Testis and epididymis
Germ cell tumors
Angiosarcoma

Author: Jennifer Gordetsky, M.D. (see Authors page)

Revised: 12 May 2017, last major update July 2013

Copyright: (c) 2002-2017, PathologyOutlines.com, Inc.

PubMed Search: angiosarcoma testis

Cite this page: Angiosarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testisangiosarcoma.html. Accessed September 21st, 2017.
Definition / general
  • Rare, highly aggressive tumor of vascular and lymphatic endothelial cell origin
  • Either a primary testicular vascular sarcoma or sarcomatous transformation of a testicular germ cell tumor
Terminology
  • Also called hemangiosarcoma
Epidemiology
  • Rare tumors of men of all ages
  • Two reported groups:
    1. Associated with teratomas in young men (J Urol 2000;163:1872)
    2. Occurring in elderly, may be associated with chronic hydrocele or prior radiation (Diagn Pathol 2007;2:23)
Sites
Clinical features
  • Testicular mass, pain, swelling, intermittent fevers
  • Patients tend to have metastatic disease at presentation, identified with imaging
Prognostic factors
  • Tend to present with advanced disease / metastasis
  • Deep soft tissue and visceral angiosarcomas have a high mortality, up to 53% succumb to disease within a year
  • Organ confined disease may have a better prognosis
  • Sarcomatous differentiation of a germ cell tumor is a poor prognostic indicator (Am J Surg Pathol 2007;31:1356, Urol Oncol 2008;26:595)
Case reports
Treatment
Gross description
  • Expansive solid, hemorrhagic nodule compressing surrounding testicular parenchyma
Gross images

Images hosted on other servers:

Expansile hemorrhagic nodule

Microscopic (histologic) description
  • Classically shows a proliferation of anastomosing blood filled channels
  • Solid pattern shows a proliferation of sheets or nests without evidence of lumen formation
  • Primitive pattern shows a nearly solid proliferation with angulated small capillary sized lumina reminiscent of tubules but filled with blood channels lined by plump hyperchromatic cells
  • May have epithelioid cytology (appearing like glandular carcinoma) and solid architectural patterns, resembling poorly differentiated carcinoma
  • No intratubular germ cell neoplasia
Microscopic (histologic) images

Images hosted on other servers:

Angiosarcoma with
classic architectural
pattern

CD34, CD31,
Ulex Europaeus lectin,
Pancytokeratin

Site unspecified

Bladder angiosarcoma:
atypical endothelial
cells

Positive stains
  • CD31 and CD34 highlight malignant endothelial cells lining anastamosing vascular channels; factor VIII
Negative stains
Molecular / cytogenetics description
  • Isochromosome 12p and chromosome 12p alterations reported in metastatic lesion containing angiosarcoma arising from germ cell tumor (Hum Pathol 2010;41:139)
Differential diagnosis