PMC9698920_01
Pathological findings of vascular neoplasms of the breast (hematoxylin and eosin, 100x). (A) Tumor cells infiltrating breast tissue and invading lobule tissue; (B) Tumor cells invading adipose tissue. Immunohistochemical image of vascular neoplasms of the breast (SP 100x); (C) positive immunohistochemical staining for CD34; (D): positive immunohistochemical staining of Ki-67.
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In view of the special location of the tumor, angiosarcoma was not excluded ( Figures 1A, B ). Immunohistochemistry showed: vimentin (+), CD31 (+), CD34 (+) and Ki67 (10%) ( Figures 1C, D ).
Chest computed tomography scan revealed a large soft tissue mass in the left breast with uniform density.
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Investigation showed low platelet count, abnormal coagulation, and significantly reduced fibrinogen; chest computed tomography (CT) indicated increased density of the left breast ( Figure 2 ), and the patient was discharged in a stable clinical condition.
Fibrinogen was significantly reduced before surgery. On November 14, 2017, the hematoma was removed and hemostasis was performed, and the fibrinogen gradually returned to normal after surgery (normal value of fibrinogen: 2-4 g/L).
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Postoperative recovery was smooth, platelet count and fibrinogen gradually returned to normal ( Figure 3 ).
Pathological findings of vascular neoplasms of the breast. (A) Formation of irregular and anastomosed vascular lumen lined with endothelial cells, large and hyperchromatic nuclei, and red blood cells in the lumen (HE, 200x); (B) Abnormal endothelial cells, which are round, ovoid, and spindle shaped. Nucleopathological mitosis was seen (HE, 400x). Immunohistochemical image of vascular neoplasms of the breast (SP, 100x); (C) Positive immunohistochemical staining for CD34; (D) Positive immunohistochemical staining of Ki-67. HE: Hematoxylin and eosin.
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Pathological examination showed hemangiosarcoma with hematoma formation in the left breast, involving nerves and epidermis; ( Figures 4A, B ). Immunohistochemistry showed: vimentin (+), CD31 (+), CD34 (+), epithelial membrane antigen (EMA) (-), cytokeratin (-), S-100 (-), desmin (-), and Ki-67 index (20%) ( Figures 4C, D ).
Contrast-enhanced magnetic resonance imaging of a patient with angiosarcoma of the left breast. (A) Progressive enhancement of the tumor on continuous dynamic enhancement scans; (B) Enhanced scan curve shows inflow type.
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T1 and long T2 signals. The tumor showed progressive enhancement, with likely recurrence of malignant tumor, and multiple enlarged lymph nodes in the right axilla ( Figure 5 ).
Cervical chest and abdominal computed tomography scan + enhancement show uneven enhancement of soft tissue mass in left lobe of liver. (A) Portal vein stage; (B) Delay stage.
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Low-density lesions in the left lobe of the liver ( Figure 6 ) and soft tissue occupation in the bilateral adnexa were considered as metastases.
Timeline.
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