Lepe M, Hui Y, Pisharodi L, Canepa M
Rhode Island Hospital, Department of Pathology and Laboratory Medicine, Brown University, Providence, Rhode Island.
Diagn Cytopathol. 2018 Apr;46(4):349-354. doi: 10.1002/dc.23853. Epub 2017 Oct 31.
Angiosarcomas are rare malignancies arising from cells of endothelial origin and are aggressive sarcomas that can occur in any anatomic site. They are reported to have predilection for the scalp, extremities and breasts. The incidence of these tumors is increasing, which has been suggested to be attributable to the growing use of radiotherapy to treat breast and other malignancies. There is currently limited literature describing the primary cytologic diagnosis of angiosarcoma on fine needle aspirate material. We describe the findings of three cases of angiosarcoma diagnosed by fine needle aspiration. Our three cases offer distinct radiologic, clinical and cytopathologic points-of-view: a thyroid angiosarcoma, a mediastinal angiosarcoma and a skin angiosarcoma. The cytomorphology of angiosarcoma is characterized by large highly atypical spindle to epithelioid cells with abundant cytoplasm in dispersed single cells or loose aggregates. The nuclei are large and pleomorphic with vesicular chromatin and prominent nucleoli. Mitoses are readily identified. The background can be bloody and/or necrotic. Occasional intracytoplasmic lumens are a helpful morphologic feature suggesting vascular differentiation. HHV-8 immunostaining may aid in the differential diagnosis with Kaposi sarcoma while epithelioid hemangioendothelioma can be distinguished based on morphologic features. Given the metastatic potential and high mortality rate associated with these tumors, this entity is an important consideration in the contexts herein described.
血管肉瘤是一种罕见的恶性肿瘤，起源于内皮细胞，是侵袭性肉瘤，可发生于任何解剖部位。据报道，它们好发于头皮、四肢和乳房。这些肿瘤的发病率正在上升，有人认为这归因于越来越多地使用放射疗法治疗乳腺癌和其他恶性肿瘤。目前，关于细针穿刺抽吸材料上血管肉瘤的原发性细胞学诊断的文献有限。我们描述了3例经细针穿刺确诊的血管肉瘤病例。我们的3例病例提供了不同的放射学、临床和细胞病理学观点：1例甲状腺血管肉瘤、1例纵隔血管肉瘤和1例皮肤血管肉瘤。血管肉瘤的细胞形态学特征是大量高度异型的梭形至上皮样细胞，单个分散或松散聚集，细胞质丰富。细胞核大，呈多形性，有泡状染色质和明显的核仁。易见核分裂象。背景可为血性和/或坏死性。偶尔可见胞质内管腔，这是提示血管分化的有用形态学特征。HHV-8免疫染色可能有助于与卡波西肉瘤进行鉴别诊断，而上皮样血管内皮瘤可根据形态学特征进行区分。鉴于这些肿瘤具有转移潜能和高死亡率，在本文所述的情况下，这一实体是一个重要的考虑因素。
