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An autopsy case of primary angiosarcoma of the pericardium mimicking malignant mesothelioma
T Terada1, Y Nakanuma, T Matsubara
1Second Department of Pathology, Kanazawa University School of Medicine, Japan.
Insights
This report details a rare primary diffuse angiosarcoma of the pericardium. The tumor mimicked malignant mesothelioma, highlighting the importance of immunohistochemistry for accurate diagnosis of vascular tumors.
Area of Science:
- Oncology
- Pathology
- Cardiovascular Research
Background:
- Primary pericardial tumors are rare.
- Angiosarcoma is an aggressive malignancy of vascular endothelial origin.
- Distinguishing pericardial angiosarcoma from other malignancies like mesothelioma is crucial for treatment.
Observation:
- A rare case of primary diffuse angiosarcoma of the pericardium is presented.
- Gross examination revealed the heart encased by tumor with superficial myocardial invasion.
- The tumor extended into the mediastinum, embedding great vessels, with metastases to lungs and hilar lymph nodes.
Findings:
- Microscopic examination showed malignant cells forming vascular channels and solid areas.
- Histochemical and immunohistochemical analysis confirmed vascular origin (Factor VIII-related antigen and Ulex europaeus I lectin positive).
- No mesothelial features were identified, ruling out mesothelioma.
Implications:
- This case underscores that primary pericardial angiosarcoma can mimic malignant diffuse mesothelioma.
- Accurate pathological diagnosis, including immunohistochemistry, is essential for differentiating these entities.
- Understanding this mimicry aids in appropriate clinical management and prognosis for patients with rare pericardial tumors.
Abstract:
The pathology of a rare case of primary diffuse angiosarcoma of the pericardium is reported. Grossly, the heart was entirely encased by the pericardial tumor, and the myocardium was only superficially invaded by the tumor. The tumor tissue extended directly to the mediastinum, where the great vessels were embedded in the tumor. A few minute distant metastases were found only in the bilateral lungs and pulmonary hilar lymph nodes. Microscopically, the tumor tissue was composed of malignant cells forming vascular channels admixed with solid areas. Histo- and immunohistochemically, no mesothelial characteristics were evident. Factor VIII-related antigen and Ulex europaeus I lectin were positive, implying that the tumor was of vascular origin. Grossly, and in part microscopically, this case resembled malignant diffuse mesothelioma, indicating that pericardial angiosarcoma may sometimes mimick malignant mesothelioma.