Rowan University School of Osteopathic Medicine, Jefferson Health NJ Voorhees Township, NJ, United States
Neethi R. Dasu, DO1, Yaser Khalid, DO2, Timsal Ghani, DO3, Zainab Shahid, DO3, Lucy Joo, DO4 1Rowan University School of Osteopathic Medicine, Jefferson Health NJ, Voorhees Township, NJ; 2Wright Center for Graduate Medical Education, Davie, FL; 3Rowan University School of Osteopathic Medicine, Stratford, NJ; 4Thomas Jefferson University Hospital, Cherry HIll, NJ
Introduction: Epithelioid Angiosarcoma (EA) is a rare endothelial cell malignancy and accounts for less than 2% of all Angiosarcomas. EA is the least common subtype and is characterized as a high-grade malignancy. EA involvement of the GI tract is unusual with very few cases published in the literature.
Case Description/Methods: A 76-year-old male presented for evaluation of anemia found on outpatient lab work. He also had associated weight loss, diminished oral intake, an episode of bright red blood in his stool as well a change in bowel habits. His past medical history was significant for hypertension, hyperlipidemia, aortic-femoral bypass with graft, and a right-sided nephrectomy. He had no family history significant for GI cancer. He did have a long-term history of tobacco use. On arrival: his vitals were normal, hemoglobin was noted to be 9.2 with normocytic indices. Physical examination revealed a firm, distended abdomen with an erythematous rash on the left side. CT Angiogram showed an infrarenal abdominal aortic aneurysm with an endoluminal stent-graft in place, a small number of abdominal ascites, and soft tissue infiltration of the omentum which was concerning for peritoneal metastatic disease from an occult primary malignancy. He underwent Esophagogastroduodenoscopy (EGD) and Colonoscopy which revealed a mass in the duodenal bulb and a 5cm mass in the sigmoid colon. Pathology of the duodenal mass revealed gastric heterotopia while the sigmoid mass was consistent with epithelioid angiosarcoma. The patient was referred to Oncology who recommended chemotherapy with Paclitaxel, but the patient chose to pursue holistic treatment modalities.
Discussion: Epithelioid angiosarcomas (EA) originate from mesenchymal tissue and are extremely rare soft tissue neoplasms. These tumors portend a poor prognosis because they are painless, slow-growing, and metastasize early. These malignancies usually show a preference for the distal upper extremities and thus there are very few cases of colorectal angiosarcoma that have been reported. A biopsy is required to diagnose these tumors which can be positive for epithelial markers such as AE1/AE3, CK7, and CD34 and CK8/18. Treatment for EA varies and options include radiation therapy, surgery, lymphadenectomy, and Neoadjuvant and Adjuvant Chemotherapy. This case highlights an extremely rare and peculiar cause of anemia and showcases the importance of early colonoscopy evaluation and tobacco cessation, as a delay in diagnosis leads to extremely poor outcomes.
Disclosures: Neethi Dasu indicated no relevant financial relationships. Yaser Khalid indicated no relevant financial relationships. Timsal Ghani indicated no relevant financial relationships. Zainab Shahid indicated no relevant financial relationships. Lucy Joo indicated no relevant financial relationships.
Neethi R. Dasu, DO1, Yaser Khalid, DO2, Timsal Ghani, DO3, Zainab Shahid, DO3, Lucy Joo, DO4. P1246 - A Peculiar Cause of Anemia: Epithelioid Angiosarcoma, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.