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An Official Publication of the Indian Association of Oral and Maxillofacial Pathologists


 
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Year : 2012  |  Volume : 16  |  Issue : 3  |  Page : 470-472
 

Angiosarcoma


Department of Oral Pathology and Microbiology, KD Dental College and Hospital, Mathura, Uttar Pradesh, India

Date of Web Publication16-Oct-2012

Correspondence Address:
Shweta Jaitley
Department of Oral Pathology and Microbiology, KD Dental College and Hospital, Mathura, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-029X.102525

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How to cite this article:
Jaitley S. Angiosarcoma. J Oral Maxillofac Pathol 2012;16:470-2

How to cite this URL:
Jaitley S. Angiosarcoma. J Oral Maxillofac Pathol [serial online] 2012 [cited 2019 Dec 6];16:470-2. Available from: http://www.jomfp.in/text.asp?2012/16/3/470/102525



   Case Details Top


A 38-year-old female patient reported with a bluish-red-colored proliferative growth present on the left side of posterior mandibular gingiva.


   Histopathological Features Top


Stratified squamous epithelium exhibiting ulceration and formation of fibrinopurulent membrane [Figure 1].
Figure 1: Stratified squamous epithelium exhibiting ulceration and formation of fibrinopurulent membrane

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Highly vascular connective tissue exhibiting numerous blood capillaries and areas of endothelial cell proliferation. Some sinusoidal capillaries are also seen [Figure 2].
Figure 2: Highly vascular connective tissue exhibiting numerous blood capillaries

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Irregular infiltrative growth pattern with anastomosing blood capillaries containing intraluminal spindle shaped tumor cells. Multi-layering of epithelioid endothelial cells with extravasated red blood cells are also seen [Figure 3].
Figure 3: Anastomosing blood capillaries with multilayering of endothelial cells

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Endothelial cells forming intraluminal plaques in the background of loosely arranged connective tissue stroma [Figure 4].
Figure 4: Endothelial cells forming intraluminal plaques

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Malignant endothelial cells arranging themselves to form lumen within the existing vascular lumina [Figure 5].
Figure 5: Malignant endothelial cells exhibiting lumen formation

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Sheets of epithelioid endothelial cells exhibiting vesicular nucleus, cleaved nuclear contours and intracytoplasmic vacuoles along with mitotic figures. Myxoid areas are seen [Figure 6].
Figure 6: Epithelioid endothelial cells arranged in sheets exhibiting vesicular nucleus and cleaved nuclear contours along with mitotic figures

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Endothelial cells show nuclear pleomorphism with prominent and multiple nucleoli. ≥10 mitotic figures/HPF and many abnormal mitotic figures are present [Figure 7].
Figure 7: Endothelial cells showing nuclear pleomorphism, prominent and multiple nucleoli along with ≥10 mitotic figures / HPF

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Some areas of necrosis seen. Intense stromal inflammation with the predominance of eosinophils present along with some extravasated RBCs [Figure 8].
Figure 8: Intense stromal inflammation with areas of necrosis

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   Differential Diagnosis Top


Epithelioid hemangioma: Well-formed canalized vessels and lobular architecture. Stromal inflammation is present but no overt vessel formation.

Epithelioid hemangioendothelioma: Shows smaller tumor cells arranged in cords, strands, or nests showing vesicular nucleus and inconspicuous nucleolous. Lacks multilayering of vascular channels and mitotic figures are not so frequent.

Reactive papillary endothelial hyperplasia: Fibrinoid micronodules evident. No endothelial atypia or multilayering present and mitosis are infrequent.

Epithelioid sarcoma: Commonly occurs in distal extremities. Shows nodular arrangement of tumor cells with areas of central necrosis. Nuclear pleomorphism is moderate.

Sinusoidal hemangioma: Although mild nuclear pleomorphism is present, distinction can be made by presence of monolayered endothelium and each narrow vessel wall also contains delicate layer of subendothelial pericytes.

Spindle cell hemangioendothelioma: Cavernous spaces lined by single layer of bland endothelial cells. Nuclear atypia is rare.

Tufted angioma: Multiple lesions seen rarely in adults. Poorly canalized small vessels with bland endothelial cells.

Malignant endovascular papillary angioendothelioma: Usually affects children. It is characterized by hobnail-like endothelial cells within the dilated spaces.


   Final Diagnosis Top


Epithelioid angiosarcoma.


   Conclusion Top


Vascular tumours may sometimes mimic just a reactive lesion clinically. They may also show some histopathological features of a reactive lesion. Therefore, thorough histopathological examination and observation of the above mentioned features would aid in correct diagnosis and further treatment of more aggressive vascular malignancies like angiosarcoma.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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