Angiosarcoma of the seminal vesicle: a case report of long-term survival following multimodality therapy

Abstract

Angiosarcoma of the seminal vesicle is an extremely rare malignancy, with few published case reports in the literature. We present a case of primary angiosarcoma of the seminal vesicle in a 45-year-old male who was treated with multimodality therapy, consisting of neoadjuvant chemotherapy and chemoradiation followed by surgical resection and intraoperative radiation therapy. He has been free of cancer recurrence for more than six years after completion of therapy. To our knowledge, this represents the longest reported survival of a patient with this rare tumor, and one of the few cases reported using a multimodality therapy approach.

Keywords: angiosarcoma; chemoradiation; neoadjuvant; prostate; seminal vesicle; surgery; trimodality therapy.

Figure 1.

Imaging studies at the time of initial presentation show a mass emanating from the left seminal vesicle and invading the left posterior bladder wall and the left obturator internus muscle. The mass demonstrates contrast enhancement on axial computed tomography (A) and magnetic resonance imaging (B). The mass is hypointense on T2 weighted axial (C) and coronal (D) magnetic resonance imaging. E) Pre-operative external beam radiotherapy plan with a prescribed dose of 50 Gray delivered in 25 fractions. The gross tumor volume (GTV) is delineated in white outline and the planning target volume (PTV) is delineated in black outline. The GTV, representing the tumor as visualized on CT and MRI, was expanded by 1.5 cm to generate the clinical tumor volume (CTV). The CTV was expanded by 0.7 cm to generate the PTV.

Figure 2.

Microscopic examination showed a poorly differentiated malignant tumor involving the left seminal vesicle soft tissue (A). The tumor showed large pleomorphic cells with prominent nucleoli (B). Few mitotic figures were also present. Immunostains were performed and the tumor cells were positive for FLI-1 (C) and CD31; and negative for Cam 5.2, cytokeratin 7, cytokeratin 20, actin, desmin, S100, CD117, synaptophysin, chromogranin and prostate specific antigen (PSA). These results supported the diagnosis of an angiosarcoma.