case_images: PMC10289867_01
case_images: Frontal lung window. Multiple bilateral ground-glass attenuation mostly centered around small nodules (arrowheads).
case_images: CRIPU2023-5553209.001.jpg
case_images: PMC10289867_01_CRIPU2023-5553209.001.jpg
case_images: fig1
case_images: An abnormal chest X-ray led to a diagnostic bronchoscopy in another hospital, but the cause of bleeding could not be determined (Figure 1).
case_images: Axial lung window. The ground-glass opacities likely represent peritumoral alveolar hemorrhage, caused by the fragility of neovascular tissue. Pleural effusion is on the right.
case_images: CRIPU2023-5553209.002.jpg
case_images: PMC10289867_01_CRIPU2023-5553209.002.jpg
case_images: fig2
case_images: After admission to our hospital, we ordered a CT scan of the lung, which showed multiple, bilateral medium sized nodules, surrounded by areas of ground-glass opacities (Figure 2).
case_images: Sheet-like proliferation and variably formed vascular channels with erythrocytes, lined by high-grade atypical cells.
case_images: CRIPU2023-5553209.003.jpg
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case_images: fig3
case_images: Microscopic examination also demonstrated subpleural and intraparenchymal nodular proliferates of anastomosing vessels and solid sheets with hemorrhage and patchy necrosis, with maximum diameters of 5 mm (Figure 3).
case_images: Bifocal nodular proliferates of epithelioid angiosarcoma.
case_images: CRIPU2023-5553209.004.jpg
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case_images: fig4
case_images: The neoplasms contained high-grade atypical epithelioid cells with slightly unrounded nuclei and small nucleoli, as well as inconspicuous mitotic figures and abundant cytoplasm (Figure 4).
case_images: Nuclear staining for transcriptional regulator ERG.
case_images: CRIPU2023-5553209.005.jpg
case_images: PMC10289867_01_CRIPU2023-5553209.005.jpg
case_images: fig5
case_images: Immunostainings revealed strong positivity for CD31 and ERG (Figure 5) and negativity for pan cytokeratin (MNF116).