PMC10152856_01
Radiological Findings of the Epithelioid Angiosarcoma of the Urinary Bladder. A), CT scan findings include a marked thickening of the wall of the urinary bladder and distension of its lumen by blood clots; B), Selective Angioembolization of left vesical vessels and angioembolization of the anterior branch of the left internal iliac artery; C-D), CT scan with IV contrast post radical cystoprostatectomy and studor ileal neobladder revealing a huge hepatic subcapsular hematoma; E), Follow-up CXR, CT chest revealed the development of metastasis in the lungs; F), post radical cystoprostatectomy follow up with pouchogram, the placement of IVC filter and angioembolization
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F1
CT scan revealed a urinary bladder markedly distended with blood clots (Figure 1-a) but no definite bladder mass.  Initially, we performed embolization of small arterial bleeder and venous malformation of left urinary bladder wall, then selective embolization of left vesical vessels and finally angioembolization of the anterior branch of the left internal iliac artery (Figure 1-b) with temporary improvement in hematuria. Hgb level (about 4 grams). He was resuscitated, and a CT scan with IV contrast showed a massive hepatic subcapsular hematoma (Figure 1-C-D) which was successfully managed conservatively (ICU admission, complete bed rest, blood transfusion, and stopping anticoagulation with the placement of IVC filter (Figure 1-F). A Follow-up CT scan revealed the development of multiple metastatic deposits in the liver (with spontaneous bleeding, Figure 1-F), regional and para-aortic lymph nodes, lungs (Figure 1- E), and left suprarenal gland.
Histological Findings of the Epithelioid Angiosarcoma of the Urinary Bladder. A-B-C, Urinary bladder with ulcerated, hemorrhagic, necrotic mucosa and numerous calcified bilharzial eggs; D-E-F, Within the lamina propria, there is a vasoformative neoplasm composed of vascular channels lined by atypical endothelial cells (nuclear pleomorphism, and hyperchromatism); G-H-I, The malignant epithelioid cells were positive for CD34, and factor VIII
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F2
A gross examination of the urinary bladder revealed irregularly ulcerated, hemorrhagic, necrotic diffusely thickened bladder mucosa but no definite mass (Figure 2: a-b-c). Numerous calcified Schistosoma eggs are noted (Figure 2: D-E-F)). Further immunohistochemical analysis revealed that the malignant epithelioid cells were reactive for CD31, CD34, factor VIII, FLI1, and p53 (Fig 2 G-H-I).