Case study
Pleural cavity angiosarcoma arising in chronic expanding
hematoma after pneumonectomy
Hideki Miyazaki MD
a
, Akiteru Goto MD, PhD
a
, Rumi Hino MD, PhD
a
,
Satoshi Ota MD, PhD
a
, Reiko Okudaira MD, PhD
b
, Tomohiro Murakawa MD, PhD
c
,
Jun Nakajima MD, PhD
c
, Masashi Fukayama MD, PhD
a,
⁎
a
Department of Human Pathology, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku,
Tokyo 113-0033, Japan
b
Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku,
Tokyo 113-0033, Japan
c
Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku,
Tokyo 113-0033, Japan
Received 10 June 2010; revised 16 June 2010; accepted 16 June 2010
Keywords:
Angiosarcoma;
Chronic expanding
hematoma;
Chest
Summary A 52-year-old man received a left pneumonectomy for pulmonary squamous cell carcinoma
without signs of recurrence after surgery. At age 68 years, a capsulated huge mass developed in the left
pleural cavity, which was diagnosed as chronic expanding hematoma. Two years and 8 months after
detection, the lesion began to invade the chest wall, and 10 months later, the patient died of active
bleeding and direct compression of the heart by the lesion. At autopsy, the left thoracic cavity was
occupied by a cystic and hemorrhagic mass infiltrating into the surrounding structures. In addition,
scattered tumorous nodules were observed in the right lung. Histologically, angiosarcoma with
irregularly anastomosing vessels lined with atypical endothelial cells was noted in the chronic
expanding hematoma. The final diagnosis was pleural cavity angiosarcoma arising in chronic expanding
hematoma and its metastases to the right lung.
© 2011 Elsevier Inc. All rights reserved.
1. Introduction
Angiosarcoma (AS) is a relatively rare soft tissue tumor,
accounting for less than 1% of all sarcomas [1]. It usually
occurs on the face and scalp, deep soft tissue, liver, spleen,
and breast. Pleural cavity AS is extremely rare and is
reported to have strong linkage with chronic pyothorax,
especially in Japanese patients [2]. Almost all of the AS cases
complicated with pyothorax are associated with tuberculous
pyothorax or a history of thoracoplasty for tuberculosis.
Chronic expanding hematoma (CEH) is a rare nonneo-
plastic reactive process, and it usually appears as a slowly
growing hematoma [3]. CEH grows supposedly because
unresolved initial hematoma leads to repeated organization
and hemorrhage from new fragile microvessels. CEH can
occur in various locations, including the chest [4]. CEH of
the chest is considered a specific type of chronic empyema
that occurs after thoracic injury, thoracic surgery, or
tuberculous pleuritis.
⁎
Corresponding author. Department of Human Pathology, Graduate
School of Medicine, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku,
Tokyo 113-0033, Japan.
E-mail address: mfukayama-tky@umin.ac.jp (M. Fukayama).
www.elsevier.com/locate/humpath
0046-8177/$ – see front matter © 2011 Elsevier Inc. All rights reserved.
doi:10.1016/j.humpath.2010.06.019
Human Pathology (2011) 42, 1576–1579