Presentation
Progressive painless swelling of the medial aspect of the left arm.
Patient Data
The MRI sequences demonstrate a relatively well-circumscribed ovoid mass of the medial aspect of the left arm with the following characteristics:
- centered on the adjacent segment of the basilic vein which is thrombosed
- measures 6 x 5 x 3.5 cm
- elicits an isosignal to muscles on T1, heterogeneous high signal on T2 with areas of low signal T1/T2 (calcifications, confirmed by ultrasound), as well as areas of high signal on T1/T1 fat sat, indicating probably intratumoral hemorrhage. Heterogeneous enhancement is noted on postcontrast sequences
- infiltration of the surrounding fatty tissue
- a mass effect on the adjacent muscles (brachialis/triceps brachii muscles) with preserved fatty interface
6 months after complete surgical resection of the previously described mass of the left arm, another similar mass appeared in the right arm measuring about 25 X 18 X 13 mm, relatively well-defined, hypoechoic, and highly vascularized on color Doppler.
On MRI sequences this mass appears well-circumscribed, centered on the basilic vein of isosignal to muscles on T1, mild inhomogeneous high signal on T2 with heterogeneous enhancement on postcontrast sequences. Small adjacent lymphadenopathies are noted. No significant infiltration of the surrounding fat plane or extension to the adjacent muscles.
Operative views of the tumor of the right basilic vein.
Case Discussion
Initially, the patient had noticed a painless swelling of the left arm for which he had an MRI (the advanced diagnoses were soft tissue sarcoma/angiosarcoma of the basilic vein) and chest/abdominopelvic CT was unremarkable. After complete surgical resection and histopathological analysis, the diagnosis was angiosarcoma.
6 months after surgery, another mass appeared in the right arm which has approximately the same location and MRI appearance. The chest/abdominopelvic CT was also unremarkable. After surgical resection with histopathological exam, the diagnosis was also angiosarcoma.
Additional contributors: Assoc Prof C. Derdous, orthopedic surgeon CHU Batna, Dr. L. Amrane oncologist EPH Tebessa, C. Boukaaba radiologist