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Difference between revisions of "Angiosarcoma"
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| Caption = Epithelioid angiosarcoma. [[H&E stain]]. | | Caption = Epithelioid angiosarcoma. [[H&E stain]]. | ||
| Micro = atypical cells - usu. spindle cells, occasionally epithelioid; vascular differentiation (abundant capillaries - "red" at low power, +/-cytoplasmic vacuolization, +/-hobnail endothelial cells) | | Micro = atypical cells - usu. spindle cells, occasionally epithelioid; vascular differentiation (abundant capillaries - "red" at low power, +/-cytoplasmic vacuolization, +/-[[hobnail]] endothelial cells) | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[Kaposi sarcoma]], other [[vascular tumours]] | | LMDDx = [[Kaposi sarcoma]], [[anastomosing hemangioma]], other [[vascular tumours]] | ||
| Stains = | | Stains = | ||
| IHC = CD31 +ve, FLI-1 +ve, CD34 +ve, HHV-8 -ve | | IHC = CD31 +ve, FLI-1 +ve, CD34 +ve, HHV-8 -ve | ||
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*May arise secondary to chronic lymphedema related to [[invasive breast cancer|breast carcinoma]]. | *May arise secondary to chronic lymphedema related to [[invasive breast cancer|breast carcinoma]]. | ||
**Known as ''Stewart–Treves syndrome''.<ref name=pmid18753651>{{Cite journal | last1 = Pincus | first1 = LB. | last2 = Fox | first2 = LP. | title = Images in clinical medicine. The Stewart-Treves syndrome. | journal = N Engl J Med | volume = 359 | issue = 9 | pages = 950 | month = Aug | year = 2008 | doi = 10.1056/NEJMicm071344 | PMID = 18753651 | url=http://www.nejm.org/doi/full/10.1056/NEJMicm071344}}</ref> | **Known as ''Stewart–Treves syndrome''.<ref name=pmid18753651>{{Cite journal | last1 = Pincus | first1 = LB. | last2 = Fox | first2 = LP. | title = Images in clinical medicine. The Stewart-Treves syndrome. | journal = N Engl J Med | volume = 359 | issue = 9 | pages = 950 | month = Aug | year = 2008 | doi = 10.1056/NEJMicm071344 | PMID = 18753651 | url=http://www.nejm.org/doi/full/10.1056/NEJMicm071344}}</ref> | ||
*Association with radiation - breast,<ref name=pmid25504856>{{Cite journal | last1 = Chikarmane | first1 = SA. | last2 = Gombos | first2 = EC. | last3 = Jagadeesan | first3 = J. | last4 = Raut | first4 = C. | last5 = Jagannathan | first5 = JP. | title = MRI findings of radiation-associated angiosarcoma of the breast (RAS). | journal = J Magn Reson Imaging | volume = | issue = | pages = | month = Dec | year = 2014 | doi = 10.1002/jmri.24822 | PMID = 25504856 }}</ref> [[urinary bladder]].<ref name=pmid25688314>{{Cite journal | last1 = Bahouth | first1 = Z. | last2 = Masarwa | first2 = I. | last3 = Halachmi | first3 = S. | last4 = Nativ | first4 = O. | title = Primary angiosarcoma of urinary bladder: 13th reported patient. | journal = Case Rep Oncol Med | volume = 2015 | issue = | pages = 652870 | month = | year = 2015 | doi = 10.1155/2015/652870 | PMID = 25688314 }}</ref> | |||
*[[Hepatic angiosarcoma|Liver angiosarcoma]]s are associated with vinyl chloride exposure.<ref>{{Ref PCPBoD8|212}}</ref> | *[[Hepatic angiosarcoma|Liver angiosarcoma]]s are associated with vinyl chloride exposure.<ref>{{Ref PCPBoD8|212}}</ref> | ||
*Cutaneous angiosarcomas are classically seen on the head and neck of whites over 60 years old.<ref name=pmid>{{Cite journal | last1 = Albores-Saavedra | first1 = J. | last2 = Schwartz | first2 = AM. | last3 = Henson | first3 = DE. | last4 = Kostun | first4 = L. | last5 = Hart | first5 = A. | last6 = Angeles-Albores | first6 = D. | last7 = Chablé-Montero | first7 = F. | title = Cutaneous angiosarcoma. Analysis of 434 cases from the Surveillance, Epidemiology, and End Results Program, 1973-2007. | journal = Ann Diagn Pathol | volume = 15 | issue = 2 | pages = 93-7 | month = Apr | year = 2011 | doi = 10.1016/j.anndiagpath.2010.07.012 | PMID = 21190880 }}</ref> | *Cutaneous angiosarcomas are classically seen on the head and neck of whites over 60 years old.<ref name=pmid>{{Cite journal | last1 = Albores-Saavedra | first1 = J. | last2 = Schwartz | first2 = AM. | last3 = Henson | first3 = DE. | last4 = Kostun | first4 = L. | last5 = Hart | first5 = A. | last6 = Angeles-Albores | first6 = D. | last7 = Chablé-Montero | first7 = F. | title = Cutaneous angiosarcoma. Analysis of 434 cases from the Surveillance, Epidemiology, and End Results Program, 1973-2007. | journal = Ann Diagn Pathol | volume = 15 | issue = 2 | pages = 93-7 | month = Apr | year = 2011 | doi = 10.1016/j.anndiagpath.2010.07.012 | PMID = 21190880 }}</ref> | ||
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*Very many small capillaries of irregular shape lined with: | *Very many small capillaries of irregular shape lined with: | ||
**Pleomorphic nuclei - '''important'''. | **Pleomorphic nuclei - '''important'''. | ||
***May have hobnail morphology. | ***May have [[hobnail morphology]]. | ||
**Usually "red" at low power - due to many RBCs - '''important'''. | **Usually "red" at low power - due to many RBCs - '''important'''. | ||
*Mitoses. | *Mitoses. | ||
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Notes: | Notes: | ||
*Epithelioid variant (with abundant cytoplasm & sheeting architecture) may resemble ''[[melanoma]]'' or ''[[hepatocellular carcinoma]]''. | *Epithelioid variant (with abundant cytoplasm & sheeting architecture) may resemble ''[[melanoma]]'' or a ''carcinoma'' (such as ''[[hepatocellular carcinoma]]'' or ''[[urothelial carcinoma]]''<ref name=pmid25929352>{{cite journal |authors=Matoso A, Epstein JI |title=Epithelioid Angiosarcoma of the Bladder: A Series of 9 Cases |journal=Am J Surg Pathol |volume=39 |issue=10 |pages=1377–82 |date=October 2015 |pmid=25929352 |doi=10.1097/PAS.0000000000000444 |url=}}</ref>). | ||
DDx: | DDx: | ||
* | *Atypical vascular lesion. | ||
*[[Kaposi sarcoma]]. | *[[Kaposi sarcoma]]. | ||
*Poorly differentiated carcinoma. | *[[Anastomosing hemangioma]] - especiallly in the [[kidney]]. | ||
*Poorly differentiated carcinoma, e.g. [[urothelial carcinoma]]. | |||
*Other [[vascular tumours]]. | |||
===Images=== | ===Images=== | ||
====Case 1==== | |||
<gallery> | <gallery> | ||
Image:Epithelioid_angiosarcoma_-_very_low_mag.jpg | Epithelioid angiosarcoma - very low mag. (WC/Nephron) | Image:Epithelioid_angiosarcoma_-_very_low_mag.jpg | Epithelioid angiosarcoma - very low mag. (WC/Nephron) | ||
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Image:Epithelioid_angiosarcoma_-_very_high_mag.jpg | Epithelioid angiosarcoma - very high mag. (WC/Nephron) | Image:Epithelioid_angiosarcoma_-_very_high_mag.jpg | Epithelioid angiosarcoma - very high mag. (WC/Nephron) | ||
Image:Epithelioid_angiosarcoma_-_CD31_-_intermed_mag.jpg | Epithelioid angiosarcoma - CD31 - intermed. mag. (WC/Nephron) | Image:Epithelioid_angiosarcoma_-_CD31_-_intermed_mag.jpg | Epithelioid angiosarcoma - CD31 - intermed. mag. (WC/Nephron) | ||
</gallery> | |||
====Case 2==== | |||
<gallery> | |||
Image: Renal angiosarcoma -- intermed mag.jpg | Angiosarcoma (kidney) - low mag. | |||
Image: Renal angiosarcoma - alt -- intermed mag.jpg | Angiosarcoma (kidney) - low mag. | |||
Image: Renal angiosarcoma -- high mag.jpg | Angiosarcoma (kidney) - high mag. | |||
Image: Renal angiosarcoma -- very high mag.jpg | Angiosarcoma (kidney) - very high mag. | |||
Image: Renal angiosarcoma in fat -- intermed mag.jpg | Angiosarcoma (kidney) - low mag. | |||
Image: Renal angiosarcoma in fat - alt -- intermed mag.jpg | Angiosarcoma (kidney) - low mag. | |||
Image: Renal angiosarcoma in fat -- high mag.jpg | Angiosarcoma (kidney) - high mag. | |||
</gallery> | |||
====Additional==== | |||
<gallery> | |||
Image:Breast Angiosarcoma Epithelioid HP2 CTR.jpg|Breast - Epithelioid angiosarcoma - high power (SKB) | |||
Image:Breast Angiosarcoma Epithelioid HP CTR.jpg|Breast - Epithelioid angiosarcoma - high power (SKB) | |||
Image:Breast Angiosarcoma Epithelioid MP CTR.jpg|Breast - Epithelioid angiosarcoma - medium power (SKB) | |||
Image:Breast Angiosarcoma HighGrade Breast HP PA.JPG|Breast - Angiosarcoma - high grade - high power (SKB) | |||
Image:Breast Angiosarcoma HighGrade Breast PA.JPG|Breast - Angiosarcoma - high grade - high power (SKB) | |||
Image:Breast Angiosarcoma HighGrade HP PA.JPG|Breast - Angiosarcoma - high grade - high power (SKB) | |||
Image:Breast Angiosarcoma HP3 SNP.jpg|Breast - Angiosarcoma - high power (SKB) | |||
Image:Breast Angiosarcoma LowGradeArea FatInvasion MP CTR.jpg|Breast - Angiosarcoma - low grade area - encircling fat - high power (SKB) | |||
Image:Breast Angiosarcoma HP SNP.jpg|Breast - Angiosarcoma - high power (SKB) | |||
Image:Breast Angiosarcoma HighGradeArea MP CTR.jpg|Breast - Angiosarcoma - high grade area - high power (SKB) | |||
Image:Breast Angiosarcoma HP PA.JPG|Breast - Angiosarcoma - high power (SKB) | |||
Image:Breast Angiosarcoma HighGrade PA.JPG|Breast - Angiosarcoma - high power (SKB) | |||
Image:Breast Angiosarcoma LP SNP.jpg|Breast - Angiosarcoma - low power (SKB) | |||
Image:Breast Angiosarcoma MP SNP.jpg|Breast - Angiosarcoma - Medium power (SKB) | |||
Image:Breast Angiosarcoma LP CTR.jpg|Breast - Angiosarcoma - low power (SKB) | |||
</gallery> | </gallery> | ||
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*CD34 +ve. | *CD34 +ve. | ||
*CD31 +ve. | *CD31 +ve. | ||
*ERG +ve <ref>{{Cite journal | last1 = Miettinen | first1 = M. | last2 = Wang | first2 = ZF. | last3 = Paetau | first3 = A. | last4 = Tan | first4 = SH. | last5 = Dobi | first5 = A. | last6 = Srivastava | first6 = S. | last7 = Sesterhenn | first7 = I. | title = ERG transcription factor as an immunohistochemical marker for vascular endothelial tumors and prostatic carcinoma. | journal = Am J Surg Pathol | volume = 35 | issue = 3 | pages = 432-41 | month = Mar | year = 2011 | doi = 10.1097/PAS.0b013e318206b67b | PMID = 21317715 }} | |||
</ref> | |||
*FLI-1 +ve.<ref name=pmid15001993>{{Cite journal | last1 = Rossi | first1 = S. | last2 = Orvieto | first2 = E. | last3 = Furlanetto | first3 = A. | last4 = Laurino | first4 = L. | last5 = Ninfo | first5 = V. | last6 = Dei Tos | first6 = AP. | title = Utility of the immunohistochemical detection of FLI-1 expression in round cell and vascular neoplasm using a monoclonal antibody. | journal = Mod Pathol | volume = 17 | issue = 5 | pages = 547-52 | month = May | year = 2004 | doi = 10.1038/modpathol.3800065 | PMID = 15001993 }}</ref> | *FLI-1 +ve.<ref name=pmid15001993>{{Cite journal | last1 = Rossi | first1 = S. | last2 = Orvieto | first2 = E. | last3 = Furlanetto | first3 = A. | last4 = Laurino | first4 = L. | last5 = Ninfo | first5 = V. | last6 = Dei Tos | first6 = AP. | title = Utility of the immunohistochemical detection of FLI-1 expression in round cell and vascular neoplasm using a monoclonal antibody. | journal = Mod Pathol | volume = 17 | issue = 5 | pages = 547-52 | month = May | year = 2004 | doi = 10.1038/modpathol.3800065 | PMID = 15001993 }}</ref> | ||
*D2-40 +ve/-ve.<ref name=pmid11950918>{{Cite journal | last1 = Kahn | first1 = HJ. | last2 = Bailey | first2 = D. | last3 = Marks | first3 = A. | title = Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi's sarcoma and a subset of angiosarcomas. | journal = Mod Pathol | volume = 15 | issue = 4 | pages = 434-40 | month = Apr | year = 2002 | doi = 10.1038/modpathol.3880543 | PMID = 11950918 | URL = http://www.nature.com/modpathol/journal/v15/n4/full/3880543a.html }}</ref> | *D2-40 +ve/-ve.<ref name=pmid11950918>{{Cite journal | last1 = Kahn | first1 = HJ. | last2 = Bailey | first2 = D. | last3 = Marks | first3 = A. | title = Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi's sarcoma and a subset of angiosarcomas. | journal = Mod Pathol | volume = 15 | issue = 4 | pages = 434-40 | month = Apr | year = 2002 | doi = 10.1038/modpathol.3880543 | PMID = 11950918 | URL = http://www.nature.com/modpathol/journal/v15/n4/full/3880543a.html }}</ref> | ||