Primary angiosarcoma of the bladder in a young female

Abstract

Our case report pertains to a 32-year-old woman initially presenting with left flank pain and gross haematuria throughout her urinary stream. CT of her kidney/ureter/bladder (CT KUB) revealed ureteric dilatation to the level of the bladder without evidence of renal calculus and subsequently a stent was inserted. She represented a month later with contralateral flank pain, and a transuretheral resection of bladder tumour was performed. Histopathological diagnosis was epithelioid angiosarcoma. Further imaging (MRI pelvis) revealed that the tumour arose from the posterior bladder wall with local invasion and regional lymph node metastasis. Ifosfamide and epirubicin chemotherapy with single-fraction radiotherapy induced significant reduction in tumour bulk, although this initial response was followed by the development of symptoms suggestive of disease progression. She died 19 months after initial diagnosis with persistent pulmonary and vertebral metastases although no autopsy was performed.

Figure 1

Malignant epithelioid cells arranged in nests. H&E stain, objective magnification ×20.

Figure 2

Nests of malignant cells stained strongly positive for pancytokeratin MNF116, objective magnification ×20.

Figure 3

Immediate postcontrast (gadolinium) T1-weighted fat-saturated MRI of the pelvis revealing bladder mass invading the anterior vaginal wall (arrow).

Figure 4

CT chest showing metastatic pulmonary lesion in the lower lobe of right lung (arrow).

Figure 5

CT chest showing a metastatic lytic lesion in the left pedicle of T5 (arrow).