Cytologic features of angiosarcoma: A review of 26 cases diagnosed on FNA

Abstract

BACKGROUND: This study describes the cytologic features of 26 angiosarcomas diagnosed on fine-needle aspiration.METHODS: Twenty-six angiosarcomas from 20 patients were confirmed by cytomorphology and immunocytochemical (immunohistochemistry) positivity for at least 2 of 3 vascular markers. Specimens were examined for spindled/epithelioid/plasmacytoid single cells, 3-dimensional clusters, multiple prominent/bar-shaped nucleoli (5 times longer than their width), chromatin strands, abnormal mitoses, necrosis, and vasoformative features. RESULTS: Eight males and 12 females with a mean age of 52 years (range, 2-94 years) underwent aspiration of tumors in the following: soft tissue or skin/subcutis (n 5 10), bone (n 5 4), nodes (n 5 5), lung (n 5 2), liver (n 5 2), heart (n 5 1), parotid gland (n 5 1), and pleural fluid (n 5 1). An angiosarcoma diagnosis was rendered for 24 of the 26 cases (92%); 1 was diagnosed as "atypical cells, cannot exclude angiosarcoma," and another was diagnosed as a malignant vascular neoplasm. Abnormal mitoses were most frequent (85%), and they were followed by single malignant cells (81%: epithelioid [69%], spindled [62%], and plasmacytoid[19%]), 3-dimensional clusters (54%), multiple prominent (62%) or bar-shaped nucleoli (54%), and chromatin strands (31%). Vasoformative features, including hemophagocytosis (54%), cytoplasmic lumina/vacuoles (69%) containing red blood cells (54%)/neutrophils (31%), and endothelial wrapping (69%), were seen in 88%; 23% had all vasoformative features, 88% had at least 1, and 12% had none. CONCLUSIONS: Angiosarcomas show a range of cytomorphologic features that make them potentially recognizable on cytology. Although vasoformative features are highly suggestive, they are not specific for angiosarcoma and may be seen in some nonvascular neoplasms. Immunohistochemistry and a high index of suspicion are required for an accurate diagnosis. Cancer Cytopathol 2016;124:659-68.

Clinical, cytologic, and immunohistochemical features of sarcomas involving body cavity fluids

“…Vasoformative features of angiosarcomas, including intracytoplasmic lumens with or without intraluminal red blood cells or neutrophils, micro‐acinar “lumen” formation, and the formation of vascular channels, were described by Boucher et al and Geller et al, although their series were predominantly fine‐needle aspiration samples and included only 1 pleural fluid. Boucher et al specifically noted that vasoformative features were not seen in the fluid specimen.…”

Epithelioid Angiosarcoma of the Thyroid Associated with Multinodular Goiter, Graves Disease, and Papillary Thyroid Carcinoma

“…A review of the literature from 2013 examined 48 cases of primary thyroid epithelioid angiosarcoma in which 25 patients underwent FNA and only 5 of the subjects had FNA results consistent with epithelioid angiosarcoma; all others were reported as anaplastic thyroid cancer, follicular thyroid cancer, unspecified malignant cells, or inconclusive (5). Cytologic features of angiosarcoma on FNA are variable and include abnormal mitoses, single or clustered malignant cells with characteristic epithelioid morphology, and vasoformative features such as hemophagocytosis (12).…”

Mammary mesenchymal and fibroepithelial lesions: An illustrated cytomorphologic update with differential diagnoses

“…Nuclear pleomorphism, hyperchromasia, and nuclear membrane irregularity are variable. Geller et al noted chromatin stranding (multiple bar or bullet‐shaped nucleoli connected by chromatin strands) in 31% of their cases …”

“…Angiosarcomas show a range of cytologic and vasoformative features that help suggest the diagnosis. The vasoformative features include: hemophagocytosis, the finding of red blood cells or neutrophils in vacuoles, and endothelial wrapping . In a review of the cytologic features of 26 angiosarcomas, Geller et al found that only 23% of tumors had both vasoformative features, while 88% had at least one feature and 12% had no vasoformative features .…”

“…The vasoformative features include: hemophagocytosis, the finding of red blood cells or neutrophils in vacuoles, and endothelial wrapping . In a review of the cytologic features of 26 angiosarcomas, Geller et al found that only 23% of tumors had both vasoformative features, while 88% had at least one feature and 12% had no vasoformative features . Important cytoarchitectural and cellular features of mammary angiosarcomas include individually dispersed malignant cells, complex architecture with papillary formation, and endothelial‐lined channels or rosette‐like structures .…”