Deep Vein Thrombosis as an Initial Symptom of Malignant Tumor: A Case Report of Angiosarcoma in the Iliac Vein

Figures

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  Fig. 1. Computed tomography images at the first visit. a Enhanced chest CT scan showed massive pulmonary embolism (red arrowhead). b, c Abdominal CT scan showing right retroperitoneal tumor (red arrow in b). Right iliac vein dilated with a grayish thrombus inside (cyan arrowhead in c).

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  Fig. 2. Gross findings of the tissue resected by autopsy. a Tumor and surrounding tissue resected by autopsy. Tumor (black arrow) was around right iliac vessels (black arrowhead), while separated from left iliac vessels (white arrowhead) and left kidney (red arrowhead). b Cut surface of the tumor. Reddish area due to bleeding was observed macroscopically. c Transverse plane of the tumor after fixation. d Enlarged view of the transverse plane. The tumor (black arrow) was located on the caudal side of the IVC filter (red arrow).

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  Fig. 3. Histology of angiosarcoma in the right external iliac vein. a Magnified image of the tumor. Hematoxylin and eosin staining (b) and Elastica van Gieson staining (c) of (a). Although the vessel wall of the right internal iliac artery (asterisk) was intact, collagen fiber (red fiber in c) and elastic fiber (black fiber in c) around the right external iliac vein were degenerated or disrupted (arrow in c), and spindle-shaped atypical cells were observed on both intraluminal and extraluminal area. Scale bar, 5 mm. d‒f Histological images of tumor cells. Tumor cells were spindle-shaped with irregular nuclei (d). The tumor cells were positive for CD31 (e) and ERG (f) by immunohistochemical analysis. Scale bar, 50 μm.