Testis & epididymis
Germ cell tumors

Topic Completed: 1 July 2013

Minor changes: 24 December 2020

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PubMed Search: angiosarcoma testis

Jennifer Gordetsky, M.D.
Page views in 2020: 376
Page views in 2021 to date: 22
Cite this page: Gordetsky J. Angiosarcoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisangiosarcoma.html. Accessed January 16th, 2021.
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
  • Also called hemangiosarcoma
  • 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)
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
Gross description
  • Expansive solid, hemorrhagic nodule compressing surrounding testicular parenchyma
Gross images

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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

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Angiosarcoma with classic architectural pattern

CD34, CD31, Ulex Europaeus lectin, Pancytokeratin

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
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