PMC6011124_01
Blue-purple firm multinodular lesion measuring 20 cm x 11 cm on surface of skin, with possible ulceration and scab formation. Black ink designating inferior aspect of partial mastectomy.
CRIS2018-7390987.002.jpg
PMC6011124_01_CRIS2018-7390987.002.jpg
fig2
A gross depiction of the mass following right partial mastectomy is shown in (Figure 2) with cut sections shown in (Figure 3).
Cut sections of skin and underlying breast parenchyma. The lesion shows a red trabeculated/reticulated cut surface that infiltrates into the fibrofatty breast parenchyma in a lobulated fashion.
CRIS2018-7390987.003.jpg
PMC6011124_01_CRIS2018-7390987.003.jpg
fig3
A gross depiction of the mass following right partial mastectomy is shown in (Figure 2) with cut sections shown in (Figure 3).
(a) 2x H&E stain. Skin with hyperkeratosis and underlying dermis containing nodular areas of poorly formed vascular spaces. (b) 2x H&E stain. Breast tissue composed of glands and adipose tissue with invasion by angiosarcoma. (c) 10x H&E stain. Infiltrating atypical spindle cells in a nodular pattern making poorly formed vascular channels with extravasated red blood cells. (d) 40x H&E stain. Atypical spindle endothelial cells with pleomorphic, large irregular nuclei, with prominent nucleoli, and multiple mitotic figures. There are red blood cells inside poorly formed vascular lumens as well as surrounding the spindle cells.
CRIS2018-7390987.004.jpg
PMC6011124_01_CRIS2018-7390987.004.jpg
fig4
Microscopic examination revealed that the tumor was composed of high-grade atypical spindle endothelial cells with poorly formed vascular spaces (Figures 4(a)-4(d)).
(a) 4x CD31 immunohistochemical stain. Positive membranous CD31 highlighting malignant endothelial cells. (b) 10x ERG immunohistochemical stain. Positive nuclear ERG immunostain in the malignant endothelial cells. (c) 10x factor VIII immunohistochemical stain. Positive cytoplasmic stain of malignant endothelial cells. (d) 20x CD34 immunohistochemical stain. Negative CD34, another membranous endothelial cell marker, failing to stain the malignant cells. Pancytokeratin immunostain was also negative.
CRIS2018-7390987.005.jpg
PMC6011124_01_CRIS2018-7390987.005.jpg
fig5
Immunochemistry analysis using antibodies to CD31, nuclear ERG, and factor VIII was positive, while analysis using CD34 and pancytokeratin was negative (Figures 5(a)-5(d)).