PMC9647023_01
Bone destruction of the L3 vertebral body with abnormal low-density shadow within it(arrows).
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CTimaging revealed bone destruction at the L3 vertebral level, with an abnormally low-density shadow (See  Figure 1 ).
Hematoxylin & eosin staining of the L3 biopsy: (A) The tumor tissue consisted of well-differentiated vascular lumen, which grew infiltratively around; (B) the lumen was irregular in size and shape, communicating with each other to form anastomosis or communication, and erythrocytes were seen in the lumen; (C) the lumen was lined with monolayer, dark-stained endothelial cells, partly forming papillae in the lumen, and the tumor cells were heterogeneous with large, dark-stained, heterogeneous nuclei.
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S-100 (-), and 30% Ki-67-positive cells (See  Figure 2 ). Considering that the angiosarcoma (L3) was metastatic, a whole-body CT scan was performed. Space-occupying lesions in the right atrium, liver segment S8, pericardium and bone (See  Figure 3 ).
CT examination of the patient. (A-C) Patient's initial CT image in March 2020. Space-occupying lesions in the right atrium, liver segment S8, pericardium; (D-F) CT images at the time of the patient's readmission in May 2020. The right atrium and liver lesion were found to be significantly larger than before, as well as pericardial effusion, right pleural effusion and incomplete right lower lung distension were detected; (G-I) Efficacy evaluation after 1 cycle of chemotherapy with stable disease in June 2020.
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S-100 (-), and 30% Ki-67-positive cells (See  Figure 2 ). Considering that the angiosarcoma (L3) was metastatic, a whole-body CT scan was performed. Space-occupying lesions in the right atrium, liver segment S8, pericardium and bone (See  Figure 3 ). A CT examination was performed and the right atrium and liver lesion were found to be significantly larger than before, as well as pericardial effusion, right pleural effusion and incomplete right lower lung distension were detected (See  Figure 3 ). Therefore, we chose Gemcitabine (1.4 g, Day 1, 8) and Docetaxel (150 mg, Day 8) for two cycles starting May 2020. The Gemcitabine dose was then increased to 1.5 g in June and after 1 cycle, stable disease (SD) was achieved on CT scan (See  Figure 3 ).
Direct invasion of the liver by a right atrial lesion(arrows).
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In addition, through imaging we found that the lesion in the liver was most likely due to direct invasion of the right atrial lesion into the liver (See  Figure 4 ), so we judged that the primary lesion in this patient was the right atrium.
Massive pleural effusion, diagnosis of cardiac tumor rupture, but no exact bleeding point found.
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CT scan indicated significant pleural effusions (See  Figure 5 ), and a routine blood test revealed an RBC of 2.69*10-12/L and HGB of 76 g/L.