Skip to main content
Close

Case 04

A rare find

This 51-year-old male presented with a recently noted diffuse erythematous painless swelling of skin over the nose. There was no previous history of disease:

 

 

 

 

 

 

Select the correct diagnosis:

You answered: Malignant Melanoma
Sorry, that is INCORRECT

The correct diagnosis is: Epithelioid Angiosarcoma

CYTOPATHOLOGY:

  • Aspirates are cellular, containing poorly cohesive moderately pleomorphic mono and multinucleate, spindled and epithelioid cells that have eccentric, focally vacuolated cytoplasm.
  • Nuclei are round to oval with prominent nucleoli. Numerous mitosis are identified. Cytoplasmic pigment was not seen.

DISCUSSION:

  • This case showed features of a malignant epithelioid neoplasm. The clinical and cytologic features favour epithelioid angiosarcoma. There was no history to suggest a metastatic lesion.
  • The differential diagnosis might include carcinoma (squamous cell carcinoma, renal cell carcinoma), melanoma and sarcoma with epithelioid features, especially angiosarcoma. Other epithelioid sarcomas (epithelioid sarcoma, alveolar soft parts sarcoma and malignant melanoma of soft parts) were essentially excluded by age and location.
  • The cytologic features were malignant but non-specific as to tumour type. Vasoformative features (cytoplasmic vacuoles with red cells or hemosiderin) were not seen in the present case.
  • Tissue biopsy was necessary to obtain a specific diagnosis. The biopsy suggested angiosarcoma.
  • Immunohistochemical stains revealed tumour cells were positive for the endothelial antigen CD-31 and negative for S-100 and Melan-A (melanoma unlikely), and negative for cytokeratin (carcinoma unlikely).

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Boucher, LD., Swanson, PE, et al. Cytology of angiosarcoma. Findings in fourteen fine-needle aspiration biopsy specimens and one pleural fluid specimen. American Journal of Clinical Pathology 2000; 11(2):210-9.



Liu, K., Layfield LJ. Cytomorphologic features of angiosarcoma on fine needle aspiration biospy. Acta Cytologica 1999; 43(3):407-15.



Minimo, C., Zakowski M, et al. Cytologic findings of malignant vascular neoplasms: a study of twenty-four cases. Diagnostic Cytopathology 2002; 26(6):349-55.

You answered: Epithelioid angiosarcoma
CORRECT!!

CYTOPATHOLOGY:

  • Aspirates are cellular, containing poorly cohesive moderately pleomorphic mono and multinucleate, spindled and epithelioid cells that have eccentric, focally vacuolated cytoplasm.
  • Nuclei are round to oval with prominent nucleoli. Numerous mitosis are identified. Cytoplasmic pigment was not seen.

DISCUSSION:

  • This case showed features of a malignant epithelioid neoplasm. The clinical and cytologic features favour epithelioid angiosarcoma. There was no history to suggest a metastatic lesion.
  • The differential diagnosis might include carcinoma (squamous cell carcinoma, renal cell carcinoma), melanoma and sarcoma with epithelioid features, especially angiosarcoma. Other epithelioid sarcomas (epithelioid sarcoma, alveolar soft parts sarcoma and malignant melanoma of soft parts) were essentially excluded by age and location.
  • The cytologic features were malignant but non-specific as to tumour type. Vasoformative features (cytoplasmic vacuoles with red cells or hemosiderin) were not seen in the present case.
  • Tissue biopsy was necessary to obtain a specific diagnosis. The biopsy suggested angiosarcoma.
  • Immunohistochemical stains revealed tumour cells were positive for the endothelial antigen CD-31 and negative for S-100 and Melan-A (melanoma unlikely), and negative for cytokeratin (carcinoma unlikely).

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Boucher, LD., Swanson, PE, et al. Cytology of angiosarcoma. Findings in fourteen fine-needle aspiration biopsy specimens and one pleural fluid specimen. American Journal of Clinical Pathology 2000; 11(2):210-9.



Liu, K., Layfield LJ. Cytomorphologic features of angiosarcoma on fine needle aspiration biospy. Acta Cytologica 1999; 43(3):407-15.



Minimo, C., Zakowski M, et al. Cytologic findings of malignant vascular neoplasms: a study of twenty-four cases. Diagnostic Cytopathology 2002; 26(6):349-55.

You answered: Spindle Cell Squamous Carcinoma
Sorry, that is INCORRECT

The correct diagnosis is: Epithelioid Angiosarcoma

CYTOPATHOLOGY:

  • Aspirates are cellular, containing poorly cohesive moderately pleomorphic mono and multinucleate, spindled and epithelioid cells that have eccentric, focally vacuolated cytoplasm.
  • Nuclei are round to oval with prominent nucleoli. Numerous mitosis are identified. Cytoplasmic pigment was not seen.

DISCUSSION:

  • This case showed features of a malignant epithelioid neoplasm. The clinical and cytologic features favour epithelioid angiosarcoma. There was no history to suggest a metastatic lesion.
  • The differential diagnosis might include carcinoma (squamous cell carcinoma, renal cell carcinoma), melanoma and sarcoma with epithelioid features, especially angiosarcoma. Other epithelioid sarcomas (epithelioid sarcoma, alveolar soft parts sarcoma and malignant melanoma of soft parts) were essentially excluded by age and location.
  • The cytologic features were malignant but non-specific as to tumour type. Vasoformative features (cytoplasmic vacuoles with red cells or hemosiderin) were not seen in the present case.
  • Tissue biopsy was necessary to obtain a specific diagnosis. The biopsy suggested angiosarcoma.
  • Immunohistochemical stains revealed tumour cells were positive for the endothelial antigen CD-31 and negative for S-100 and Melan-A (melanoma unlikely), and negative for cytokeratin (carcinoma unlikely).

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Boucher, LD., Swanson, PE, et al. Cytology of angiosarcoma. Findings in fourteen fine-needle aspiration biopsy specimens and one pleural fluid specimen. American Journal of Clinical Pathology 2000; 11(2):210-9.



Liu, K., Layfield LJ. Cytomorphologic features of angiosarcoma on fine needle aspiration biospy. Acta Cytologica 1999; 43(3):407-15.



Minimo, C., Zakowski M, et al. Cytologic findings of malignant vascular neoplasms: a study of twenty-four cases. Diagnostic Cytopathology 2002; 26(6):349-55.

You answered: Metastatic Adenocarcinoma
Sorry, that is INCORRECT

The correct diagnosis is: Epithelioid Angiosarcoma

CYTOPATHOLOGY:

  • Aspirates are cellular, containing poorly cohesive moderately pleomorphic mono and multinucleate, spindled and epithelioid cells that have eccentric, focally vacuolated cytoplasm.
  • Nuclei are round to oval with prominent nucleoli. Numerous mitosis are identified. Cytoplasmic pigment was not seen.

DISCUSSION:

  • This case showed features of a malignant epithelioid neoplasm. The clinical and cytologic features favour epithelioid angiosarcoma. There was no history to suggest a metastatic lesion.
  • The differential diagnosis might include carcinoma (squamous cell carcinoma, renal cell carcinoma), melanoma and sarcoma with epithelioid features, especially angiosarcoma. Other epithelioid sarcomas (epithelioid sarcoma, alveolar soft parts sarcoma and malignant melanoma of soft parts) were essentially excluded by age and location.
  • The cytologic features were malignant but non-specific as to tumour type. Vasoformative features (cytoplasmic vacuoles with red cells or hemosiderin) were not seen in the present case.
  • Tissue biopsy was necessary to obtain a specific diagnosis. The biopsy suggested angiosarcoma.
  • Immunohistochemical stains revealed tumour cells were positive for the endothelial antigen CD-31 and negative for S-100 and Melan-A (melanoma unlikely), and negative for cytokeratin (carcinoma unlikely).

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Boucher, LD., Swanson, PE, et al. Cytology of angiosarcoma. Findings in fourteen fine-needle aspiration biopsy specimens and one pleural fluid specimen. American Journal of Clinical Pathology 2000; 11(2):210-9.



Liu, K., Layfield LJ. Cytomorphologic features of angiosarcoma on fine needle aspiration biospy. Acta Cytologica 1999; 43(3):407-15.



Minimo, C., Zakowski M, et al. Cytologic findings of malignant vascular neoplasms: a study of twenty-four cases. Diagnostic Cytopathology 2002; 26(6):349-55.

From the Cytopathology files of BC Cancer
Submitted by: Tom Thomson, MD
SOURCE: Case 04 ( )
Page printed: . Unofficial document if printed. Please refer to SOURCE for latest information.

Copyright © BC Cancer Agency. All Rights Reserved.

    Copyright © 2017 Provincial Health Services Authority