PMC1242259_01
Enhanced abdominal CT scan of upper abdomen showing a 6 cm sized mass in the right lower quadrant of the abdomen at the first operation. The mass contained air bubbles, tiny calcifications and hematoma.
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F1
The small bowel series showed an external compressive lesion in the distal ileum and the computerized tomographic (CT) scan revealed a 6 cm, well-marginated mass in the anteromedial aspect of the ascending colon (Figure 1).
Macroscopic view of the mass in the right paracolic gutter showing a 5 x 3 cm sized, encapsulated mass filled with abscess and granulation tissue.
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F2
In the anteromedial aspect of ascending colon, there was an encapsulated mass 5 cm in size, and it was adhered to ascending colon and distal ileum (Figure 2).
Macroscopic view of the segment of the small intestine showing an ill-defined tan solid mass that involved the entire intestinal layer.
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F3
Microscopic findings of the angiosarcoma in the small intestine. 4a) Atypical spindle or epithelioid tumor cells were arranged in sheets, and rudimentary lumen formation was rarely noted. (H&E, x 200) 4b) The tumor cells are strongly positive for anti-CD31. (PAP, x 100)
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F4
Under microscope, spindle-shaped or epithelioid cells were arranged as a plate and the rudimentary vessel lumen were detected occasionally (Figure 4a). Immunohistochemical staining was performed and tumor cells were positive for CD31, CD34, and vimentin (Figure 4b), whereas negative for factor antigen, CD117, and S-100.
Microscopic finding of the angiosarcoma in the anteromedial aspect of ascending colon. Proliferation of malignant blood vessels was seen in the periphery of the abscess(left upper corner) (H&E, x 40). Inlet: Malignant epitheliod tumor cells were proliferating around the calcified foreign material, which was found in the periphery of the abscess. (H&E, x 200)
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F5
In a low magnification field, abscess in the center and fibrosis with vascular proliferation in the periphery were noted (Figure 5).