Angiosarcoma around total hip arthroplasty: case series and review of the literature
- 169 Downloads
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.
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.
In conclusion in a patient who presents with uncontrollable bleeding, loss of weight and massive osteolysis, AS must be actually considered as possible diagnosis.
KeywordsAngiosarcoma Total hip arthroplasty Hip revision surgery Aseptic loosening
Compliance with ethical standards
Conflict of interest
All authors declare they have no conflict of interests.
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 was obtained from all individual participants included in the study.
- 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
- 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
- 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
- 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.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.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
- 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