Pulmonary angiosarcoma is a rare, aggressive malignancy often mimicking other lung cancers. The present study describes the case of a 36-year-old male patient with human immunodeficiency virus (HIV) on highly active antiretroviral therapy who developed severe hemoptysis and respiratory distress, initially attributing his symptoms to mold exposure. Imaging revealed bilateral pulmonary nodules surrounded by ground-glass (suggestive of hemorrhagic lesions), and a biopsy confirmed stage IV pulmonary angiosarcoma. Immunohistochemical staining yielded positive results for ERG, CD31, CD34 and CD117, and echocardiography identified a large tricuspid valve mass, suggesting metastatic disease. He was commenced on paclitaxel treatment, but switched to doxorubicin following an infusion reaction. His course was complicated by recurrent hemothorax and pericardial effusions, requiring thoracentesis, chest tube placement and pericardiocentesis. Due to disease progression and frequent readmissions, he ultimately opted for hospice care. The case described herein illustrates the diagnostic complexity of pulmonary angiosarcoma in the setting of HIV and highlights the poor prognosis associated with extensive pulmonary and cardiac involvement.
Maule et al. (Tue,) studied this question.