2021 Volume 30 Issue 6 Pages 329-333
Primary aortic angiosarcomas, especially those in the ascending aorta, are rare. The prognoses in most cases are extremely poor owing to the aggressive behavior of angiosarcomas and their delayed diagnosis. We report a case of angiosarcoma in the ascending aorta in a 55-year-old woman. The patient was admitted with multiple stroke recurrences. Preoperative computed tomography revealed irregular masses extending from the ascending aorta to the descending aorta. Transesophageal echocardiography showed swinging masses in the aorta. Although the mass appeared to be a thrombus, vegetation, atheroma, or tumor, it was difficult to establish a diagnosis. Surgery was planned to confirm a diagnosis and offer appropriate treatment. The surgical findings showed a large fungating tumor in the ascending aorta with invasion extending from the ascending to the proximal descending aorta, suggesting difficulty in en bloc mass resection. Total arch replacement using the frozen elephant trunk technique was performed to prevent further embolization from the residual tumor in the descending aorta. Histological analysis indicated angiosarcoma. The patient initially recovered well from the surgery; however, her condition deteriorated rapidly 8 days postoperatively, and she died 19 days postoperatively because of multiple cerebral emboli and brain metastasis. We present an extremely rare case of angiosarcoma in the ascending aorta causing recurrent strokes. The features observed on preoperative multimodality imaging are similar to those of non-tumor lesions. However, the prognosis is extremely poor because of the difficulty in establishing a preoperative diagnosis and aggressive behavior of angiosarcoma. We anticipate that this report will be vital in helping readers develop awareness of this very rare disease, contributing to early diagnosis and developments in treatment.
