Duodenal angiosarcoma can be misdiagnosed as a Dieulafoy's lesion

Abstract

Angiosarcomas are soft-tissue neoplasms that originate from the vascular epithelium. The most commonly involved sites include the skin and subcutaneous tissues. In the GI tract, generally, angiosarcomas involve the spleen and liver, although locations in the small intestine and colon have been very occasionally reported. In the present study we report the unusual case of a man with duodenal epithelioid angiosarcoma, presenting with anemia and recurrent upper gastrointestinal bleeding, which was initially misdiagnosed as a Dieulafoy's lesion. It is important to consider the diagnosis of gastrointestinal malignancy, including unusual neoplasms such as angiosarcomas, in the setting of anendoscopic appearance such as hemorrhagic nodule, purpuric mass and/or recurrent bleeding lesions that are persistent despite repeat interventions. In such cases, a biopsy should be considered to confirm the diagnosis.

Keywords: Angiosarcoma; Dieulafoy’s lesion; Duodenal.

Figure 1

A single 5 mm raised actively bleeding lesion was found in the 2nd part of the duodenum. It already had two clips placed on it. To stop active bleeding, two more hemostatic clips were successfully placed

Figure 2

Red blood was found in the second part of the duodenum. For hemostasis, two hemostatic clips were successfully placed

Figure 3

A single 11 mm mucosal nodule with a localized distribution was found in the 2nd part of the duodenum. Area was successfully injected with 2 mL India ink for tattooing. For hemostasis, one hemostatic clip was successfully placed. There was no bleeding during the procedure. Biopsies were taken with cold forceps for histology

Figure 4

A.H&E at 400x (original magnification) showing area with vasoformative features.B.CD31 immunohistochemical stain at 400x (original magnification) showing membranous and cytoplasmic staining