Case Number : case 101 Posted By: Guest

Phillip McKee - Overseas consultations (Sedona, Arizona, USA) Wrote:

This is a challenging case but you are all along the correct lines. The final diagnosis is epithelioid angiosarcoma. The cytological atypia of the endothelial cells lining the vessels on the left side of the field is a helpful clue. The lack of red cells within the lumina, absence of sieve-like features, plasma cells and the characteristic inclusions argue against a diagnosis of Kaposi's sarcoma. It is obviously difficult to make a diagnosis on one field and sometimes you are not meant to come to a definitive diagnosis but to give appropriate differential diagnoses.

Submitted on 28/10/2010 19:23
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alva mtz angoa - hosp gral de puebla (puebla mex) Wrote:

Hemangioma epitelioide

Submitted on 28/10/2010 17:32
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Wayne Grayson - (Johannesburg, South Africa) Wrote:

This clearly is a vascular neoplasm, demonstrating striking autolumination and a lack of significant atypia. It is difficult to make a confident diagnosis based on this single field. Although I favour an epithelioid haemangioendothelioma, I have encountered areas such as this in some examples of nodular Kaposi's sarcoma. It would also be prudent to consider an angiosarcoma here.

Submitted on 28/10/2010 16:46
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Juan Carlos Garcés - Hospital Oncológico / Hospital Luis Vernaza (Guayaquil Ecuador) Wrote:

Good morning...my opinion Epithelioid hemangioendothelioma

Submitted on 28/10/2010 16:32
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Mona Abdel-Halim - Dermatology Department (Egypt) Wrote:

Could be also angiosarcoma with poorly differentiated areas.

Submitted on 28/10/2010 16:26
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Mona Abdel-Halim - Dermatology Department (Egypt) Wrote:

This is a very challenging case, I am thinking of epithelioid angiosarcoma.

Submitted on 28/10/2010 16:01
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Ruifeng Guo - (OK, USA) Wrote:

Most part looks like epithelioid hemangioendothelioma with intracytoplasmic vacuolation. There is one area of anastomosing vessels with a few hobnailing cells. Interestingly, there is small number of plasma cell and a few hemosiderin deposition areas. So I would agree with my colleagues here that epithelioid hemangioendothelioma is the most possible diagnosis with Angiosarcoma and Kaposi sarcoma on DD.

Submitted on 28/10/2010 15:21
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Eman El-Nabarawy - Cairo University (Egypt) Wrote:

Epithelioid hemangioendothelioma.DD angiosarcoma.

Submitted on 28/10/2010 14:46
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Saleem Taibjee - Warwick () Wrote:

I agree this looks like a vascular lesion. KS was also in my differential as Marcela has already suggested, with the rather sieve-like pattern. However, I could not see the typical inclusions, and plasma cells seem to be very sparse, if indeed present at all. The cells themselves also look quite epithelioid. Hence I wondered about epithelioid haemangioendothelioma (intracytoplasmic vacuolation). Towards the left there appears to be a more complex architecture, with some free-floating cells within the spaces that reminded me of the "fishes swimming in the brook" described in angiosarcoma. Hence could not entirely exclude angiosarcoma based on this single field.

Submitted on 28/10/2010 13:09
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Marcela Saeb Lima - Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (Mexico City) Wrote:

Kaposi sarcoma would be my first diagnosis.

Submitted on 28/10/2010 11:26
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