary sarcoma of the aorta associated with a vascular prosthesis. A case report
Cancer
(1980)
AW Burns et al.
Fibrosarcoma occurring at the site of a plastic vascular graft
Cancer
(1972)
AB Voorhees et al.
Use of tubes constructed from Vingon “N” cloth in bridging arterial defects
Ann Surg
(1952)

There are more references available in the full text version of this article.

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Angiosarcoma may rarely arise near an inert foreign body material including vascular grafts and metal joint prostheses. Sixteen such cases have been reported since 1972 but mostly in the radiologic or surgical literature without detailed histologic or molecular analyses. We herein describe the clinicopathologic and molecular features of 2 new cases and reanalyzed 3 previously reported cases of angiosarcoma that developed in association with Dacron grafts for vascular repair (n = 3) or related to orthopedic metal prostheses for joint replacement (n = 2). All patients were men aged 50 to 84 years (median, 71 years). Mean time to development of angiosarcoma was 9 years (range, 4.6-17 years). Symptoms were recurrent bleeding/loosening of prosthesis for suspected infection (in the joint prosthesis cases) and fatigue, weight loss, and abdominal symptoms in the Dacron-associated cases. Four patients died of disease within 1 to 24 months (mean, 8 months). One patient was alive after radical surgery, radiochemotherapy, and embolization of pulmonary metastases (17 months). Histologically, all tumors were high-grade epithelioid neoplasms with a predominant solid growth pattern and variable vasoformation. All tumors expressed CD31, ERG, FLI-1, and variably pancytokeratin (diffuse in 3 cases), but none expressed D2-40, MDM2, or CDK4. Fluorescence in situ hybridization analysis revealed no MDM2 or CDK4 alterations. MYC was expressed in all cases, but only 1 case was MYC amplified by fluorescence in situ hybridization. Angiosarcomas are exceedingly rare fatal complications of long-standing metal and Dacron prostheses. Awareness of their morphology and frequent cytokeratin expression is necessary to avoid misdiagnosis as metastatic carcinoma. Limited awareness of their existence explains delayed clinical diagnosis in most of cases. Absence of MDM2/CDK4 alterations underlines their distinction from intimal-type sarcomas.

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Case ReportsAngiosarcoma at the site of a Dacron vascular prosthesis: A case report and literature review*

Abstract

Section snippets

Case report

Discussion

Ann Thorac Surg

J Thorac Cardiovasc Surg

Risk assessment of carcinogenesis at implantation sites

Plast Reconstr Surg

Primary sarcoma of the aorta associated with a vascular prosthesis. A case report

Cancer

Fibrosarcoma occurring at the site of a plastic vascular graft

Cancer

Use of tubes constructed from Vingon “N” cloth in bridging arterial defects

Ann Surg

Case Reports
Angiosarcoma at the site of a Dacron vascular prosthesis: A case report and literature review*