case_images: PMC4805390_01
case_images: Evolution of angiosarcoma in a 78-year-old female nonsmoker: in A, initial CT scan of the chest showing a left upper lobe pulmonary mass; in B and C, CT scans of the chest, obtained two years later, showing a 10 x 7 cm lesion in the left upper lobe, with a small left pleural effusion and small mediastinal lymph nodes; in D, an 18F-fluorodeoxyglucose positron emission tomography-CT scan showing increased metabolic activity in many organs, greatest in the mass in the upper left lobe.
case_images: 1806-3713-jbpneu-42-01-00068-gf01.jpg
case_images: PMC4805390_01_1806-3713-jbpneu-42-01-00068-gf01.jpg
case_images: f01
case_images: A 78-year-old female nonsmoker had previously been examined, a CT scan of the chest having shown a left upper lobe pulmonary mass (Figure 1A). A chest X-ray and a chest CT scan (without contrast) identified a 10 x 7 cm lesion in the left upper lobe without forming cleavage plans with the aorta and the pulmonary artery (Figures 1B and 1C), with a small left pleural effusion and small mediastinal lymph nodes. An 18F-fluorodeoxyglucose positron emission tomography-CT (FDG PET-CT) scan (Figure 1D) showed increased metabolic activity in many organs, greatest in the mass in the upper left lobe, the maximum standardized uptake value (SUVmax) of which was 22.
case_images: Photograph of a mass occluding the left upper lobe bronchus.
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case_images: The bronchoscopic examination revealed a mass occluding the left upper lobe bronchus (Figure 2), and a bronchoscopic biopsy was performed.
case_images: Histological examination of the biopsy specimen: in A, extensive necrosis and hemorrhage; in B, immunohistochemical staining for CD31; in C, immunohistochemical staining for factor VIII-related antigen.
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case_images: PMC4805390_01_1806-3713-jbpneu-42-01-00068-gf03.jpg
case_images: f03
case_images: The histological examination of the biopsy specimen showed a soft-tissue neoplasm with a sheet-like or enclosing cleft arrangement of spindle and epithelioid cells with prominent nucleoli, with some multinucleation; mitotic figures were conspicuous, as were extensive necrosis and hemorrhage (Figure 3A). Immunohistochemical staining of the tumor specimen revealed that it was strongly positive for CD31 (Figure 3B), factor VIII-related antigen (Figure 3C), and vimentin; weakly positive for the nuclear transcription factor Fli-1 and cytokeratin AE1/AE3; and negative for CD34, desmin, and smooth muscle actin.