Disseminated Angiosarcoma With Multifocal Small‐Bowel Involvement Presenting as Suspected Small‐Bowel Bleeding

Figures

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  FIGURE 1. Endoscopic findings. (a) Small‐bowel capsule endoscopy showing active bleeding from an irregular circumferential ulcerative lesion in the mid‐jejunum (arrows). (b) Antegrade double‐balloon endoscopy (DBE) showing a friable ulcerated tumor with surrounding mucosal elevation and luminal narrowing in the jejunum (arrows). (c) Close‐up view showing an irregular indurated ulcer base with active oozing. (d) Retrograde DBE showing multiple elevated ileal lesions with surface oozing (arrows).

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  FIGURE 2. Computed tomography (CT) scan. (a) Contrast‐enhanced CT showing focal jejunal wall thickening with associated luminal stenosis at the bleeding site (arrowheads). (b) CT bone window demonstrating multiple suspected bone metastases (arrowheads). (c) Abdominal aortic graft with soft‐tissue infiltration (arrows).

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  FIGURE 3. Histopathological findings of angiosarcoma. (a) Hematoxylin and Eosin (H&E) staining showing sheets of atypical epithelioid tumor cells with enlarged nuclei and prominent nucleoli. (b) H&E staining showing tumor cells within vascular lumina of the aortic wall, indicating lymphovascular invasion (arrows). (c) Immunohistochemistry showing strong nuclear expression of ERG in tumor cells. (d) Tumor cells showing strong expression of pancytokeratin (AE1/AE3 + CAM5.2).

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  FIGURE 4. Jejunal involvement at autopsy. (a) Gross specimen showing jejunal tumors associated with intestinal stenosis (arrows). (b) Histological section showing invasive angiosarcoma infiltrating the intestinal wall (Hematoxylin and Eosin stain); the area outlined in black indicates tumor involvement.