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Updated: Aug 16, 2026
Scanning Electron Microscopy of Macerated Tissue to Visualize the Extracellular Matrix
Published on: June 14, 2016
Angiosarcoma of the heart: structural and ultrastructural study
F Carpino1, F Pezzoli, V Petrozza
1Department of Experimental Medicine and Pathology, University of Rome La Sapienza--Rome, Italy.
Insights
This case study details a rare cardiac angiosarcoma, highlighting diagnostic challenges in differentiating tumor grades. Microscopic analysis revealed mixed differentiation, complicating definitive classification.
Area of Science:
- Oncology
- Pathology
- Cardiovascular Medicine
Background:
- Primary cardiac tumors are rare, with angiosarcoma being the most frequent malignant type.
- Cardiac angiosarcomas represent 31% of all primary malignant cardiac neoplasms.
- This study presents a unique case of cardiac angiosarcoma with detailed microscopic analysis.
Observation:
- A 52-year-old male presented with a right ventricle filling deficit due to an intracavitary tumor originating from the right atrial wall.
- Autoptic cardiac tissue samples were analyzed using light and transmission electron microscopy.
- Immunohistochemical studies were performed for vimentin, Factor VIII related antigen, and Ulex Europaeus lectin.
Findings:
- Hematoxylin-eosin staining revealed a tumor with well-differentiated vascular areas and less-differentiated solid areas.
- Immunohistochemistry showed positive Ulex Europeaeus Agglutinin I labeling in both areas, with less intensity in solid zones.
- Electron microscopy indicated a less differentiated nature, with disarranged extracellular matrix and presence of Weibel-Palade bodies.
Implications:
- Differentiating the grade of cardiac angiosarcoma can be challenging using light microscopy and immunohistochemistry alone.
- The combination of vascular lumen presence and endothelial markers suggests well-differentiated features.
- Ultrastructural findings may indicate a less differentiated tumor, underscoring the complexity of diagnosis.
Background:
Primary cardiac tumours are rare. Nearly 70% of primary cardiac tumours are benign, the majority of which are represented by myxomas. The most frequent primary cardiac neoplasm is the angiosarcoma that represents 31% of primary cardiac malignant. We report a particular clinical case of cardiac angiosarcoma, its light and transmission electron microscopic aspects and a review of the recent literature.
Methods:
A 52 years old man died for a severe right ventricle filling deficit caused by an intracavitary tumour originated from the right atrial anterolateral wall. The fragments obtained from autoptic tumoral cardiac tissue were processed for light and electron microscopy. The section were stained with haematoxilineosin, Masson trichromic and Gomori method. An immunohistochemical study for vimentin, Factor VIII related antigen and peroxidase-conjugated lectin from Ulex Europaeus was also performed using the unlabed peroxidase-antiperoxidase method.
Results:
The hematoxylin-eosin staining showed that the tumoral mass was composed by a well-differentiated histotype characterized by numerous vascular areas in which neoplastic cells were loosely and irregularly arranged to form incomplete vessels or anastomized blood-filled vascular channels. On the other hand, some less-differentiated solid areas were present and irregularly surrounded the differentiated vascular areas. Results of Ulex Europeaeus Agglutinin I labelling were positive in both solid and vascular areas of the tumour although the positive reaction was less evident in the solid zones Factor VIII related antigen positive cells were less numerous and mainly found in vascular areas. The observation by electron microscopy showed the lack of evident pinocytotic vesicles, the presence of thin and delicate cytoplasmatic processes, Weibel-Palade bodies, and also the disarrangement of the extracellular fibrous matrix.
Conclusion:
The light microscopy observation and immunohistochemical study underscore that is not easy to obtain information about the level of differentiation of this tumour. The presence of blood-filled lumina and the identification of typical markers of endothelial cells seems to indicate a well-differentiated nature. However, the ultrastructural findings seem to indicate a less differentiated nature.
