Angiosarcoma

Case 63 (P. McKee) mixed epithelioid and spindle-celled; intracytoplasmic lumina. 

Case 101  Oct 2010 (P. McKee). Epithelioid variant.   Main clue is atypical cytology of endothelial cells. 

DD: KS – but – no RBC’s in lumina; no sieve-like features; no plasma cells; no inclusions 

Case 239   May 2011 (P. McKee)  mainly spindle cell type.  Post irradiation. 

Case 337   Sept 2011 (P. McKee)  F 78 purple plaque cheek (*teaching)   

Case 338   Sept 2011 (P. McKee)  M 38 sub-cut lump thigh 

Looked like metastatic malignancy, possibly sebaceous.  However, intracytoplasmic 

       lumen containing RBC indicated vascular origin.  Vascular markers +ve. 

Case 441   Feb 2012 (P. McKee)  M 81 ulcerated scalp nodule 

Poorly differentiated epithelioid malignancy with wide differential including SCC, MM, epithelioid sarcoma; metastasis etc.  D confirmed by IH. 

Case 465  Mar 2012 P. McKee  F 86  ulcerated scalp nodule 

Spindle cell variant.  Undifferentiated with wide DD:  RC’s suggested IH panel: 

p63 & pan-keratin cocktail (carcinoma); S100 melanoma; CD10 (AFX/cutaneous sarcoma NOS). We only do the others if it looks like an angiosarcoma, leiomyosarcoma, lymphoma etc. 

Case 633  12.11.12 (IH Chaudhry)  M 70 scalp 

Only one field shown.  Impossible to come near the diagnosis on this field which looks more like a benign adnexal tumour such as spiradenoma. 

Case 840  5.9.13  (H. Diwan)  F 60 breast lesion (history of RT unknown) 

Epithelioid variant.  Cutaneous angiosarcomata much less often +ve for keratin stains than visceral angiosarcomata 

Case 1234  17.3.15  (U. Sundram)  F 80 haemorrhagic lesion scalp 

Good example of epithelioid variant. Positive for CD34, CD31 and erg, confirming vascular origin. 

Case 1440  30.12.15 (H. Diwan)  M 63 arm – subsequent widespread metastases 

Faded H+E.  Not all slides visible.  Epithelioid angiosarcoma (with osteoid, but this wasn’t visible).  +ve for CD31, ERG, FLI-1. 

Case 1698  20.11.16 (H. Diwan) M 65 scalp 

Large thick area of necrosis infected with Enterbacter spp..   Fairly straightforward angiosarcoma underneath. 

Case 1732  17.1.17  (U. Sundram) F 65 large lesion on back (diagnosis debated) 

Punch biopsy only.  Dissecting pattern of endothelial cells both superficial and deep.  Minimal atypia.  Arrector pili involvement.  Considerable discussion about diagnosis.  Wanted larger biopsy.  Concern about AS because of lesion size. 

DD: microvenular haemangioma, in view of branching vasculature and involvement of arrector pili muscles. 

Case 1860  14.7.17 (R. Carr)  M 80 three scalp lesions 

Interstitial infiltrative spindle cell proliferation.  CD31+ve (endothelium).  These 2 views don’t show trhe malignant endothelium seen on later biopsy. 

Case 2135  15.8.18  (H Diwan)  F 81 breast 

Radiation-induced – history of breast cancer  

Case 2177  12.10.18  (Richard Carr)  F 90 forehead   

Straightforward histology. 

Case 2596  18.6.20 (S. Taibjee) F 93 haemorrhagic lesion breast (H/O RT) 

Epithelioid histology 

Case 2661  17.9.20 (S. Taibjee) M 83 leg (*teaching) 

Good example of the risk of superficial biopsy.  The upper dilated vessels look rather banal, unless you look closely at the endothelial cytology.  More diagnostic appearances deeper in the dermis. 

Case 2982  10.12.21 (R.Carr)  F 85 fast growing lesion on calf 

Curetted specimen caused initial diagnostic confusion. Elements of epidermal hyperplasia and changes of venous hypertension obscured the true pathology only revealed at a later biopsy with vascular immunostains CD31+ve. 

Case 4409 14.12.23  M 76 lesion cheek.  H/O metastatic colonic ca and NE Ca of lung 

ERG and CD31 +ve