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Bladder

Other tumors

Angiosarcoma

Reviewers: Turki Al-Hussain, M.D., Johns Hopkins Medical Centers (see Reviewers page)
Revised: 24 March 2011, last major update March 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Rare vascular tumor with anastomosing vascular channels
● Endothelial cells usually exhibit marked cytologic atypia

Epidemiology
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● Mean age 64 years, 89% occur in males

Etiology
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● Due to radiation therapy for pelvic malignancy in 1/3; also exposure to arsenic, thorium dioxide, polyvinyl chloride or chemotherapeutic agents
● It has been reported to arise in bladder with preexisting hemangioma

Clinical features
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● Patients typically present with hematuria
● Traditionally considered to have a poor prognosis, but see Arch Pathol Lab Med 2006;130:1543

Case reports
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● Survival 6 years after initial presentation (Urology 2007;69:575.e9)

Treatment
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● Wide radical resection, possibly radiotherapy/chemotherapy

Gross
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● Hemorrhagic, raised mass (mean 7 cm) of trigone or dome

Micro
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● Anastomosing vascular channels lined by plump hyperchromatic cells
● Also solid growth and epithelioid cytology
● Typically invades the muscularis propria (Am J Surg Pathol 2008;32:1213)

Micro images
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Anastomosing vascular channels lined by atypical endothelial cells, below normal appearing urothelium


Endothelial cells have marked atypia with prominent nucleoli


Various images

Positive stains
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● CD31, CD34
● Cytokeratin can be focally positive, especially in epithelioid tumors

Differential diagnosis
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● Hemangioma: typically 1 cm or less, 80% are cavernous, no atypia, no anastomosing or solid areas
● Kaposi’s sarcoma: associated with HIV and HHV8; extravasated red blood cells present; usually less atypia than angiosarcoma
● Sarcomatoid urothelial carcinoma: undifferentiated spindle cells; associated urothelial carcinoma; vascular markers are negative

End of Bladder > Other tumors > Angiosarcoma

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