Cytological Features of a Metastatic Angiosarcoma in the Lymph Node Diagnosed via Liquid-Based Cytology

Figures

• 

  Figure 1. An 88-year-old Taiwanese male initially presented with ill-defined, erythematous patches over the forehead in November 2020. (a) Twenty months later, he developed confluent, erythematous patches from the head to the neck in September 2022. (b) Neck CT scans revealed diffuse, cutaneous, and subcutaneous infiltrations in the head and neck areas, being more prominent on the left side, with the imaging differential diagnoses of cellulitis, metastasis, among others. Subsequent neck sonography showed enlarged lymph nodes in the bilateral neck regions, up to 2.3 cm in size.

• 

  Figure 2. Sono-guided FNA cytology of the left cervical lymph node was performed smoothly and prepared into a SurePath slide (Becton, Dickinson and Company, Sparks, MD, USA). The nodal FNA cytology specimen showed a low cellularity, comprising singly scattered, and loosely or tightly clustered tumor cells with three-dimensional clusters arranged similarly to streams of fishes in the fibrous stroma of the microtissue ((a) Papanicolaou stain, ×40). The tumor cells exhibited a variable appearance, from spindled to epithelioid or plasmacytoid with abundant cytoplasm ((b,c), Papanicolaou stain, ×800). The tumor cells were large in size and highly atypical with round-to-oval nuclei and prominent nucleoli observed ((c), Papanicolaou stain, ×800). There were occasionally vasoformative features observed, including the hemophagocytosis of neutrophils (arrow) or RBCs ((d), Papanicolaou stain, ×800), intracytoplasmic lumen (arrow) ((e), Papanicolaou stain, ×800), and cells-in-cells or cell grasping ((f), Papanicolaou stain, ×800). The differential diagnoses based purely on the cytological findings of epithelioid cells were broad, and might include poorly differentiated carcinoma, sarcoma, and less…

• 

  Figure 3. We prepared a cell block from the FNA specimen. The tumor cells, although small in number, were large in size and highly atypical with intra-cytoplasmic lumen formation ((A), H&E stain, ×800). With the presentation of metastatic malignancy suggestive of angiosarcoma, we performed only two immunohistochemical stains using cell block sections with the endothelial cell markers CD31 ((B), ×1000) and ERG ((C), ×1000). The tumor cells were found to be positive for both markers, confirming the diagnosis of angiosarcoma.