case_images: PMC10995281_01
case_images: (A) Patient underwent CT guided pericardial biopsy. (A,B) Chest CT scan revealed bilateral pleural effusion, pericardial thickening, and pericardial effusion before treatment. (C,D) Chest CT showed a significance reduction in pleural and pericardial effusion after receiving one cycle of anlotinib treatment.
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case_images: F1
case_images: Bilateral pleural effusion was observed, partially enveloped on the left, with thickening of the left pleura and irregular cystic enhancement of the anterior and lower pleura (Figures 1A,B). Chest CT examination showed that the space-occupying lesion at the upper edge of the right atrium was smaller than before, and there was a significant decrease in pericardial and right pleural effusion (Figures 1C,D).
case_images: (A) Tumor cell staining of pericardial tissue (HE staining, x20). (B-E) Staining of tumor markers in cellular tissues (immunohistochemical, x20). (B) CD31 protein expression; (C) D2-40 protein expression; (D) ERG protein expression; (E) Ki-67 protein expression. Immunohistochemical results showed that D2-40 and ERG in tumor cells were diffusely positive; Ki-67 positive rate was about 30%; and CD31 in tumor cells were diffusely strongly positive.
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case_images: F2
case_images: TTF-1 (-), P63 (-), Ki-67 (+, 30%), Napsina (-), CR (-), ERG (+), CD31 (+), CD45 (-), Desmin (-). To further clarify the diagnosis, a CT-guided pericardial biopsy was performed again, indicating that pericardial angiosarcoma had immunohistochemical features such as CK (-), TTF-1 (-), CR (-), D2-40 (+), P53 (-), Ki-67 (+, 10%), ERG (+), CD31 (+), HHV-8 (-), Desmin (-) (Figures 2A-E).
case_images: PMC10995281_02
case_images: (A-D) Chest CT scan of the patient revealed dispersed sub-solid ground glass shadows in both lungs, soft tissue shadows in the right atrium, numerous nodular shadows in the liver, and a considerable pericardial effusion before treatment. (E,F) After 4 cycles of anlotinib treatment, the patient's numerous nodules in the lungs and liver showed significant reduction, the tumor lesion in the right atrium decreased, and pericardial effusion as managed.
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case_images: F3
case_images: Additionally, soft tissue density shadows were found in the right atrium, along with a small amount of pericardial effusion (Figures 3A-D). No noticeable side effects from the medication were observed (Figures 3E-H).
case_images: (A) CT guided liver biopsy. (B) Tumor cell staining of liver tissue (HE staining, x20). (C-E) Tumor marker staining of liver cell tissue (immunohistochemical, x20); (C) CD31 protein expression; (D) ERG protein expression; (E) Ki-67 protein expression. Immunohistochemical results showed that CD31 and ERG in tumor cells were diffusely positive; Ki-67 positive rate was about 10%.
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case_images: F4
case_images: To confirm the diagnosis, a liver puncture biopsy was performed (Figure 4A), which indicated angiosarcoma; CK (-), CD34 (stove+), P53 (2%+), Ki-67 (+, 10%), ERG (+), CD31 (+), S-100 (-), HMB45 (-), Desmin (-), SMA (stove+) (Figures 4B-E).