PMC4836142_01
a Lower extremities of the patient. The morbid obesity and the lymphedema are evident. Also noted are some pressure ulcers in the posterior aspect of the legs with signs of infection. b Multiple hemorrhagic and elevated purple-black lesions as well as multiple small satellite lesions in the lower extremity. c Close-up of the multiple purple-black lesions of the lower extremity, with hemorrhagic characteristics and signs of infection.
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F1
The patient developed multiple hemorrhagic and elevated purple-black lesions (fig. 1a-c).
a Hematoxylin and eosin. x100. The neoplasm infiltrates through the dermis and is associated with hemorrhage. b Hematoxylin and eosin. x400. Irregular vascular spaces are lined by layers of cytologically malignant epithelioid endothelial cells that have amphophilic cytoplasm, large vesicular nuclei with prominent nucleoli. c CD31. x400. Immunohistochemical stain for CD31 stains neoplastic endothelial cells in a membranous pattern.
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F2
There were prominent epithelioid cytology and characteristic hemorrhage (fig. 2a, b). Immunohistochemical studies revealed that the tumor cells were positive for CD31, FLI-1 with a high Ki-67 proliferation rate (up to 30% of total tumor cells) (fig. 2c).