Epithelioid Vascular Lesions: The Differential Diagnosis and Approach in Cytology and Small Biopsies

Abstract

Vascular neoplasms are rare tumors with a multitude of clinical presentations and behavior, which make accurate identification and subclassification challenging on limited small biopsies. Within the spectrum of these lesions, the ones with epithelioid morphology, such as epithelioid hemangioendothelioma and epithelioid angiosarcoma, are particularly challenging given the morphologic overlap with nonvascular lesions and the limited cells due to hemodilution on sampling. Herein, we review the differential diagnosis of epithelioid vascular neoplasms, with a focus on the cytomorphology, differential diagnoses, and ancillary studies that pathologists should be aware of when evaluating small biopsies and aspirates, including novel translocations, and associated monoclonal immunohistochemistry antibodies, that can help in the diagnosis of some of these tumors. Awareness of these morphologic and ancillary study findings in these rare tumors will hopefully allow pathologists to recognize and render-specific diagnoses on limited samples of these challenging lesions.

Anteroposterior Combined Surgery of a Rare Massive Epithelioid Hemangioendothelioma at the Cervicothoracic Junction

“…This phenomenon is most prevalent in elongated bones. In contrast, the manifestation of lesions in the spinal region is comparatively infrequent [ 9 ].…”

Proximal‐type vulvar epithelioid sarcoma masquerading as cellulitis in a young female

“…Various epithelioid vascular tumours, such as epithelioid angiosarcoma, epithelioid hemangioendothelioma, pseudomyogenic hemangioendothelioma and epithelioid melanoma, should be differentiated. 5 Panel of immunohistochemistry revealed positive expression of pan-cytokeratin and EMA, whereas negative for S-100, CD31, INI-1, FOSB and CAMTA1. CD34 expression was detected only in the autopsy section.…”