Pathologic quiz case: A 39-year-old man with diffuse pleural thickening and massive hemothorax

Department of Pathology and Laboratory Medicine, Nassau University Medical Center, East Meadow, NY 11554, USA.
Archives of pathology & laboratory medicine (Impact Factor: 2.84). 12/2004; 128(11):1299-300. DOI: 10.1043/1543-2165(2004)128<1299:PQCAYM>2.0.CO;2
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    • "One should bear in mind that cytokeratin is also frequently expressed in epithelioid vascular tumors. Although the expression pattern of cytokeratin can range from diffuse and strong to focal and weak in distribution, it is usually not as strong as that in carcinoma or mesothelioma [17]. Mesothelial markers such as calretinin, CK5/6, HBME-1 and WT-1, are used to exclude malignant mesothelioma. "
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    ABSTRACT: Primary pleural angiosarcoma is a rare and clinically aggressive tumor. Patients usually present with chest pain, dyspnea, hemoptysis and/or cough. Radiologic studies reveal diffuse pleural thickening and pleural effusion with or without mass lesion. The clinical and radiological features both resemble those of mesothelioma, and its definite diagnosis requires careful histologic examination. However, frequent epithelioid feature and immunoreactivity to cytokeratin in primary pleural angiosarcoma further complicate the pathologic diagnosis. The use of proper immunohistochemical stains is often needed to support endothelial differentiation in the tumor cells and to exclude metastatic carcinoma and mesothelioma. We report the case of a 49-year-old male patient with primary pleural angiosarcoma, who presented with initial hemothorax, followed by a rapid progress to an inoperable status.
    Diagnostic Pathology 12/2011; 6(1):130. DOI:10.1186/1746-1596-6-130 · 2.60 Impact Factor
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    ABSTRACT: Epithelioid angiosarcoma is a rare malignant vascular tumor with poor prognosis. Pleural or pericardial angiosarcomas are usually secondary tumors. We report a unique case of primary epithelioid angiosarcoma of the pleura and the pericardium in a 28-year-old man who was admitted for Pancoast Tobias syndrome. Thoracoscopy revealed a multifocal neoplasm and pleural biopsy showed a malignant tumor which histological and immunophenotypical features were characteristic of epithelioid angiosarcoma.
    Indian Journal of Thoracic and Cardiovascular Surgery 03/2009; 25(1):34-37. DOI:10.1007/s12055-009-0009-9
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    ABSTRACT: We report a case of angiosarcoma complicated by bilateral massive bloody pleurisy (hematocrit of 7.2%) in an 83-year-old woman. An autopsy revealed hemorrhagic tumors infiltrating both the diaphragm and serosal surface of the peritoneum. Histological examination confirmed an anastomosing vascular channel pattern of the tumor cells with characteristic immunohistochemical findings for angiosarcoma, such as positive staining for vimentin, CD31, CD34, D2-40, and factor VIII-related antigen. The tumor was thought to have originated from a small vessel on the serosal surface of the duodenum. We also reviewed cases of hemothorax associated with angiosarcoma, which suggested that primary or metastatic pleural angiosarcoma should be considered a cause of spontaneous hemothorax, especially in patients with bilateral and/or intractable hemothorax.
    Internal Medicine 02/2007; 46(3):125-8. · 0.90 Impact Factor
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