Soft tissue epithelioid angiosarcoma

We present a case of 48-year-old male with a nine months history of right inferior thoracic (T10-T12) paravertebral mass, which became painful after a back trauma; dyspnea and hemoptysis were associated. The preoperative native and with contrast substance CT revealed a tumor mass extended from the right paravertebral muscles to the diaphragmatic right pillar muscle, invading the postero-basal pleura and the posterior arches of the right XIth and 12th ribs with osteolysis. Fragments of 10 cm large tumor resection specimen (striated muscle, dense connective tissue, adipose tissue, lymph nodes and intercostals nerves) were routinely processed, further immunohistochemical investigations were needed, using Dako antibodies pan-CK clone MNF116, CD34, CD20, vimentin, synaptophysin, melanoma HMB45 clone, with LSAB 2Kits system and further CK AE1÷AE3, CK7, CK20, CEA, S-100 protein, CD31, von Willebrand factor, D2-40÷podoplanin, Ki-67 antigen, with EnVision system and DAB visualization in both systems. The histological and immunohistochemical aspects were indicative for soft tissue epithelioid angiosarcoma, which was misdiagnosed on frozen and HE sections as a carcinoma, because of the cohesiveness and nesting properties of the malignant cells, together with the presence of lymph node metastases. The proliferative activity of the malignant cells, highlighted by Ki-67 antibody, clone MIB 1 was high (30% of malignant cells were positive at HPF). The patient was discharged with adjuvant therapy indication: radiotherapy and chemotherapy. The tumor locally recurred 12 months afterwards, but the patient is still alive 22 months after surgery.