Primary Pleural Epithelioid Angiosarcoma With Extensive and Rapid Metastasis to Brain and Bilateral Adrenal Glands

Figures

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  Figure 1. Axial and coronal CT images of the chest showing heterogeneous left apical mass Axial (a) and coronal (b) CT images of the chest demonstrating an 8.0 x 6.7 x 7.9 cm heterogeneous left apical mass with central necrosis and invasion into the left extra pleural space and chest wall with partial destruction of the second and third ribs.

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  Figure 2. CT images of the chest showing heterogeneous enlarged left adrenal mass concerning for metastatic lesion Axial (a) and coronal (b) CT images of the chest demonstrating a heterogeneous enlarged left adrenal mass concerning for metastatic lesion (arrow). (c) Axial image obtained during CT-guided biopsy for tissue sampling.

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  Figure 3. Pathologic specimen of adrenal mass (a) H&E staining shows sheets of large epithelioid cells with abundant eosinophilic cytoplasm and vesicular nuclei with moderate pleomorphism. (b) CD31 staining demonstrates membranous and cytoplasmic staining. (c) CD34 staining demonstrates strong membranous staining in tumor cells. (d) FLI1 staining shows strong nuclear staining of tumor cells. (e) CK7 shows diffuse and strong cytoplasmic staining in tumor cells. (f) AE1/AE3 shows diffuse staining of tumor cytoplasm.

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  Figure 4. Axial T1 MRI of brain Axial post-contrast T1 MR images of the brain demonstrating ring-enhancing lesions (red arrows) in the (a) left occipitotemporal, (b) right occipital, and (c) bifrontal regions with significant surrounding vasogenic edema.