Spinal epithelioid angiosarcoma

Case contributed by Dr Dalia Ibrahim

Presentation

Back swelling.

Patient Data

Age: 20 years
Gender: Male

Destructive lesion involving the spinous process of L1 with extra-osseous soft tissue component within the inter-spinous plane. The lesion is eliciting heterogeneous signal on T1 with areas of high signal and heterogenous predominately high signal on T2 WI. Areas of low T2 signal within, suggestive of hemorrhagic components. It is smoothly displacing the adjacent paravertebral muscles. No intra-spinal extension.

PET-CT

CT

The lytic lesion centered upon the spinous process of L1 with extra-osseous component is FDG avid (SUVmax 10). It demonstrates heterogenous avidity with central photopaenia. The mass is displacing the adjacent paravertebral muscles.

No other metabolically active lesions were distinctive for neoplasia.

Photo

Biopsy revealed moderately differentiated epithelioid angiosarcoma.

Case Discussion

Angioarcomas are tumors arising from the endothelial cells of vascular structures, hence they can develop anywhere in the body.

MRI features lesions include intermediate T1 signal (with possible areas of high signal indicating hemorrhage) and predominantly high T2 signal intensity (with possible fluid-fluid level secondary to necrosis and hemorrhage). The most diagnostic finding is high-flow serpentine vessels (low signal on both T1 and T2). Angiosarcomas demonstrate enhancement after contrast, with internal non-enhancing areas reflecting tumor necrosis.

Angiosarcoma is hypermetabolic/avid on FDG PET/CT. 

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