What Is a Clinically Meaningful Change in Diabetes Distress? Findings for Diabetes Care and Research From the SFDT1 Cohort.

Primary splenic angiosarcoma (PSA) is an extremely rare and highly aggressive vascular tumor of the spleen, accounting for a very small fraction of all primary splenic malignancies, with an incidence rate of about 0.1%. It originates from malignant transformation of mesenchymal-derived endothelial cells lining the splenic sinusoidal vasculature. Clinically, PSA often presents insidiously with nonspecific systemic symptoms including fatigue, weight loss, abdominal discomfort, anemia, and splenomegaly, and may initially mimic benign or non-vascular splenic disease [, ]. Radiologically, the disease may manifest as heterogeneous, multifocal splenic masses on computed tomography (CT) or magnetic resonance imaging (MRI) [], but these imaging findings lack specificity and can be difficult to distinguish from benign vascular lesions or lymphomas []. Definitive diagnosis depends on histopathological evaluation showing disorganized vascular channels lined by atypical endothelial cells, with immunohistochemical positivity for vascular markers such as CD31, CD34, FLI-1, or ERG []. Bone marrow examination, when performed as part of anemia or hepatosplenomegaly workup, is often nonspecific and may show reactive changes such as compensatory erythroid hyperplasia rather than evidence of a primary hematologic malignancy [, ]. The prognosis is poor, with median survival typically less than 1 year due to early hematogenous dissemination, and total splenectomy remains the cornerstone of treatment for localized disease [, ]. A 25-year-old Middle Eastern male with no significant past medical history except for tonsillectomy presented with progressive generalized fatigue and weakness of 10 days’ duration. He also reported subjective fever partially responsive to antipyretics and right upper abdominal and epigastric pain that began approximately 40 days prior after lifting heavy objects. There was one episode of vomiting. He denied gastrointestinal bleeding, weight loss, or night sweats. There were no clinical features suggestive of intra-abdominal infection such as chills, rigors, or focal infectious symptoms, and no history suggestive of splenic abscess or sepsis. He was an active smoker with a 6-pack-year history. Family history was unremarkable. Medications prior to admission included diclofenac potassium, thiocolchicoside, etoricoxib, and cinnarizine.