PMC2731464_01
(a) (colouring H&E 10x) Angiosarcoma moderately differentiated. (b) (colouring H&E 40x) Greater enlargement angiosarcoma moderately differentiated. (c) (20x) Immunohistochemical investigation tumor cells were positive for CD 31. (d) (20x) Immunohistochemical investigation tumor cells were positive for CD34. (e) (20x) Immunohistochemical investigation tumor cells were positive for FVIII rAg. (f) (40x) Positive for Mib-1 60%.
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fig1
At low power, the tumor showed an alternation of hyper- and hypocellular areas with the presence of dense keloid-type collagen alternating to myxoid areas (Figure 1(a)). In other areas, the neoplasm showed clusters of small and short capillary-like slits, sometimes in stellate configuration, lined with variably atypical tumor cells (Figure 1(b)). The immunohistochemical investigation documented that tumor cells were positive for CD31 (Figure 1(c)), CD34 (Figure 1(d)), Von Willebrand Factor (VWF) (Figure 1(e)), and about 60% of them were positive for Mib-1 (Figure 1(f)), whereas they were negative for EMA, bcl-2, smooth muscle actin, common muscle actin, desmin, and protein S-100.
Voluminous left pleural effusion. Large mass extending from the free wall of the right atrium to the anterior mediastinum beside the superior vena cava and ascending aorta and above until the right pulmonary artery.
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fig2
A further evaluation with cardiac magnetic resonance imaging (MRI) showed a large mass (53 mm) extending from the free wall of the right atrium to the anterior mediastinum beside the superior vena cava and ascending aorta, above up to the right pulmonary artery, clearly revealed irregular signals in the mass after gadolinium enhancement (Figure 2).