VOLUME 16 - NUMBER 2 / March - April (Clinical case / Caso clínico)
Ruth Fuente-Garrido, Médico Residente, Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario, Valladolid, España
Enrique María San Norberto-García, Facultativo Especialista, Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario, Valladolid, España
Cintia Flota-Ruiz, Médico Residente, Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario, Valladolid, España
Miguel Martín-Pedrosa, Facultativo Especialista, Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario, Valladolid, España
Álvaro Revilla-Calavia, Facultativo Especialista, Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario, Valladolid, España
Carlos Vaquero-Puerta, Catedrático, Jefe de Servicio, Servicio de Angiología y Cirugía Vascular, Hospital Clínico Universitario, Valladolid, España
Introduction: The prevalence of vascular malformations is estimated at 1.5% in the general population. Sarcomas are a rare group of mesenchymal-origin malignant tumors that accounts for less than 1% of all tumors in adults. We present one case of sarcomatous degeneration in an arteriovenous malformation of 50 years’ evolution. Material: A 60-year-old male patient was admitted to our department presenting with soft tissue infection and hindfoot bleeding in the context of an arteriovenous malformation of 50 years’ evolution and unidentified etiology. The patient had bilateral distal pulses. A 5 x 6 cm ulcerated and over-infected hindfoot lesion, with mamelonated borders that collapsed on digital pressure, was observed at the right lower limb. Methods: Diagnostic arteriography revealed a vascular formation with angiomatous nidus on the medial surface of the talotibiofibular joint, arising from the posterior tibial artery. The arteriovenous malformation was embolized, with total exclusion thereof at final control. In spite of medical treatment and dressing, bad evolution persisted, with over-infection and appearance of new mamelonated formations, and infracondylar amputation was therefore decided. Results: Anatomic pathology revealed a malignant mesenchymal neoplasm suggestive undifferentiated pleomorphic sarcoma with giant cells (malignant fibrous histocytoma of the giant cell type). The patient passed away at 3 months of diagnosis due to tumor disease dissemination. Conclusion: Sarcomatous degeneration is a rare complication of arteriovenous malformations and, since clinical suspicion is low, the diagnosis is delayed, which entails poor results on the short-term.
Keywords: Arteriovenous malformation. Embolization. Pleomorphic undifferentiated sarcoma.
