PMC4805390_01
Evolution of angiosarcoma in a 78-year-old female nonsmoker: in A, initial CT scan of the chest showing a left upper lobe pulmonary mass; in B and C, CT scans of the chest, obtained two years later, showing a 10 x 7 cm lesion in the left upper lobe, with a small left pleural effusion and small mediastinal lymph nodes; in D, an 18F-fluorodeoxyglucose positron emission tomography-CT scan showing increased metabolic activity in many organs, greatest in the mass in the upper left lobe.
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A 78-year-old female nonsmoker had previously been examined, a CT scan of the chest having shown a left upper lobe pulmonary mass (Figure 1A). A chest X-ray and a chest CT scan (without contrast) identified a 10 x 7 cm lesion in the left upper lobe without forming cleavage plans with the aorta and the pulmonary artery (Figures 1B and 1C), with a small left pleural effusion and small mediastinal lymph nodes. An 18F-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) scan (Figure 1D) showed increased metabolic activity in many organs, greatest in the mass in the upper left lobe, the maximum standardized uptake value (SUVmax) of which was 22.
Photograph of a mass occluding the left upper lobe bronchus.
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The bronchoscopic examination revealed a mass occluding the left upper lobe bronchus (Figure 2), and a bronchoscopic biopsy was performed.
Histological examination of the biopsy specimen: in A, extensive necrosis and hemorrhage; in B, immunohistochemical staining for CD31; in C, immunohistochemical staining for factor VIII-related antigen.
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The histological examination of the biopsy specimen showed a soft-tissue neoplasm with a sheet-like or enclosing cleft arrangement of spindle and epithelioid cells with prominent nucleoli, with some multinucleation; mitotic figures were conspicuous, as were extensive necrosis and hemorrhage (Figure 3A). Immunohistochemical staining of the tumor specimen revealed that it was strongly positive for CD31 (Figure 3B), factor VIII-related antigen (Figure 3C), and vimentin; weakly positive for the nuclear transcription factor Fli-1 and cytokeratin AE1/AE3; and negative for CD34, desmin, and smooth muscle actin.