Primary pleural epithelioid angiosarcoma. A case report and review of the literature

Dainese, Emanuele; Pozzi, Barbara; Milani, Mario; Rossi, Giorgio; Pezzotta, Maria Grazia; G, Vertemati; Tricomi, Paolo; Sessa, Fausto

doi:10.1016/j.prp.2009.11.008

Cited by 26 publications

(48 citation statements)

References 36 publications

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“…Pleural angiosarcomas are often epithelioid and can easily be mistaken for a mesothelioma, both clinically and histologically, [27][28][29][30] and examples of epithelioid pleural angiosarcomas exhibiting marked pleomorphism that could easily be confused with pleomorphic mesotheliomas have been documented in the literature. 31 The pleural biopsy of one of the mesotheliomas cases in this study (case 1), in addition to being somewhat hemorrhagic, showed areas in which the neoplastic cells appeared to be lining irregular spaces resembling the vascular spaces seen in an angiosarcoma ( Figure 1a). As a result of this, the possibility of an angiosarcoma was considered in the differential diagnosis; however, the strong keratin expression and the mesothelin positivity, together with the lack of reactivity for the endothelial markers CD31 and CD34, allowed the diagnosis of angiosarcoma to be ruled out.…”

Section: Discussionmentioning

confidence: 65%

Pleomorphic mesothelioma: report of 10 cases

Ordóñez

2012

Modern Pathology

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Mesotheliomas with pleomorphic features are rare and only a few studies on this mesothelioma variant have been published. Little information regarding the immunoprofile of these tumors and none on their electron microscopic features was included in these studies. Herein are reported 10 cases of pleomorphic mesothelioma that were investigated using a large panel of immunohistochemical markers, 4 of which were also studied by electron microscopy. All of the patients were men and seven had a history of asbestos exposure. Nine of the cases originated in the pleura and one in the peritoneum. Histologically, the tumors were characterized by being composed of large, often discohesive, cells that varied in size and shape, had dense abundant eosinophilic cytoplasm, and single or multiple irregular nuclei, which often contained one or several large nucleoli. Mitotic activity was high and atypical mitoses frequent. Immunoreactivity for pan-keratin and keratin 7 was strong in all of the cases. Expression for calretinin, WT1, podoplanin, mesothelin and keratin 5/6 was also frequent, but variable. All cases were negative for MOC-31, carcinoembryonic antigen, CD15, TAG-72 and thyroid transcription factor-1. Electron microscopy often showed the presence of abundant long, slender microvilli on the cell membrane of the neoplastic cells. These findings demonstrate that, contrary to what has been suggested by some investigators, both immunohistochemistry and electron microscopy can be very helpful in assisting in the diagnosis of pleomorphic mesotheliomas. That the seven patients who underwent extrapleural pneumonectomy had extensive lymph node metastasis and that the median survival of those patients for whom follow-up information was available was only 8.2 months indicates that mesotheliomas with pleomorphic features are associated with highly aggressive clinical behavior. Therefore, when this subtype of epithelioid mesothelioma is present, it should be reported as it can significantly affect the prognosis and treatment of the patient.

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Section: Discussionmentioning

confidence: 65%

Pleomorphic mesothelioma: report of 10 cases

Ordóñez

2012

Modern Pathology

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“…Endothelial (vascular) markers are necessary for warranting definitive diagnosis of angiosarcoma such as CD31, CD34, and factor VIII-related antigens [7]. By far, CD31 is the most sensitive and specific marker for vascular neoplasms and has been shown to hardly ever stain positive with nonvascular neoplasms (such as mesotheliomas and adenocarcinomas) [7, 18, 19]. Coexpression of mesenchymal (vimentin) and endothelial (particularly CD31 and Fli-1) markers along with epithelioid histopathological features confirms diagnosis of epithelioid angiosarcoma.…”

Section: Discussionmentioning

confidence: 99%

Primary Pleural Angiosarcoma in a 63-Year-Old Gentleman

Abu‐Zaid

Mohammed

2013

Case Reports in Pulmonology

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Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature. Herein, we report the case of a 63-year-old gentleman who presented with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. Chest X-ray showed bilateral pleural effusion with partial bibasilar atelectasis. Ultrasound-guided thoracocentesis showed bloody and exudative pleural fluid. Cytologic examination was negative for malignant cells. An abdominal contrast-enhanced computed tomography (CT) scan showed two right diaphragmatic pleural masses. Whole-body positron emission tomography/computed tomography (PET/CT) scan showed two hypermetabolic fluorodeoxyglucose- (FDG-) avid lesions involving the right diaphragmatic pleura. CT-guided needle-core biopsy was performed and histopathological examination showed neoplastic cells growing mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. Immunohistochemical analysis showed strong positivity for vimentin, CD31, CD68, and Fli-1 markers. The overall pathological and immunohistochemical features supported the diagnosis of epithelioid angiosarcoma. The patient was scheduled for surgery in three weeks. Unfortunately, the patient died after one week after discharge secondary to pulseless ventricular tachycardia arrest followed by asystole. Moreover, we also present a brief literature review on pleural angiosarcoma.

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“…According to the literature, merely 31 cases of primary pleural angiosarcomas were published until 2010. They featured a distinct male predominance (Dainese et al 2010).…”

Section: Discussionmentioning

confidence: 99%

“…Up to now, 17 cases of pleural epithelioid haemangioendotheliomas were described in the literature (Dainese et al 2010). It has been reported that 80% of pulmonary epithelioid haemangioendothelioma occur in women, which is consistent with our data (Travis et al 2004).…”

Section: Discussionmentioning

confidence: 99%