PMC3977171_01
Imaging studies at the time of initial presentation show a mass emanating from the left seminal vesicle and invading the left posterior bladder wall and the left obturator internus muscle. The mass demonstrates contrast enhancement on axial computed tomography (A) and magnetic resonance imaging (B). The mass is hypointense on T2 weighted axial (C) and coronal (D) magnetic resonance imaging. E) Pre-operative external beam radiotherapy plan with a prescribed dose of 50 Gray delivered in 25 fractions. The gross tumor volume (GTV) is delineated in white outline and the planning target volume (PTV) is delineated in black outline. The GTV, representing the tumor as visualized on CT and MRI, was expanded by 1.5 cm to generate the clinical tumor volume (CTV). The CTV was expanded by 0.7 cm to generate the PTV.
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The mass was invading the left bladder base and ureterovesicular junction (UVJ), and a few cm of left distal ureter (Figure 1A). Magnetic resonance imaging (MRI) was performed, which showed an infiltrating soft tissue mass in the left lower pelvis involving the left seminal vesicle, the base of the prostate and the left bladder wall (Figure 1B-D). The patient then received external beam radiation therapy (Figure 1E) consisting of 50 Gray in 25 fractions delivered daily over 5 weeks with 2 cycles of concomitant MAP chemotherapy, consisting of mitomycin (8 mg/m2 IV), adriamycin (40 mg/m2 IV) and cisplatin (60 mg/m2 IV).
Microscopic examination showed a poorly differentiated malignant tumor involving the left seminal vesicle soft tissue (A). The tumor showed large pleomorphic cells with prominent nucleoli (B). Few mitotic figures were also present. Immunostains were performed and the tumor cells were positive for FLI-1 (C) and CD31; and negative for Cam 5.2, cytokeratin 7, cytokeratin 20, actin, desmin, S100, CD117, synaptophysin, chromogranin and prostate specific antigen (PSA). These results supported the diagnosis of an angiosarcoma.
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Review of the surgical pathology demonstrated grade 4 (of 4) epithelioid angiosarcoma forming a 3.5x2.6x1.8 cm mass in soft tissue in the region of the left seminal vesicle (Figure 2).