Local treatment with electrochemotherapy of superficial angiosarcomas: Efficacy and safety results from a multi-institutional retrospective study

Background: Angiosarcoma is an aggressive vascular neoplasm with a high propensity for local recurrence. Electrochemotherapy is an emerging skin-directed therapy, exerting prominent cytotoxic activity, and antivascular effects. Its efficacy in angiosarcoma has not been investigated. Methods: This multicenter retrospective analysis reviewed patients who underwent electrochemotherapy from 2007 to 2014 for superficial advanced angiosarcomas. Bleomycin was administered intravenously and delivered within tumors by means of percutaneously applied electric pulses, according to the European Standard Operating Procedures for Electrochemotherapy. Tumor assessment was performed using RECIST (version 1.1). Toxicity (CTCAE, v4.0) and local progression-free survival (LPFS) were also evaluated. Results: Nineteen patients (13 with locally advanced and 6 with metastatic angiosarcomas) were treated. Tumor sites were: scalp (n¼5), breast(n¼8), other skin sites (n¼3), and soft tissue (n¼3). Target lesions (n¼54) ranged in size from 1.5 to 2.5 cm (median, 2 cm). Treatment was well tolerated. After 2 months, an objective response was observed in 12/19 (63%) patients, complete in 8 (42%). One-year LPFS within treatment field was 68%. Local symptom improvement included palliation of bleeding (5/19 patients) and pain relief (6/19 patients). Conclusions: Electrochemotherapy may represent a new locoregional treatment for selected patients with superficial angiosarcomas

Cutaneous angiosarcoma of the leg

Angiosarcomas are malignant neoplasms arising from endothelial cells. Cutaneous angiosarcoma is the most common form, typically occurring in the setting of chronic lymphedema or previous radiation. The head and neck are the most common locations for cutaneous angiosarcoma, with rare occurrence on the trunk and extremities. Herein, we present a case of angiosarcoma on the lower extremity in an elderly man. This 71-year-old man presented with a two-year history of red-yellow discoloration of the left lower leg with subsequent development of black nodules over the past several months prior to presentation. He denied any itching, bleeding, or ulceration. Past medical history included diabetes, hypertension, and non-melanoma skin cancer. Physical examination showed erythematous, violaceous, non-blanchable papules with yellow atrophic regions and overlying black crusted nodules and plaques. Biopsies were taken and the patient was diagnosed with angiosarcoma and referred to a tertiary care center for further evaluation

A literature review on surgery for cervical vagal schwannomas

Cervical vagal schwannoma is a benign, slow-growing mass, often asymptomatic, with a very low lifetime risk of malignant transformation in general population, but diagnosis is still a challenge. Surgical resection is the treatment of choice even if its close relationship with nerve fibres, from which it arises, threats vagal nerve preservation. We present a case report and a systematic review of literature. All studies on surgical resection of cervical vagal schwannoma have been reviewed. Papers matching the inclusion criteria (topic on surgical removal of cervical vagal schwannoma, English language, full text available) were selected. Fifty-three patients with vagal neck schwannoma submitted to surgery were identified among 22 studies selected. Female/male ratio was 1.5 and median age 44 years. Median diameter was 5 cm (range 2 to 10). Most schwannoma were asymptomatic (68.2%) and received an intracapsular excision (64.9%). Postoperative symptoms were reported in 22.6% of patients. Cervical vagal schwannoma is a benign pathology requiring surgical excision, but frequently postoperative complications can affect patients lifelong, so, surgical indications should be based carefully on the balance between risks and benefits

Treatment of hepatic epithelioid hemangioendothelioma with liver transplantation

Ten patients received liver transplants for unresectable epithelioid hemangioendothelioma (EHE). At the time of transplantation, four patients had microscopic metastases to the hilar lymph nodes, and one of the four also had metastases to a rib. The fifth patient had metastases to the lung, pleura, and diaphragm. The remaining five patients were believed to be free of metastatic disease. Two of these five patients died of metastatic disease at 3 and 16 months, respectively, after transplantation. Interestingly, all five patients with metastatic involvement are currently alive 40.6 ± 22 months (mean ± standard error of mean [SEM]) after transplantation, although one of these patients currently has metastatic disease to the lungs and mediastinum. Thus, the projected 5‐year actuarial survival rate is 76%, with two patients at risk after the third year. In conclusion, liver transplantation is a reasonable procedure for bulky, otherwise unresectable, EHE even in the presence of metastatic disease. Copyright © 1988 American Cancer Societ

Liver Resection for Primary Hepatic Neoplasms.

Subtotal hepatic resection was performed in 356 patients; 87 had primary hepatic malignancies, 108 had metastatic tumors, and 161 had benign lesions including 8 traumatic injuries. The global mortality was 4.2%. The experience has elucidated the role of subtotal hepatic resection both for benign and malignant neoplasms

Angiosarcoma cutáneo idiopático : presentación de tres casos y revisión de la bibliografía

El angiosarcoma es un tumor vascular maligno, poco frecuente, que deriva de las células endoteliales. Se reconocen tres variantes clínicas: el angiosarcoma cutáneo idiopático o primario (forma más frecuente), el asociado a linfedema crónico y el angiosarcoma post-radioterapia. Presenta una clínica variable, con múltiples diagnósticos diferenciales, resultando esencial el estudio histopatológico y la inmunohistoquímica para arribar al diagnóstico de certeza. Se caracteriza por presentar un alto índice de recidiva local y un alto potencial metastásico, por lo que el tratamiento quirúrgico asociado a radioterapia regional resulta el tratamiento de elección. La quimioterapia y radioterapia se reservan para lesiones irresecables. Se presentan tres casos de angiosarcoma cutáneo idiopático, en pacientes con características epidemiológicas diferentes y se lleva a cabo una revisión bibliográfica.Angiosarcoma is a rare and aggressive malignant tumor of the vascular endothelial cells. Three clinical variants are recognized: idiopathic or primary cutaneous angiosarcoma (most common form), angiosarcoma associated with chronic lymphedema and post- radiotherapy angiosarcoma. It presents variable clinic, with multiple differential diagnosis, being essential histopathological study and immunohisto-chemistry to arrive at an accurate diagnosis. It is characterized by a high rate of local recurrence and a high metastatic potential. Surgical excision associated with regional radiotherapy is recommended treatment. Chemotherapy and radiation therapy are reserved for unresectable lesions. We present three cases of idiopathic cutaneous angiosarcoma in patients with different epidemiological characteristics, and a bibliographic review is performed.Fil: Fernández Tapia, María Jimena. Hospital Luis Lagomaggiore (Mendoza, Argentina). Servicio de DermatologíaFil: Merino, Avelina. Hospital Teodoro J. Schestakow (San Rafael, Mendoza). Servicio de Dermatología.Fil: Suarez Módica, Florencia. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Marabini, Noelia. Hospital Luis Lagomaggiore (Mendoza, Argentina)Fil: Innocenti, Carolina. Universidad Nacional de Cuyo. Facultad de Ciencias MédicasFil: Parra, Viviana. Universidad Nacional de Cuyo. Facultad de Ciencias Médica

Angiosarcoma of the scalp diagnosed by the presence of neck inflammation: a case report

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Applying Cost-Benefit to Past Decisions: Was Environmental Protection Ever a Good Idea?

In this Article, however, we do not mount a critique from outside the technique of cost-benefit analysis. Instead, we examine an argument that proponents of cost-benefit analysis have offered as a linchpin of the case for cost-benefit: that this technique is neither anti- nor pro-regulatory, but rather a neutral tool for evaluating public policy. In making this argument, these proponents have often invoked the use of cost-benefit analysis to support previous regulatory decisions (their favorite example involves the phase down of lead in gasoline, which we shall shortly discuss) as a sign that this technique can be used to support as well as to undermine protective regulation. As we demonstrate, however, cost-benefit analysis would have stood as an obstacle to early regulatory successes. Before turning to the various case studies illustrating this point, we first take a brief look at previous efforts to undertake retrospective cost-benefit analyses of important regulatory achievements

Imaging features of rare mesenychmal liver tumours: beyond haemangiomas.

Tumours arising from mesenchymal tissue components such as vascular, fibrous and adipose tissue can manifest in the liver. Although histopathology is often necessary for definitive diagnosis, many of these lesions exhibit characteristic imaging features. The radiologist plays an important role in suggesting the diagnosis, which can direct appropriate immunohistochemical staining at histology. The aim of this review is to present clinical and imaging findings of a spectrum of mesenchymal liver tumours such as haemangioma, epithelioid haemangioendothelioma, lipoma, PEComa, angiosarcoma, inflammatory myofibroblastic tumour, solitary fibrous tumour, leiomyoma, leiomyosarcoma, Kaposi sarcoma, mesenchymal hamartoma, undifferentiated embryonal sarcoma, rhabdomyosarcoma and hepatic metastases. Knowledge of the characteristic features of these tumours will aid in guiding the radiologic diagnosis and appropriate patient management