Cytology of Angiosarcoma

Abstract

We report the cytologic features of 15 cases of angiosarcoma from various sites and include 14 fine-needle aspiration (FNA) biopsy specimens and 1 pleural fluid specimen. Six were initial diagnoses with histologic confirmation; an additional case in the liver was an initial diagnosis without tissue confirmation. One case represented lymph node metastasis from a primary prostatic epithelioid angiosarcoma. In 10 cases, immunohistochemical staining for factor VIII-related antigen, CD34, CD31, or Ulex europaeus agglutinin I was performed on the cytology or histology specimen. The aspirates varied in cellularity, and the degree of nuclear atypia ranged from relatively bland in a case of low-grade angiosarcoma of the prostate to highly pleomorphic in a lymph node metastasis from a facial cutaneous angiosarcoma. Vasoformative features such as intracellular RBCs, well-formed vessels, attempts at microacinar/lumen formation, and intracytoplasmic lumens were variably present. The background was bloody in all specimens, with necrosis in rare cases. This cytologic series emphasizes that the cytologic features are heterogeneous but that the diagnosis can be suggested by fine-needle aspiration (FNA) when vasoformative features are present. The diagnosis can be made conclusively by FNA with immunocytochemical confirmation of endothelial differentiation.

Fine Needle Aspiration of Metastatic Epithelioid Angiosarcoma

“…Moreover, several epithelial cell markers may give positive results, such as cytokeratins AE1-AE3, epithelial membrane antigen and Cam 5.2. [7][8][9] This implies that if the epithelial markers are used alone in the absence of a clarifying clinical history, a false diagnosis of carcinoma may be made and an erroneous treatment may be initiated. This paper introduces 2 new cases of metastatic EA in which the lesion was correctly diagnosed by fine needle aspiration cytology (FNAC), illustrates their…”

Cytopathologic Characteristics of Epithelioid Vascular Malignancies

“…At least one third can be positive for pancytokeratin, which complicates the exclusion of carcinoma. Furthermore, no vascular marker is entirely specific, suggesting that multiple markers should be used in combination [10,11,12,13,14]. The high-grade nature of EAS helps exclude this entity from other vascular tumors, as the majority have a high proliferation index (>10% MIB-1) and necrosis may be present [5].…”

A Case of Metastatic Angiosarcoma Diagnosed by Liquid-Based Preparation: Peculiar Cytoplasmic Changes

“…Although the background of our case was clean without hemorrhage, it is uncertain whether the clean background is a property related to tumor subtypes or the result of clearance of the RBCs during the course of LBP 1. Some investigators have reported that there have been no cases of epithelioid angiosarcoma with a hemorrhagic background by CP,5 while others have reported that epithelioid angiosarcoma can also have a hemorrhagic background 3. Erythrophagocytosis may be rare in cytology smears, but it has been reported that erythrophagocytosis is more frequent in the epithelioid subtype than the classic subtype (80% vs. 33%, respectively) 3,5.…”

“…The cytopathologic features related to this tendency include a hemorrhagic background, erythrophagocytosis, and hemosiderin pigmentation 3. Although the background of our case was clean without hemorrhage, it is uncertain whether the clean background is a property related to tumor subtypes or the result of clearance of the RBCs during the course of LBP 1.…”

“…The reported cytopathologic findings of angiosarcoma, particularly those with epithelioid features by CP are variable nuclear atypia, intracellular red blood cells (RBCs), bloody background and vasoformative features such as intracytoplasmic lumen, microacinar arrangement or well-formed vessels 2,3. However, there have only been a few reports on LBP,4 and the cytopathologic findings by LBP are required for the correct diagnosis.…”