Epithelioid Angiosarcoma Arising from a Huge Leiomyoma: A Case Report and a Literature Review

Figures

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  Figure 1. MRI image of a T2-weighted sagittal section. A huge abdominal tumor derived from the uterus, presenting with uneven intratumor signal.

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  Figure 2. MRI image of a Gadolinium enhanced T1-weighted coronal section. The center of the abdominal tumor was not enhanced, implicating a suspicion of necrosis in the center.

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  Figure 3. Intraoperative findings of the abdominal tumor. The surgery revealed a huge tumor occupying the space from the pelvis to the diaphragm. The tumor surface was smooth and hard with many dilated veins.

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  Figure 4. Gross findings of the excised tumor. The size of the tumor was 28 × 23 cm and the weight was 7600g. The tumor showed continuity with the posterior wall of the uterus.

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  Figure 5. Macroscopic findings of sections of the tumor. On the sliced surface of the tumor, an obvious heterogeneous pattern was recognized within the mixture of a white homogeneous area, suggesting benign uterine fibroids, and a vulnerable part, due to bleeding and necrosis.

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  Figure 6. Microscopic findings of the tumor (H.E. stain; original magnification X40). The tumor was mostly composed of spindle-shaped cells, consistent with degenerated leiomyoma. Enlargement of blood vessels was observed within an area of about 2 cm × several mm, and proliferation of atypical cells showing a fine meshwork microvascular structure was observed in the blood vessel cavity.

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  Figure 7. Microscopic findings of the tumor (H.E. stain; original magnification X400). These atypical cells consisted of various contours, such as cubic, polygonal, and short spindle shape. The nucleus was circular with a high degree of vacuolar enlargement and pleomorphism. Abnormal mitotic figures were also interspersed.

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  Figure 8. Immunohistochemical findings of the tumor (ERG; original magnification X400). The cytoplasm of the tumor cells was strongly positive for ERG stains.

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  Figure 9. Immunohistochemical findings of the tumor (CD31; original magnification X400). The cytoplasm of the tumor cells was diffusely positive for CD31 stains.