A 55-year-old female presented with pain and swelling of the abdomen. On investigation, she was found to have ascites, multiple sclerotic lesions in the vertebra, ribs, hip bone, and femur, multiple enhancing lesions in bilateral liver lobes with hepatomegaly and splenomegaly. Her hemoglobin was 7.1 gm/dL, total leucocyte count 2.88 × 109/L, total platelet count was 13 × 109/L. The bone marrow aspirate showed large clusters of tumor cells. The tumor cells were large, round to spindle-shaped with central to eccentrically placed nuclei with prominent nucleoli and abundant gray-blue cytoplasm (Fig. 1a, b). The morphology on the aspirate smears resembled a pleomorphic myeloma. The bone marrow biopsy showed total replacement of the marrow spaces by a tumor composed of spindle to round pleomorphic cells arranged in the form of variable-sized vascular spaces and solid sheets (Fig. 1c, d). The tumor cells were immunopositive for CD31, CD34, (Fig. 1e, f) Vimentin, and BCL-2 and immunonegative for Pan-cytokeratin, S-100, HMB-45, Synaptophysin, LCA, CD38, Desmin, SMA and EMA. A diagnosis of metastatic angiosarcoma was made.
Fig. 1.
Panel of photomicrograph showing the bone marrow aspirate and biopsy
Angiosarcoma may present with disseminated metastatic deposits. Clinically and cytomorphologically it may mimic a hematolymphoid neoplasm such as plasma cell myeloma, lymphoma or leukemia. A large panel of immunomarkers may be necessary for its proper diagnosis.
Authors contribution
SM performed the bone marrow, staining of smears, collection of patient data and drafting of the manuscript. AP was involved in treating the patient, providing of clinical data, and review of manuscript. AKA was involved in interpretation, immunohistochemistry, diagnosis, drafting the manuscript and acquiring the images.
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The authors declare that they have no conflict of interest.
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Consent obtained from patient.
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