MUSCULOSKELETAL SURGERY

, Volume 102, Issue 1, pp 21–27 | Cite as

Angiosarcoma around total hip arthroplasty: case series and review of the literature

  • S. Terrando
  • A. Sambri
  • G. Bianchi
  • L. Cevolani
  • L. Foschi
  • E. Gozzi
  • G. Pignatti
  • D. M. Donati
Review
  • 169 Downloads

Abstract

Background

Angiosarcoma (AS) is a rare and malignant tumor which mainly arises in the skin and superficial soft tissue and less frequently in deep soft tissue and bones. Some cases of AS are described in association with vascular and orthopedic devices. Nonetheless, only a few cases of AS around THA are reported in the literature.

Materials and methods

We describe five cases of AS arising around total hip arthroplasty who received surgery at our institution (Istituto Ortopedico Rizzoli, Bologna, Italy), and we report the cases described in literature.

Results

Foreign bodies such as polyethylene were demonstrated to have a carcinogenic role in animals, but reports of similar cases in humans are rare. Nevertheless, osteolysis induced by wear particles of polyethylene is a frequent event and could induce to desist form considering other more rare causes of osteolysis such as AS. This could be the reason why the diagnosis in several cases was significantly delayed. Common features of these cases could be helpful for doing a prompt diagnosis. The initial presentation is suggestive for septic or aseptic loosening with a massive osteolysis around the cup and/or the stem associated with peculiar aspects as bleeding and loss of weight. Frequently, needle biopsy is negative because foreign-body reaction might have “covered” the most relevant condition of epithelioid AS.

Conclusions

In conclusion in a patient who presents with uncontrollable bleeding, loss of weight and massive osteolysis, AS must be actually considered as possible diagnosis.

Keywords

Angiosarcoma Total hip arthroplasty Hip revision surgery Aseptic loosening 

Notes

Compliance with ethical standards

Conflict of interest

All authors declare they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Maloney WJ, Woolson ST (1996) Increasing incidence of femoral osteolysis in association with uncemented Harris-Galante total hip arthroplasty. A follow-up report. J Arthroplasty 11(2):130–134CrossRefPubMedGoogle Scholar
  2. 2.
    Agaimy A, Ben-Izhak O, Lorey T, Scharpf M, Rubin BP (2016) Angiosarcoma arising in association with vascular Dacron grafts and orthopedic joint prostheses: clinicopathologic, immunohistochemical, and molecular study. Ann Diagn Pathol 21:21–28. doi: 10.1016/j.anndiagpath.2016.01.002 CrossRefPubMedGoogle Scholar
  3. 3.
    Ben-Izhak O, Kerner H, Brenner B, Lichtig C (1992) Angiosarcoma of the colon developing in a capsule of a foreign body. Report of a case with associated hemorrhagic diathesis. Am J Clin Pathol 97(3):416–420CrossRefPubMedGoogle Scholar
  4. 4.
    Nascimento AF, Raut CP, Fletcher CD (2008) Primary angiosarcoma of the breast: clinicopathologic analysis of 49 cases, suggesting that grade is not prognostic. Am J Surg Pathol 32(12):1896–1904. doi: 10.1097/PAS.0b013e318176dbc7 CrossRefPubMedGoogle Scholar
  5. 5.
    Mallick A, Jain S, Proctor A, Pandey R (2009) Angiosarcoma around a revision total hip arthroplasty and review of literature. J Arthroplasty 24(2):e317–e320. doi: 10.1016/j.arth.2008.04.007 CrossRefGoogle Scholar
  6. 6.
    Zhu W, Feng B, Ma Q, Li YL, Song XT, Weng XS (2016) Angiosarcoma around hip joint prosthesis. Chin Med J 129(21):2642–2643. doi: 10.4103/0366-6999.192783 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    van der List JJ, van Horn JR, Slooff TJ, ten Cate LN (1988) Malignant epithelioid hemangioendothelioma at the site of a hip prosthesis. Acta Orthop Scand 59(3):328–330CrossRefPubMedGoogle Scholar
  8. 8.
    Fabbri N, Rustemi E, Masetti C, Kreshak J, Gambarotti M, Vanel D, Toni A, Mercuri M (2011) Severe osteolysis and soft tissue mass around total hip arthroplasty: description of four cases and review of the literature with respect to clinico-radiographic and pathologic differential diagnosis. Eur J Radiol 77(1):43–50. doi: 10.1016/j.ejrad.2010.08.015 CrossRefPubMedGoogle Scholar
  9. 9.
    Langkamer VG, Case CP, Collins C, Watt I, Dixon J, Kemp AJ, Atkins RM (1997) Tumors around implants. J Arthroplasty 12(7):812–818CrossRefPubMedGoogle Scholar
  10. 10.
    O’Shea K, Kearns SR, Blaney A, Murray P, Smyth HA, McElwain JP (2006) Periprosthetic malignancy as a mode of failure in total hip arthroplasty. J Arthroplasty 21(6):926–930. doi: 10.1016/j.arth.2005.11.002 CrossRefPubMedGoogle Scholar
  11. 11.
    Coleman MP (1996) Cancer risk from orthopedic prostheses. Ann Clin Lab Sci 26(2):139–146PubMedGoogle Scholar
  12. 12.
    Wagner P, Olsson H, Lidgren L, Robertsson O, Ranstam J (2011) Increased cancer risks among arthroplasty patients: 30 year follow-up of the Swedish knee arthroplasty register. Eur J Cancer 47(7):1061–1071. doi: 10.1016/j.ejca.2010.11.023 CrossRefPubMedGoogle Scholar
  13. 13.
    Broomfield JA, Malak TT, Thomas GE, Palmer AJ, Taylor A, Glyn-Jones S (2017) The relationship between polyethylene wear and periprosthetic osteolysis in total hip arthroplasty at 12 years in a randomized controlled trial cohort. J Arthroplasty 32(4):1186–1191. doi: 10.1016/j.arth.2016.10.037 CrossRefPubMedGoogle Scholar
  14. 14.
    Carter RL, Roe FJ (1969) Induction of sarcomas in rats by solid and fragmented polyethylene: experimental observations and clinical implications. Br J Cancer 23(2):401–407CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Matharu GS, Pandit HG, Murray DW, Judge A (2016) Adverse reactions to metal debris occur with all types of hip replacement not just metal-on-metal hips: a retrospective observational study of 3340 revisions for adverse reactions to metal debris from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man. BMC Musculoskelet Disord 17(1):495. doi: 10.1186/s12891-016-1329-8 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Smith AJ, Dieppe P, Porter M, Blom AW, National Joint Registry of England and Wales (2012) Risk of cancer in first seven years after metal-on-metal hip replacement compared with other bearings and general population: linkage study between the National Joint Registry of England and Wales and hospital episode statistics. BMJ 344:e2383. doi: 10.1136/bmj.e2383 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Brewster DH, Stockton DL, Reekie A, Ashcroft GP, Howie CR, Porter DE, Black RJ (2013) Risk of cancer following primary total hip replacement or primary resurfacing arthroplasty of the hip: a retrospective cohort study in Scotland. Br J Cancer 108(9):1883–1890. doi: 10.1038/bjc.2013.129 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Drexler M, Dolkart O, Amar E, Pritsch T, Dekel S (2010) Late recurrent hemarthrosis following knee arthroplasty associated with epithelioid angiosarcoma of bone. Knee 17(5):365–367. doi: 10.1016/j.knee.2009.10.010 CrossRefPubMedGoogle Scholar
  19. 19.
    Natu S, Sidaginamale RP, Gandhi J, Langton DJ, Nargol AV (2012) Adverse reactions to metal debris: histopathological features of periprosthetic soft tissue reactions seen in association with failed metal on metal hip arthroplasties. J Clin Pathol 65(5):409–418. doi: 10.1136/jclinpath-2011-200398 CrossRefPubMedGoogle Scholar
  20. 20.
    Cadossi M, Tedesco G, Sambri A, Mazzotti A, Giannini S (2015) Hip resurfacing implants. Orthopedics 38(8):504–509. doi: 10.3928/01477447-20150804-07 CrossRefPubMedGoogle Scholar
  21. 21.
    Orishimo KF, Claus AM, Sychterz CJ, Engh CA (2003) Relationship between polyethylene wear and osteolysis in hips with a second-generation porous-coated cementless cup after seven years of follow-up. J Bone Jt Surg Am 85-A(6):1095–1099CrossRefGoogle Scholar
  22. 22.
    Leigh W, O’Grady P, Lawson EM, Hung NA, Theis JC, Matheson J (2008) Pelvic pseudotumor: an unusual presentation of an extra-articular granuloma in a well-fixed total hip arthroplasty. J Arthroplasty 23(6):934–938. doi: 10.1016/j.arth.2007.08.003 CrossRefPubMedGoogle Scholar
  23. 23.
    Pandit H, Glyn-Jones S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CL, Ostlere S, Athanasou N, Gill HS, Murray DW (2008) Pseudotumours associated with metal-on-metal hip resurfacings. J Bone Jt Surg Br 90(7):847–851. doi: 10.1302/0301-620X.90B7.20213 CrossRefGoogle Scholar

Copyright information

© Istituto Ortopedico Rizzoli 2017

Authors and Affiliations

  1. 1.Istituto Ortopedico RizzoliBolognaItaly

Personalised recommendations