Siddaraju Neelaiah, Soundararaghavan Jayanthi, Bundele Manish Mahadeorao, Roy Sumit Kumar
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Acta Cytol. 2008 Jan-Feb;52(1):109-13. doi: 10.1159/000325445.
Malignant vascular tumors are rare. Few studies have described cytomorphologic features of hemangioendothelioma and angiosarcoma on fine needle aspiration cytology (FNAC). Malignant vascular tumor with epithelioid morphology can create diagnostic difficulty, as the cytology may simulate that in other nonvascular malignant tumors. We describe epithelioid angiosarcoma, diagnosed on FNAC, in which a differential diagnosis of histiocytosis and inflammatory granulation tissue was considered.
A 20-year-old man presented with forehead and scalp swellings. The forehead lesion was radiologiocally associated with a lytic lesion in the bone. FNA resulted in high cellular yield, and smears revealed prominent vascular pattern with endothelial cell atypia and histiocytoid/epithelioid neoplastic cells, occasional mitotic figures and a few cells displaying nuclear grooving. Smear background showed a significant number of neutrophils. Epithelioid hemangioendothelioma/angiosarcoma, histiocytosis and inflammatory granulation tissue were considered. A cytologic diagnosis of epithelioid angiosarcoma/epithelioid hemangioendothelioma was suggested and confirmed on histopathologic and immunohistochemical examination.
Cellular aspirates from malignant epithelioid endothelial tumors involving bone may be cytologically mistaken for histiocytosis and, rarely, inflammatory granulation tissue. However, prominent vascular pattern with striking endothelial cell atypia, presence of mitotic figures and careful search for presence of endothelial differentiation are helpful in accurate cytologic diagnosis.
恶性血管肿瘤较为罕见。很少有研究描述过细针穿刺细胞学检查（FNAC）中血管内皮瘤和血管肉瘤的细胞形态学特征。具有上皮样形态的恶性血管肿瘤可能会造成诊断困难，因为其细胞学表现可能与其他非血管性恶性肿瘤相似。我们描述了一例经FNAC诊断的上皮样血管肉瘤，该病例曾考虑组织细胞增多症和炎性肉芽组织的鉴别诊断。
一名20岁男性出现前额和头皮肿胀。前额病变在影像学上与骨溶骨性病变相关。细针穿刺获得了高细胞产量，涂片显示出明显的血管模式，伴有内皮细胞异型性以及组织细胞样/上皮样肿瘤细胞、偶见的有丝分裂象和一些显示核沟的细胞。涂片背景中有大量中性粒细胞。考虑了上皮样血管内皮瘤/血管肉瘤、组织细胞增多症和炎性肉芽组织。建议对上皮样血管肉瘤/上皮样血管内皮瘤进行细胞学诊断，并经组织病理学和免疫组织化学检查得以证实。
累及骨骼的恶性上皮样内皮肿瘤的细胞抽吸物在细胞学上可能被误诊为组织细胞增多症，很少情况下会误诊为炎性肉芽组织。然而，具有显著内皮细胞异型性的明显血管模式、有丝分裂象的存在以及仔细寻找内皮分化的存在有助于准确的细胞学诊断。
