Epithelioid angiosarcoma of the chest wall with atypical morphology: report of one case

Epithelioid angiosarcoma is a rare soft-tissue sarcoma, which originates from endothelial cells. Herein, we report a case of an uncommon morphology of epithelioid angiosarcoma in the chest wall with diffuse hemorrhage and necrosis. The 52-years-old man suffered from severe chest pain, hemoptysis, and fever. Contrast-enhanced chest CT scans showed a large space-occupying lesion in the right chest cavity. A right thoracotomy was performed for definite diagnosis and surgical resection. Microscopically, the specimen demonstrated extensive hemorrhage and necrosis, while few visible tumor cells were noted. These cells were round to polygonal and even had an epithelioid appearance, with abundant eosinophilic cytoplasm. Vesicular nuclei and prominent nucleoli were observed. Immunohistochemistry indicated that these abnormal cells were positive for cytokeratin, vimentin, CD31, ERG, and FLI-1. They were negative for D2-40, CK5/6, calretinin, WT-1, CK7, TTF-1, napsin A, and CEA. Moreover, Ki-67 with MIB-1 was about 40%. On the whole, histology and immunohistochemistry supported the diagnosis of epithelioid angiosarcoma.