Surgical biopsy definitively diagnosed stage IV metastatic angiosarcoma in a 67-year-old man after standard evaluations for pulmonary nodules and hemorrhagic effusions were unrevealing.
Case Report (n=1)
Pulmonary angiosarcoma is a rare, aggressive malignancy that can mimic infection or autoimmune disease, highlighting the need for early surgical biopsy when standard evaluations are unrevealing.
Abstract Introduction Angiosarcoma is a rare, aggressive vascular malignancy that most commonly arises from cutaneous, cardiac, or hepatic tissue. Primary or metastatic pulmonary angiosarcoma is exceedingly uncommon and frequently misdiagnosed due to its nonspecific clinical and radiographic features. We present a case of rapidly progressive pulmonary and hepatic angiosarcoma initially masquerading as an infectious or autoimmune granulomatous disease despite extensive evaluation. Case Presentation A 67-year-old man with a history of testicular cancer (status post orchiectomy 1993), atrial fibrillation, chronic kidney disease, diastolic heart failure, and severe OSA/OHS on BiPAP presented with progressive dyspnea, cough, and hemoptysis of six months’ duration. Prior CT imaging in mid-2024 had shown small ground-glass opacities thought to be inflammatory. By late 2024, repeat CT demonstrated innumerable bilateral pulmonary nodules and right pleural effusion. EBUS-guided biopsy and bronchoalveolar lavage were nondiagnostic, showing only necrotizing inflammation. Pleural fluid was repeatedly exudative and bloody but cytology remained negative. Extensive infectious work-up including AFB, fungal serologies, and Strongyloides testing and autoimmune markers (ANA, SSA) were negative. Given worsening respiratory failure, new hepatic lesions, and recurrent effusions, he underwent CT-guided liver biopsy showing bile-duct proliferation and fibrosis without malignancy. A PET scan revealed multiple hypermetabolic pulmonary and hepatic nodules. After transfer to the ICU for hypoxic-hypercapnic failure, bilateral chest tubes were placed, and he ultimately underwent left upper-lobe wedge resection. Histopathology demonstrated vasoformative malignant spindle cells positive for CD34 and factor VIII, and negative for actin, S100, desmin, and cytokeratin, confirming angiosarcoma. Given the extensive bilateral disease and hepatic involvement, the diagnosis represented stage IV metastatic angiosarcoma. His performance status precluded cytotoxic chemotherapy. Discussion Pulmonary angiosarcoma is a diagnostic chameleon that can mimic infection, vasculitis, or interstitial disease. Repeatedly negative cytology and inconclusive biopsies often delay recognition. Radiographically, diffuse nodules, hemorrhagic effusions, and liver lesions should raise suspicion when standard evaluations are unrevealing. Immunohistochemistry (CD31, CD34, Factor VIII) is essential for diagnosis. Prognosis remains poor, with median survival under one year despite surgery or chemotherapy. This case underscores the importance of considering angiosarcoma in patients with persistent multifocal pulmonary nodules and hemorrhagic effusions despite negative infectious and autoimmune work-ups, and highlights the value of early surgical biopsy for definitive diagnosis. Rapidly progressive pulmonary and hepatic angiosarcoma can masquerade as granulomatous or infectious lung disease. Early multidisciplinary collaboration and tissue diagnosis are crucial to avoid diagnostic delay in this aggressive malignancy. This abstract is funded by: None
Sinawe et al. (Fri,) conducted a case report in Disseminated Angiosarcoma (n=1). Surgical biopsy was evaluated. Surgical biopsy definitively diagnosed stage IV metastatic angiosarcoma in a 67-year-old man after standard evaluations for pulmonary nodules and hemorrhagic effusions were unrevealing.