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A 32-year-old healthy man developed a small pericardial effusion following a motor vehicle accident, which progressed to cardiac tamponade and bilateral pleural effusions over 2 months. Pericardiocentesis drained 1.5 L of hemorrhagic, lymphocyte-predominant exudative fluid, leading to symptomatic improvement and close outpatient follow-up for suspected postcardiac injury syndrome. However, he was readmitted 1.5 months later with recurrent effusions, mediastinal lymphadenopathy, and enlarging hepatic lesions, but without elevated inflammatory markers. Extensive analyses of various fluids, including expert-reviewed cytology and immunostaining, were inconclusive. Despite conservative management, worsening respiratory failure and persistent high chest tube output necessitated venovenous extracorporeal membrane oxygenation. Suspected constrictive pericarditis on transthoracic echocardiography led to the patient's transfer to our quaternary-care hospital for evaluation for pericardiectomy. However, pericardiectomy was deferred due to his unstable respiratory status. Despite intensive care, he eventually died of multiorgan failure 7 months after his initial presentation. Autopsy revealed high-grade hepatic angiosarcoma metastatic to lungs and pericardium with diffuse invasion into the myocardium. This case highlights the importance of cautious interpretation of negative cytology results in patients with recurrent hemorrhagic pericardial effusion, especially without elevated inflammatory markers. When clinical exclusion of pericardial malignancy is challenging, early multidisciplinary consideration of pericardial biopsy may be considered to enhance the diagnostic yield and guide management.

Angiosarcomas (ASs) are a heterogeneous subtype of soft tissue sarcomas. They can be subdivided into primary and secondary AS, with secondary AS being predominant, particularly those following radiotherapy. The aim of this study was first to analyze our patient cohort on a descriptive level and then to identify possible risk factors with regard to one and 5-year survival using logistic regression. The study was designed as a retrospective, single-center cohort study. All patients with histologically confirmed AS over 18 years of age were included in the study. Binary logistic regression was used for univariate analysis screening of continuous or dichotomous variables, respectively. For multivariate analysis, binary multivariate logistic regression was performed to assess independent associations between chosen variables and AS. A total of 39 patients were included in this study. 14 (35.9%) had primary and 25 (64%) had secondary AS. Women were more frequently affected (76.9%) than men (23.1%). The 1-year survival rate was 87.2%, and the 5-year survival rate was 51.3%. In the logistic regression analyses, nicotine consumption and a history of carcinoma were identified as significant factors influencing the 1-year survival rate. For the 5-year survival rate, only breast cancer was found to be a significant influencing factor in the univariate analysis. Based on univariate logistic regression, all variables with a value of < 0.1 were chosen to be included into multivariate analysis. The multivariate analysis showed diabetes mellitus ( =0.067) with an association to influence the 5-year survival rate. We were able to show that the proportion of secondary ASs is predominant. These occur after radiation treatment of the breast. Diabetes mellitus may be associated with reduced 5-year survival, although this finding did not reach statistical significance and requires further investigation. Due to its small sample size, this study should be regarded more as hypothesis-generating.

Angiosarcoma (AS) is a rare disease with a dismal prognosis. The treatment landscape and prognostic factors for advanced AS, including locally advanced, unresectable, and metastatic disease remain elusive. The Asian Sarcoma Consortium is an international collaborative effort to understand the sarcoma treatment landscape in Asia. We undertook a retrospective chart review of AS patients seen in 8 sarcoma academic centers across Asia. Patients with complete clinical, treatment, and follow‐up data were enrolled. Overall, 276 advanced AS patients were included into this study; 84 (30%) of the patients had metachronous metastatic AS. The median age was 67 y; primary sites of AS was cutaneous in 55% and visceral in 45% of patients. In total, 143 (52%) patients received at least 1 line of systemic chemotherapy. The most common first‐line chemotherapy regimen used was paclitaxel (47.6%) followed by liposomal doxorubicin (19.6%). The median overall survival (OS) was 7.8 mo. Significant prognostic factors for OS included age > 65 (hazard ratio (HR) 1.54, P = .006), male gender (HR 1.39, P = .02), and a cutaneous primary AS site (HR 0.63, P = .004). The median progression‐free survival (PFS) for first‐line chemotherapy was 3.4 mo. PFS for single vs combination or paclitaxel vs liposomal doxorubicin chemotherapy regimens were comparable. This study provides an insight into the treatment patterns and prognostic factors of advanced AS patients in Asia. Prognosis of advanced AS remains poor. Data from this study serve as a benchmark for future clinical study design. With a total of 276 advanced angiosarcoma patients, we provided the complete clinicopathological demographics, treatment patterns, and prognostic outcomes of advanced angiosarcoma in Asia.

Brain metastases (BM) represent an unmet medical need in human medicine, and they are poorly documented in dogs. The aim of this multi‐centre retrospective study was to report the clinical characteristics, primary solid cancer histology, advanced imaging findings, treatment modalities and potential prognostic factors in dogs with presumed BM that occurred either at the time of initial diagnosis or during follow‐up. BM diagnosis was established through either imaging studies or histologic examination of specimens obtained during necropsy. A total of 58 client‐owned dogs with histologically proven solid cancer and BM were included. Clinicopathologic variables, BM characteristics based on imaging and survival post‐BM (SPBM) were recorded. Haemangiosarcoma (53.4%) and carcinoma (27.6%) were the most common primary tumour histotypes, followed by melanoma (12.1%) and undifferentiated sarcoma (6.9%). Synchronous BM and solitary BM occurred in 63.8% and 51.7% of dogs, respectively. The prosencephalus was most commonly affected, with 79% of dogs showing neurologic deficits. Antitumoural or palliative treatment was attempted in a minority of dogs, with no improved outcome. The median SPBM was 3 days (range, 1–255). The 3‐ and 6‐month survival rates were 8.6% and 1.7%, respectively. Dogs with haemangiosarcoma (OR: 7.6; 95% CI, 2.2–25.8; p = 0.001) and those with distant metastases at presentation (OR: 16; 95% CI, 4.2–60.9; p < 0.001) had an increased likelihood of developing synchronous BM. Haemangiosarcoma and carcinoma were the tumours most frequently associated with BM, which were more commonly synchronous and symptomatic, with a high incidence of forebrain localization. The prognosis was poor, regardless of the primary cancer type. Brain metastases (BM) are poorly documented in dogs. The aim of this study was to report the clinical characteristics, primary solid cancer histology, advanced imaging findings, treatment modalities and potential prognostic factors in dogs with BM. A total of 58 dogs with histologically proven solid cancer and BM were included. Haemangiosarcoma and carcinoma were the tumours most frequently associated with BM, which were more commonly synchronous and symptomatic, with a high incidence of forebrain localization. The prognosis was poor, regardless of the primary cancer type.

BackgroundAngiosarcomas are tumors of malignant endothelial origin that have a poor prognosis with a five-year survival of less than 40%. These tumors can be found in all age groups, but are more common in older patients; with the cutaneous form most common in older white men. Combined modality therapy including surgery and radiation appears to have a better outcome than each modality alone. When metastatic, agents such as liposomal doxorubicin, paclitaxel and ifosfamide have activity but it is short-lived and not curative. Immunotherapy targeting either the PD-1 receptor or PD-L1 ligand has recently been shown to have activity in multiple cancers including melanoma, renal, and non-small lung cancer. Although these agents have been used in sarcoma therapy, their ability to treat angiosarcoma has not been reported.Case presentationHere we describe the case of a 63-year-old man who presented initially with angiosarcoma of the nose and received surgery for the primary. Over 4 years he had recurrent disease in the face and liver and was treated with nab-paclitaxel, surgery, and radioembolization, but continued to have progressive disease. His tumor was found to express PD-L1 and he received off-label pembrolizumab 2 mg/kg every 21 days for 13 cycles with marked shrinkage of his liver disease and no new facial lesions. Secondary to this therapy he developed hepatitis and has been treated with decreasing doses of prednisone. During the 8 months off therapy he has developed no new or progressive lesions.ConclusionsAlthough occasional responses to immunotherapy have been reported for sarcomas, this case report demonstrates that angiosarcoma can express PD-L1 and have a sustained response to PD-1 directed therapy.

Cutaneous angiosarcomas of the scalp are rare and aggressive tumors with non-specific appearances. They rarely affect the retroauricular region, and diagnoses are often difficult and delayed. We present the case of an 87-year-old patient referred for a large, spontaneously appearing, and rapidly progressing retroauricular bruise while on anticoagulants. Initial biopsies were negative, and the cervico-facial computed tomography (CT) scan with contrast injection was inconclusive. Despite stopping the anticoagulants, the lesion persisted and extended, leading to new biopsies that revealed a high-grade cutaneous angiosarcoma. Positron emission tomography-computed tomography (PET-CT) detected homolateral supraclavicular lymph node involvement and pleuropulmonary metastases. Given the patient's deteriorating general condition and the metastatic spread of the disease, exclusive comfort care was decided. With a highly variable clinical presentation, the diagnosis of cutaneous angiosarcoma is often delayed and made at a metastatic stage. Optimal treatment remains complete surgical excision followed by radiotherapy, but this is challenging in very extensive tumors.

Positron Emission Tomography-Computed Tomography (PET-CT) is routinely used for staging and monitoring of human cancer patients and is becoming increasingly available in veterinary medicine. In this study, 18-fluorodeoxyglucose (18FDG)-PET-CT was used in dogs with naturally occurring splenic hemangiosarcoma (HSA) to assess its utility as a staging and monitoring modality as compared to standard radiography and ultrasonography. Nine dogs with stage-2 HSA underwent 18FDG-PET-CT following splenectomy and prior to commencement of chemotherapy. Routine staging (thoracic radiography and abdominal ultrasonography) was performed prior to 18FDG-PET-CT in all dogs. When abnormalities not identified on routine tests were noted on 18FDG-PET-CT, owners were given the option to repeat a PET-CT following treatment with eBAT. A PET-CT scan was repeated on Day 21 in three dogs. Abnormalities not observed on conventional staging tools, and most consistent with malignant disease based on location, appearance, and outcome, were detected in two dogs and included a right atrial mass and a hepatic nodule, respectively. These lesions were larger and had higher metabolic activity on the second scans. 18FDG-PET-CT has potential to provide important prognostic information and influence treatment recommendations for dogs with stage-2 HSA. Additional studies will be needed to precisely define the value of this imaging tool for staging and therapy monitoring in dogs with this and other cancers.

Introduction Angiosarcoma is a rare and aggressive malignancy accounting for 1–2% of soft tissue sarcomas. Primary adrenal angiosarcomas are exceptionally rare, with fewer than 60 cases reported.To our knowledge, this is the first documented case of an adrenal angiosarcoma presenting as a colonic metastasis. Case report A 68-year-old Caucasian North African woman with a history of adrenalectomy for a right adrenal tumor presented with gastrointestinal bleeding, and endoscopy revealed a hemorrhagic ulcerative lesion in the sigmoid colon. Histopathological examination revealed a malignant vascular tumor. Immunohistochemistry showed positivity for CD31, erythroblastosis virus E26 transforming sequence related gene, and pan-cytokeratin, consistent with angiosarcoma. In light of her history, a review of the adrenalectomy specimen confirmed the diagnosis of primary adrenal angiosarcoma. Conclusion This case underscores the necessity of thorough pathological evaluation, use of vascular markers, and interdisciplinary collaboration to improve diagnosis and management.

Abstract Background This study investigates the frequency, location, and clinical findings associated with 177 secondary brain tumors in dogs. Hypothesis Secondary intracranial neoplasia is more common than primary intracranial neoplasia in dogs during the time period studied, and hemangiosarcoma (HSA) is the most common secondary intracranial tumor. Animals One hundred and seventy-seven client-owned dogs presented to the Matthew J. Ryan Veterinary Hospital between 1986 and 2003. Methods Medical records were searched for a diagnosis of intracranial neoplasia in dogs who underwent complete postmortem examination. Of these dogs, those with a diagnosis of primary intracranial neoplasia were excluded. Results Of the 177 secondary brain tumors, 51 (29%) were HSAs, 44 (25%) were pituitary tumors, 21 (12%) were lymphosarcomas, and 21 (12%) were metastatic carcinomas. The average age at diagnosis was 9.6 ± 3.0 years. Most tumors were located in the cerebrum, and a mentation change was the most common presenting clinical sign. On postmortem examination, the same tumor that was in the brain was also present in the lung in 84 cases (47%), in the kidney in 62 cases (35%), and in the heart in 55 cases (31%). Conclusions and Clinical Importance Secondary intracranial neoplasia in dogs was more common than primary intracranial neoplasia during the time period studied. Many of these dogs had related disease in other body systems that was apparent on diagnostic tests such as thoracic radiography.