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Gupta P, Singh B, Chaluvashetty SB, Gupta N, Kalra N, Duseja A, Behera A. Cytomorphologic and immunocytochemical diagnosis of primary hepatic angiosarcoma in a young adult: Challenging diagnosis of a rare, aggressive malignancy. Diagn Cytopathol 2023; 51:E82-E88. [PMID: 36409510 DOI: 10.1002/dc.25076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022]
Abstract
Primary hepatic angiosarcoma (PHA) is a rare, rapidly growing, highly aggressive hepatic malignancy, primarily seen in elderly males. Establishing an accurate clinical diagnosis is challenging owing to its rarity and nonspecific presentation. Rendering a cytologic diagnosis of PHA is extremely difficult, and immunocytochemistry(ICC) on cell block(CB) sections is essential to confirm the diagnosis. The characteristic cytomorphologic features of PHA have rarely been documented, further augmenting the diagnostic challenge. A 32-year-old male presented with abdominal pain, abdominal distension, and significant weight loss over the past 9 months. On examination, the abdomen was distended, with multiple spider angiomas and a large mass in the right hypochondrium. His renal function tests, liver function tests, and serum tumor markers were within normal limits. An abdominal triphasic computerized tomography revealed a large lobulated mass in the right lobe with central necrosis. An ultrasound-guided FNA was performed from the liver lesion. The cytologic smears showed singly scattered large, markedly pleomorphic, epithelioid-elongated tumor cells having oval-elongated nuclei, irregular nuclear contours, coarse chromatin, prominent macronucleoli, and abundant finely vacuolated cytoplasm in a background of blood. ICC on the CB demonstrated diffuse positivity for vimentin, CD31, and nuclear positivity for FLI-1, confirming a vascular origin. Hence, a final cytologic diagnosis of primary hepatic angiosarcoma was rendered. The index report describes the characteristic cytomorphologic and immunocytochemical features of a rare hepatic malignancy in a young male and reiterates the usefulness of FNAC coupled with CB-ICC in the quick and precise diagnosis of such challenging cases.
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Affiliation(s)
- Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Brijdeep Singh
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B Chaluvashetty
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunanshu Behera
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Kuang R, Li S, Wang Y. Primary cerebral epithelioid angiosarcoma: a case report. BMC Neurol 2023; 23:49. [PMID: 36721255 PMCID: PMC9887824 DOI: 10.1186/s12883-023-03085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/23/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Primary cerebral epithelioid angiosarcoma (PCEA) is a rare malignant tumor of the central nervous system. To the best of our knowledge, only three cases have been reported in the English language literature thus far. CASE PRESENTATION Here, we report a fourth case in a 73-year-old man admitted for headache. Radiological examination revealed a mass in the right occipital lobe, which was removed by right occipital craniotomy. Histopathological examination revealed epithelioid angiosarcoma. The patient received radiotherapy after resection but survived for only nine months due to recurrence of the tumor and his declining further surgery. CONCLUSIONS In this report, we add to the knowledge base on this exceedingly rare tumor, review the small number of relevant cases published previously, and analyze and summarize the clinical and pathological characteristics, treatment options and prognosis of this cancer.
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Affiliation(s)
- Renzhao Kuang
- grid.413387.a0000 0004 1758 177XDepartment of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
| | - Shun Li
- grid.413387.a0000 0004 1758 177XDepartment of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
| | - Yuanchuan Wang
- grid.413387.a0000 0004 1758 177XDepartment of Neurosurgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000 China
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3
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Vats K, Al-Nourhji O, Wang H, Wang C. Primary epithelioid angiosarcoma of the mediastinum, cytomorphologic features of a rare entity-A case report and literature review. Diagn Cytopathol 2022; 50:E181-E187. [PMID: 35142097 DOI: 10.1002/dc.24946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/01/2022] [Indexed: 11/08/2022]
Abstract
Epithelioid angiosarcoma (EA) is a highly aggressive vascular neoplasm. Primary mediastinal EA is extremely rare with only few cases reported in the English literature. We herein present a case of a 78-year-old patient, who was found to have a right superior mediastinal mass associated with mediastinal and hilar lymphadenopathy. Endobronchial ultrasound guided fine needle aspiration cytology of a station 4R lymph node revealed a cellular, discohesive malignant neoplasm displaying primarily epithelioid morphology with occasional spindled, plasmacytoid, and tumor giant cells. The tumor cells had ample eosinophilic cytoplasm with pleomorphic nuclei and prominent nucleoli. Vasoformative features were noted, exemplified by widespread cytoplasmic vacuoles containing neutrophils and rare red blood cells (hemophagocytosis) and vascular channels identified solely in the cell block. By immunohistochemistry, the tumor cells stained strongly positive for vimentin, positive for ERG, CD-31, FLI-1, and focally positive for pan-cytokeratin. The cytomorphological features and immunostaining patterns were diagnostic of EA. No history of malignancy was reported, and no other lesions were identified on imaging. The diagnosis of primary mediastinal EA on cytology and small biopsy specimens may be challenging due to the rarity of this tumor, limited diagnostic material, and overlapping morphologic features with other entities in the differential diagnosis. A high index of suspicion, especially in cases with vasoformative features, and utilization of ancillary studies can help establish the diagnosis.
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Affiliation(s)
- Karan Vats
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Omar Al-Nourhji
- Department of Pathology and Laboratory Medicine, Eastern Ontario Regional Laboratory Association, University of Ottawa, Ottawa, Canada
| | - Hui Wang
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Chunjie Wang
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Saskatoon, Canada
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4
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Harada H, Ono T, Akiba J, Hirose T, Kawahara A, Abe H, Umeno H, Kurose A. Epithelioid angiosarcoma of the parotid area: A case report with immunohistochemical features and cytological correlation. ORAL AND MAXILLOFACIAL SURGERY CASES 2021. [DOI: 10.1016/j.omsc.2021.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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5
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Khandakar B, Chen H. Ultrasound-guided fine needle aspiration cytology of angiosarcoma of head and neck: a review of cytomorphologic features and discussion of diagnostic pitfall of aspiration cytology of vascular lesions. Diagn Cytopathol 2021; 49:902-906. [PMID: 33964187 DOI: 10.1002/dc.24767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/11/2022]
Abstract
Angiosarcoma is a rare malignant tumor of vascular origin (<2% of sarcomas). It represents <1% of all head-neck malignancies. A cytological diagnosis on fine needle aspiration (FNA) is extremely difficult. Most tumors yield a predominantly hemorrhagic aspirate with only rare neoplastic cells, a diagnostic pitfall of aspiration cytology of vascular lesions. An 81-year-old male, 2 years status post resection of a nasal tip angiosarcoma and adjuvant radiation therapy, presented to another institution with an enlarging left neck mass of 2 months duration. Outside FNA diagnosis of cyst was made. Patient was referred to our institution for a pathologist-performed ultrasound-guided FNA. Ultrasound examination revealed a hypoechoic cystic left neck mass. Direct smears showed blood with occassional single malignant spindled to epithelioid cells, with some cells showing "spider-leg" like cytoplasmic processes/projections and "tadpole/fiber" like morphology. Immunohistochemistry performed on cell block sections revealed the tumor cells to be positive for D2-40, CD31 and CD34, supported a diagnosis of regional recurrent angiosarcoma. Left neck dissection showed recurrent high-grade angiosarcoma infiltrating periparotid soft tissues and metastatic angiosarcoma involving multiple lymph nodes. A diagnosis of angiosarcoma on FNA samples can be challenging, as the aspirate may contain only rare tumor cells hidden in a background of abundant blood. Such cases require careful screening to avoid an incorrect diagnosis of inadequate or cyst contents. This short review highlights key cytomorphologic features of angiosarcoma, includes novel cytologic features of angiosarcoma which has not been described previously and also discusses challenges and diagnostic pitfalls of FNA of vascular lesions.
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Affiliation(s)
- Binny Khandakar
- Fine Needle Aspiration Biopsy Clinic, Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
| | - Hua Chen
- Fine Needle Aspiration Biopsy Clinic, Department of Pathology, Molecular and Cell Based Medicine, Icahn School of Medicine at Mount Sinai Hospital, Mount Sinai Beth Israel, New York, New York, USA
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6
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Nodit PG, Snyder DH, Duncan LD, Clark CT. Solitary scalp nodule-A diagnostic dilemma. Diagn Cytopathol 2021; 49:779-781. [PMID: 33881799 DOI: 10.1002/dc.24747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Paul G Nodit
- The Neuroscience department, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Lisa D Duncan
- Department of Pathology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
| | - Christopher T Clark
- Department of Pathology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee, USA
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Okonkowski LK, Newman RG, Piperisova I. Pathology in Practice. J Am Vet Med Assoc 2020; 255:1237-1239. [PMID: 31730433 DOI: 10.2460/javma.255.11.1237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Lott-Limbach AA, Wakely PE. Mediastinal sarcomas: experience using fine needle aspiration cytopathology. MEDIASTINUM (HONG KONG, CHINA) 2020; 4:14. [PMID: 35118282 PMCID: PMC8794425 DOI: 10.21037/med-20-30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/15/2020] [Indexed: 12/15/2022]
Abstract
Fine needle aspiration (FNA) cytology is a sparsely used diagnostic method in the evaluation of mediastinal sarcomas in most medical centers worldwide with most literature citations regarding this category of malignancies consisting of small series and individual case reports. Most of these published studies highlight vascular sarcomas such as epithelioid hemangioendothelioma, and angiosarcoma, various subtypes of liposarcoma including well-differentiated liposarcoma, myxoid liposarcoma, and pleomorphic liposarcoma, malignant peripheral nerve sheath tumor, and sarcomas of uncertain differentiation, primary synovial sarcoma and the Ewing sarcoma family of tumors. This paucity of cytopathology reports regarding mediastinal sarcomas is in marked contrast to the almost daily application of endobronchial ultrasound (EBUS)-guided FNA biopsy for sampling mediastinal lymph nodes and mediastinal masses for primary and metastatic carcinomas which, of course, are considerably more common that any type of sarcoma in this location. EBUS, endoscopic ultrasound-guided (EUS) needle biopsy, and percutaneous image-guided biopsy using either core needle, fine-needle, or both can serve a potentially useful role for diagnostic sampling of mediastinal sarcomas, be they primary or metastatic. This review catalogues much of the published data regarding FNA cytopathology and its application to mediastinal sarcomas. An attempt is made to primarily highlight case series rather than individual case reports; however, due to the paucity of these, case reports are cited and discussed where appropriate.
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Affiliation(s)
- Abberly A Lott-Limbach
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
| | - Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, OH, USA
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9
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Redaelli D, Guraya SS. Primary hemangioendothelioma of liver; report of a case and review of literature. J Taibah Univ Med Sci 2015. [DOI: 10.1016/j.jtumed.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Klijanienko J, Pierron G, Sastre-Garau X, Theocharis S. Value of combined cytology and molecular information in the diagnosis of soft tissue tumors. Cancer Cytopathol 2014; 123:141-51. [DOI: 10.1002/cncy.21496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/17/2014] [Accepted: 10/27/2014] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gaelle Pierron
- Department of Tumor Biology; Curie Institute; Paris France
| | | | - Stamatios Theocharis
- Department of Tumor Biology; Curie Institute; Paris France
- First Department, Department of Pathology; Medical School; University of Athens; Athens Greece
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11
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Lima PMDA, Oliveira MP, Ferreira GR, Lima TPDM, Lima JDA, Mello RJVD. Effectiveness of histology and cytology on musculoskeletal tumor diagnosis. ACTA ORTOPEDICA BRASILEIRA 2014; 22:132-5. [PMID: 25061418 PMCID: PMC4108694 DOI: 10.1590/1413-78522014220300440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 04/16/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To compare cytology and histology on the diagnosis of musculoskeletal neoplasms. METHOD: Fifty eight cases available to evaluation were analyzed both by cytology and histology. The results of the biopsies studied by histology and cytology were compared to the results obtained on the surgical specimen or immunohistochemistry. We determined the percentage of correct results, sensitivity, specificity, positive and negative predictive values and accuracy of each method. RESULTS: Twelve per cent of biopsies were inconclusive by cytology. The percentage of correct diagnosis was 70.7% and 81% (p=.179), the ability to differentiate benign lesions from malignant ones was 84.5% and 93.1% (p=0.18) respectively, for cytology and histology. Cytology showed sensitivity of 87.8%, specificity of 76.5%, positive predictive value of 90%, negative predictive value of 72% and accuracy 84.5%. Histology showed sensitivity of 90.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 81% and accuracy of 93.1%. The Youden index for cytology was 64.3% and for histology it was 90.2%. CONCLUSION: Despite promising, cytology obtained by thin needle aspiration is less accurate and reliable than the histological evaluation on musculoskeletal tumors diagnosis. Level of Evidence II, Diagnostic Studies.
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12
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Jung MJ, Kim YO. A case of metastatic angiosarcoma diagnosed by liquid-based preparation: peculiar cytoplasmic changes. KOREAN JOURNAL OF PATHOLOGY 2014; 48:241-7. [PMID: 25013424 PMCID: PMC4087139 DOI: 10.4132/koreanjpathol.2014.48.3.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 04/02/2014] [Accepted: 04/07/2014] [Indexed: 01/06/2023]
Abstract
Angiosarcoma with predominantly epithelioid features is a rare soft tissue neoplasm and the interpretation of its cytopathologic findings may be difficult. We report a case of metastatic angiosarcoma with predominantly epithelioid features diagnosed by liquid-based cytology. The cytopathologic findings in this case differed from those of the conventional preparation and we found a clean background, no hyperchromatic nuclei and several cytoplasmic changes, including intracytoplasmic vacuoles with peculiar shapes, juxtanuclear condensation and perinuclear clearing. Identification of these changes using liquid-based cytology supplemented with immunochemistry may be helpful in reaching a correct cytopathologic diagnosis.
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Affiliation(s)
- Min Jung Jung
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
| | - Young Ok Kim
- Department of Pathology, Kosin University College of Medicine, Busan, Korea
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13
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Lima PMDA, Oliveira MP, Silva HJD, Mello RJVD. The role of cytology in the diagnosis of musculoskeletal neoplasms: systematic review. ACTA ORTOPEDICA BRASILEIRA 2014; 20:48-52. [PMID: 24453581 PMCID: PMC3718411 DOI: 10.1590/s1413-78522012000100010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 04/02/2011] [Indexed: 12/14/2022]
Abstract
The authors systematically reviewed the literature of the last decade on the role of
cytology in the evaluation of musculoskeletal neoplasms, and its diagnostic accuracy. A
search was carried out on the databases PubMed, MEDLINE, LILACS and SciELO, selecting
articles in which cytology was used in the diagnosis of musculoskeletal neoplasms. Limits
were used for English, Spanish and Portuguese, and only articles published since 2000 were
selected. 757 articles were retrieved, 24 of which were selected based on criteria of
inclusion and exclusion. It was concluded that although promising in the assessment of
musculoskeletal neoplasms, cytology obtained by fine needle aspiration is less accurate
and reliable than histological evaluation of such lesions.
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VandenBussche CJ, Wakely PE, Siddiqui MT, Maleki Z, Ali SZ. Cytopathologic characteristics of epithelioid vascular malignancies. Acta Cytol 2014; 58:356-66. [PMID: 25195738 DOI: 10.1159/000366151] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 07/24/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Epithelioid hemangioendothelioma (EHE) and epithelioid angiosarcoma (EAS) are rare vascular neoplasms that share many morphological characteristics on histology but demonstrate different clinical behavior. Given the many reported clinical and morphological features shared between EAS and EHE, we examined all cases of EAS and EHE diagnosed primarily on fine needle aspiration (FNA) at our three institutions that were confirmed by a tissue diagnosis. STUDY DESIGN A total of 29 cases from 25 patients were identified: 15 EHE from 11 patients and 14 EAS from 14 patients. RESULTS Many cytomorphological features existed on a spectrum that overlapped considerably between EAS and EHE cases. Common features between the two entities include epithelioid morphology and eccentrically placed nucleus. Intracytoplasmic lumens (ICL), a morphological feature that may suggest vascular origin, can be found in both entities but are not always present. CONCLUSIONS Given the general absence of vascular cytomorphological features, such as ICL, the proper classification of these tumors depends on the successful use of immunoperoxidase markers such as factor VIII-related antigen, ERG, or CD31 as well as a high index of suspicion. The distinction between EAS and EHE on FNA alone is treacherous at best.
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Barger AM, Skowronski MC, MacNeill AL. Cytologic identification of erythrophagocytic neoplasms in dogs. Vet Clin Pathol 2012; 41:587-9. [DOI: 10.1111/j.1939-165x.2012.00472.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Melissa C. Skowronski
- Veterinary Clinical Medicine; College of Veterinary Medicine; University of Illinois; Urbana; IL; USA
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Abstract
Soft tissue swelling represents a common clinical sign of a variety of neoplastic and non-neoplastic lesions. Sarcoma is rarely a cause. Fine needle biopsy as a minimally invasive, economic and accurate method is well suited for the diagnosis of inflammatory/infectious processes as well as of recurrent and metastatic disease. Cytologic diagnosis of primary soft tissue tumors is also feasible. It requires close collaboration with other medical disciplines and incorporation of clinical, radiological and morphologic findings. Clinical data such as age, gender, size and topography are important parameters. The differentiation of cells and properties of the extracellular matrix supplies clues for the differential diagnosis and forms the starting point for immunohistochemical or molecular analysis (FISH, RT-PCR). This analysis may be performed on cytological smears, paraffin embedded material of the cell blocks or on frozen material.
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Singh C, Xie L, Schmechel SC, Manivel JC, Pambuccian SE. Epithelioid angiosarcoma of the kidney: a diagnostic dilemma in fine-needle aspiration cytology. Diagn Cytopathol 2011; 40 Suppl 2:E131-9. [PMID: 21698784 DOI: 10.1002/dc.21762] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 05/21/2011] [Indexed: 02/07/2023]
Abstract
Epithelioid angiosarcomas (EAS) of kidney are rare and aggressive tumors with noncharacteristic imaging features that overlap with those of inflammatory conditions and renal cell carcinoma (RCC). We report the fine-needle aspiration (FNA) cytology findings of a case of EAS that involved the left kidney of an 83-year-old male. The smears and cell block sections showed pleomorphic epithelioid cells with ample cytoplasm, eccentric nuclei, occasional cytoplasmic hyaline globules, and rare intracytoplasmic lumina. Immunohistochemical stains performed on cellblock sections showed that the tumor cells were positive for vimentin, CD31, CD34, Factor VIII, and CD10, but showed no staining for cytokeratins AE1/AE3 and 8/18, HMB45, CD45, smooth muscle actin, and S100. The morphological and immunohistochemical distinction between EAS, primary tumors of the kidney, and other epithelioid and rhabdoid neoplasms is discussed.
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Affiliation(s)
- Charanjeet Singh
- Department of Laboratory Medicine & Pathology, University of Minnesota Medical School, 420 Delaware SE, Minneapolis, MN 55455, USA
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18
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Ji JX, Chu YC, Kim L, Choi SJ, Park IS, Han JY, Kim JM, Kim KH, Song JY. Fine Needle Aspiration Cytologic Findings of Angiosarcoma - Report of Two Cases -. KOREAN JOURNAL OF PATHOLOGY 2011. [DOI: 10.4132/koreanjpathol.2011.45.2.217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Jin Xian Ji
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Young Chae Chu
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Lucia Kim
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Suk Jin Choi
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - In Suh Park
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jee Young Han
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Joon Mee Kim
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Kyu Ho Kim
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Ju Young Song
- Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Chen YB, Guo LC, Yang L, Feng W, Zhang XQ, Ling CH, Ji C, Huang JA. Angiosarcoma of the lung: 2 cases report and literature reviewed. Lung Cancer 2010; 70:352-6. [DOI: 10.1016/j.lungcan.2010.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/02/2010] [Accepted: 09/06/2010] [Indexed: 01/18/2023]
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20
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Pohar-Marinšek Ž, Lamovec J. Angiosarcoma in FNA smears: diagnostic accuracy, morphology, immunocytochemistry and differential diagnoses. Cytopathology 2010; 21:311-9. [DOI: 10.1111/j.1365-2303.2009.00726.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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22
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Application of immunocytochemistry to the diagnosis of primary epithelioid angiosarcoma of the lung. Med Mol Morphol 2009; 42:250-3. [DOI: 10.1007/s00795-008-0417-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2008] [Accepted: 09/11/2008] [Indexed: 12/17/2022]
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23
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Lemos MM, Chaves P, Mendonça ME. Is preoperative cytologic diagnosis of epithelioid sarcoma possible? Diagn Cytopathol 2008; 36:780-6. [DOI: 10.1002/dc.20835] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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24
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Abstract
Soft tissue swellings represent common clinical signs of a variety of neoplastic and non-neoplastic lesions. Sarcomas are rarely the cause. Fine needle biopsy as a minimally invasive, economic and accurate method is well suited for the diagnostics of recurrent and metastatic diseases. Cytologic diagnosis of primary soft tissue tumors is also feasible but requires close collaboration with other medical disciplines and incorporation of clinical, radiological and morphologic findings. Clinical data such as age, gender, size and topography are also important parameters. Differentiation of the cells and the properties of the extracellular matrix offer initial indications for the differential diagnosis and are the starting point for immunohistochemical and molecular analyses (FISH, RT-PCR). These analyses can be performed on cytological smears, on paraffin-embedded cell blocks on snap frozen material.
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Affiliation(s)
- B Bode-Lesniewska
- Abteilung Zytopathologie,Institut für Klinische Pathologie, Universitätsspital Zürich, CH-8091, Zürich, Schweiz.
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Abstract
OBJECTIVE To discuss the treatment and outcomes for cutaneous angiosarcoma. METHODS Review of the pertinent literature. RESULTS Cutaneous angiosarcoma is a rare, aggressive malignancy with a poor prognosis. It usually arises in the scalp or face and is locally advanced at presentation. Patients are most often white, male, and elderly. A subset of patients presents with multifocal disease and/or positive regional nodes. Although the optimal treatment is surgery followed by wide-field radiotherapy (RT), the disease is frequently so extensive at diagnosis that it is not completely resectable. Even after optimal local-regional treatment, there is a relatively high likelihood of a local recurrence at the margins of the RT fields. The probability of hematogenous dissemination is relatively high. Limited data suggest that chemotherapy may be useful for palliation with progression-free survival rates ranging from 1 to 5 months. The 5-year local-regional control rates are approximately 40% to 50%, the 5-year distant metastasis-free survival rates range from 20% to 40%, and the 5-year survival rates range from 10% to 30%. CONCLUSION Cutaneous angiosarcoma is a rare, aggressive malignancy that is optimally treated with resection and wide-field postoperative RT. The likelihood of local-regional failure is high, as is the risk of distant relapse. Chemotherapy may be useful for short-term palliation.
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Affiliation(s)
- William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA.
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Sanchez-Mejia RO, Ojemann SG, Simko J, Chaudhary UB, Levy J, Lawton MT. Sacral epithelioid angiosarcoma associated with a bleeding diathesis and spinal epidural hematoma: case report. J Neurosurg Spine 2006; 4:246-50. [PMID: 16572625 DOI: 10.3171/spi.2006.4.3.246] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Epithelioid angiosarcoma of bone is a rare, high-grade lesion that is highly vascular and can be associated with a bleeding diathesis. An association has been reported in angiosarcomas in other locations with coagulopathy from tumor-related disseminated intravascular coagulopathy and fibrinolysis. The authors report the case of a rare occurrence of a primary sacral epithelioid angiosarcoma associated with a large epidural hematoma and a severe bleeding diathesis. A 25-year-old woman presented with weakness, fatigue, neck and low-back pain, and progressive left S-1 radiculopathy. Imaging studies revealed a large ventral epidural hematoma extending from the sacral region rostrally to C-2 and a vascular tumor located in the sacrum. The patient underwent a sacral laminectomy, complicated by postoperative bleeding from the wound, and required massive transfusions. Ultimately, multimodal therapy was required to obtain hemostasis, including the use of endovascular embolization, radiation therapy, and an infusion of epsilon-aminocaproic acid with heparin. This case represents the first report of a primary epithelioid angiosarcoma in the sacrum and emphasizes that the coagulopathy seen in angiosarcoma is also a feature of this epithelioid variant.
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Affiliation(s)
- Rene O Sanchez-Mejia
- Department of Neurological Surgery, University of California, San Francisco 94143, USA
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Levine PH, Nimeh D, Guth AA, Cangiarella JF. Aspiration biopsy of nodular pseudoangiomatous stromal hyperplasia of the breast: clinicopathologic correlates in 10 cases. Diagn Cytopathol 2005; 32:345-50. [PMID: 15880710 DOI: 10.1002/dc.20270] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nodular pseudoangiomatous stromal hyperplasia (PASH) of the breast is rare and often indistinguishable from fibroadenoma, clinically and on aspiration biopsy smears. We report our observations in 10 patients with PASH, evaluated by fine-needle aspiration (FNA) biopsy and core biopsy. We retrospectively reviewed the clinical, radiographic, cytologic, and histologic findings in 10 cases of pure nodular PASH. Ten patients with a presumed clinical and radiologic diagnosis of fibroadenoma underwent aspiration biopsy. The aspiration smears were diagnosed as fibroadenoma (4 cases), cellular fibroadenoma (1 case), schwannoma versus neurofibroma (1 case), fibrocystic change (3 cases; 2 with atypia), and "not specific for a lesion" (1 case). A diagnosis of PASH was not suspected in any case. A discrepant or imprecise cytologic diagnosis and/or the presence of dissociated spindle or epithelial cells, or cellular stromal fragments prompted a surgical excision in 7 of 10 patients (70%). The remaining 3 patients exhibited cytologic features of fibroadenoma and were diagnosed as such; however, surgical excision was recommended. Three patients underwent a subsequent core biopsy, with a diagnosis of PASH being made in 1 patient. FNA biopsy could not discriminate PASH from fibroadenoma in 4 of 10 patients (40%) or suggest a diagnosis of PASH in any case. On retrospective review, the finding of plump, spindle-shaped mesenchymal cells may be a cytologic clue to suggest a diagnosis of PASH.
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Affiliation(s)
- Pascale Hummel Levine
- Department of Pathology, New York University School of Medicine, New York, New York 10016, USA.
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28
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Gherardi G, Rossi S, Perrone S, Scanni A. Angiosarcoma after breast-conserving therapy: Fine-needle aspiration biopsy, immunocytochemistry, and clinicopathologic correlates. Cancer 2005; 105:145-51. [PMID: 15844179 DOI: 10.1002/cncr.21035] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Angiosarcoma that arises after breast-conserving therapy can present clinically as a cutaneous and/or subcutaneous breast lump, which is misinterpreted easily as a recurrence of carcinoma. To the authors' knowledge, the role of fine-needle aspiration (FNA) cytology in the early diagnosis of this life-threatening complication of breast carcinoma therapy has not been established fully. METHODS The authors studied three new patients with this type of secondary angiosarcoma diagnosed by FNA biopsy and immunocytochemistry, reviewed the literature on the topic, and examined relevant differential diagnostic issues. RESULTS Patients presented with a discrete skin lump that had arisen several years after breast-conservative therapy for early-stage breast carcinoma near the scar from the previous surgery. The lesions were interpreted clinically as recurrent carcinoma. FNA yielded moderately cellular to highly cellular samples with variable patterns of cellular aggregation. Cells were epithelioid and spindle-shaped. Angioformative changes were subtle, and the overall picture suggested an epithelial malignancy, possibly a metaplastic carcinoma. Immunostaining of smears, however, provided conclusive evidence of the endothelial differentiation of tumor cells, and an FNA diagnosis of angiosarcoma was rendered in all patients. The histopathology of all surgically excised tumors confirmed the diagnosis of high-grade angiosarcoma. CONCLUSIONS Based on the authors' experience, the FNA cytologic appearance of angiosarcoma that presented as a breast skin nodule in a breast carcinoma survivor easily could have been misinterpreted as carcinoma. A correct diagnosis of this tumor relies on the proper evaluation of clinical findings and, as also shown by a review of the literature, requires immunocytochemical evidence of endothelial differentiation.
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MESH Headings
- Aged
- Aged, 80 and over
- Biopsy, Fine-Needle
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma in Situ/pathology
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/secondary
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Lobular/secondary
- Carcinoma, Lobular/surgery
- Female
- Hemangiosarcoma/secondary
- Hemangiosarcoma/therapy
- Humans
- Immunohistochemistry
- Mastectomy, Segmental/adverse effects
- Mastectomy, Segmental/methods
- Neoplasm Staging
- Prognosis
- Risk Assessment
- Sampling Studies
- Sensitivity and Specificity
- Skin Neoplasms/secondary
- Skin Neoplasms/therapy
- Survival Rate
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Affiliation(s)
- Giorgio Gherardi
- Department of Pathology, Fatebenefratelli Hospital, Milan, Italy.
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29
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Gagner JP, Yim JH, Yang GCH. Fine-needle aspiration cytology of epithelioid angiosarcoma: A diagnostic dilemma. Diagn Cytopathol 2005; 33:429-33. [PMID: 16299742 DOI: 10.1002/dc.20379] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
A 28-year-old woman with a 2-yr history of unilateral chronic leg swelling, initially thought to be secondary to deep vein thrombosis, later thought to be due to congenital venous malformation, eventually developed a pelvic mass, which was biopsied by fine-needle aspiration. On the basis of cytologic features on smears, high-grade sarcoma was reported. The patient underwent surgery to resect the pelvic mass, which showed anastomosing vascular channels arising from external iliac vein in histology. However, the tumor cells unexpectedly showed strong and diffuse immunohistochemical expression of cytokeratin and epithelial membrane antigen. The case was sent for expert consultation, and the expert's opinion was epithelioid angiosarcoma. The expert's diagnosis was confirmed 2 yr later by local recurrence. The clinical presentation, cytology, histology, and immunohistochemistry of the current case and 15 other cases of epithelioid angiosarcoma found in the cytology literature are summarized. This case illustrates that morphology with clinicopathologic correlation tends to be a better guide than available special techniques.
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Affiliation(s)
- Jean-Pierre Gagner
- Department of Pathology, New York University School of Medicine, New York, New York 10016, USA
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Lin O, Olgac S, Zakowski M. Cytological features of epithelioid mesenchymal neoplasms: A study of 21 cases. Diagn Cytopathol 2004; 32:5-10. [PMID: 15584049 DOI: 10.1002/dc.20146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Epithelioid mesenchymal neoplasms (EMNs) are rare tumors that share cytological, histological, and immunohistochemical features with epithelial tumors. It is important to distinguish EMNs from epithelial tumors in cytology specimens due to their different clinical management and prognosis. The cytomorphological features of histologically confirmed EMN were reviewed. Twenty-one cytological specimens of EMN were evaluated and characterized by polygonal cells with moderate to abundant dense cytoplasm, prominent nucleoli, and pleomorphism. Additional findings included the presence of a distinct population of spindle cells, hemosiderin-containing cells, multinucleated cells, and granuloma-like structures in selected cases. Cytokeratin immunoreactivity was seen in two cases and was negative in one case. This study shows that the cytological features of EMNs and epithelial tumors overlap; nonetheless, some features are more helpful in suggesting EMN. A panel of immunocytochemical studies must include specific mesenchymal markers to avoid a misdiagnosis of carcinoma in cases of cytokeratin-positive EMN.
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Affiliation(s)
- Oscar Lin
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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