Lymphangitic carcinomatosis of lungs.
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We report two cases of early Kaposi's sarcoma illustrating the risk of misdiagnosis. Both lesions showed histological features and clinical aspects that mimicked lymphangioendothelioma. The diagnosis of lymphangioma-like Kaposi's sarcoma was not made until a few years later, after the lesions had become more extensive and bilateral. Because of this evolution which is uncommon for a lymphangioendothelioma, immunohistochemical staining with anti-HHV8 antibody was done, and was positive in successive biopsies of our two patients. These results reveal that these vascular lesions had been Kaposi's sarcomas of the lymphangioma-like type since the beginning. In conclusion, it seems essential to search for HHV8 within endothelial cells of any vascular lesion mimicking lymphangioendothelioma or any other vascular proliferation difficult to classify. These results lead us to question whether lymphangioendothelioma is a real entity.
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A 76-year-old woman developed angiosarcoma 11 years after a radical mastectomy in the chronic lymphedema of the ipsilateral arm, referred to as Stewart-Treves syndrome. The patient was treated by intravenous and intralesional injection of recombinant interleukin 2 (rIL-2; TGP-3, Takeda Chemical Industries, LTD, Osaka). Intralesional injection was more effective than systemic administration. After a month, the lesion where the local injection was done showed little tumor cells with a dense infiltrate composed of lymphoid cells. It was observed that NK activity, LAK activity and IL-2 receptor positive T-cells in the peripheral blood increased during the administration of rIL-2. As the lesion was too large to be treated with rIL-2 alone, radiotherapy was performed. But the patient had no remarkably improvement and died 16 months later from the onset. Immunotherapy with rIL-2 can be useful for angiosarcoma and more effective regimen of rIL-2 is a important problem.
Reported is the case of a 54-year-old female manifesting the Stewart-Treves syndrome (a postmastectomy angiosarcoma.) The patient had developed an angiosarcoma in her lymphoedematous right shoulder and lower neck develop ten years after a radical mastectomy for a papillo-tubular adenocarcinoma of the right mammary gland. Radiologically, a well-enhanced tumor was revealed by computed tomography, which angiographically had more stains and tumor vessels than usual for a mammary carcinoma and less than usually seen in a cavernous hemangioma. Histologically, this tumor showed less of a luminal differentiation than a conventional angiosarcoma and resembled a fibrosarcoma. Computed tomography and angiography were found useful in achieving a diagnosis and the subsequent therapy for this Stewart-Treves syndrome.
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