PMC10289867_01
Frontal lung window. Multiple bilateral ground-glass attenuation mostly centered around small nodules (arrowheads).
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fig1
An abnormal chest X-ray led to a diagnostic bronchoscopy in another hospital, but the cause of bleeding could not be determined (Figure 1).
Axial lung window. The ground-glass opacities likely represent peritumoral alveolar hemorrhage, caused by the fragility of neovascular tissue. Pleural effusion is on the right.
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fig2
After admission to our hospital, we ordered a CT scan of the lung, which showed multiple, bilateral medium sized nodules, surrounded by areas of ground-glass opacities (Figure 2).
Sheet-like proliferation and variably formed vascular channels with erythrocytes, lined by high-grade atypical cells.
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fig3
Microscopic examination also demonstrated subpleural and intraparenchymal nodular proliferates of anastomosing vessels and solid sheets with hemorrhage and patchy necrosis, with maximum diameters of 5 mm (Figure 3).
Bifocal nodular proliferates of epithelioid angiosarcoma.
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The neoplasms contained high-grade atypical epithelioid cells with slightly unrounded nuclei and small nucleoli, as well as inconspicuous mitotic figures and abundant cytoplasm (Figure 4).
Nuclear staining for transcriptional regulator ERG.
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Immunostainings revealed strong positivity for CD31 and ERG (Figure 5) and negativity for pan cytokeratin (MNF116).