title: Aggressive clinical course of epithelioid angiosarcoma in the femur: a case report.
abstract: BACKGROUND
  Epithelioid angiosarcoma is a rare variant of angiosarcoma, and is characterized by an epithelioid morphologic appearance that mimics carcinoma. These tumors usually arise in extraskeletal sites; origination in bone is rare.
  
  
  METHODS
  A 69-year-old woman presented with right knee pain. Plain radiographs and magnetic resonance imaging showed an osteolytic lesion with a large soft-tissue extension into the distal femur. Under a diagnosis of metastatic carcinoma of unknown origin based on the biopsy specimen, resection and replacement with an artificial joint were performed. Histologic analysis of the resected material confirmed epithelioid angiosarcoma, supported by immunoexpression of cytokeratins and vascular markers. Three months after surgery, metastasis to the bone and lymph nodes was observed, and the patient died of the disease shortly thereafter.
  
  
  CONCLUSIONS
  Epithelioid angiosarcoma of bone is characterized by an aggressive clinical course. A possibility of epithelioid angiosarcoma of bone should be considered in cases with such epithelial features, particularly if only small specimens are available.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan. akio@med.kyushu-u.ac.jp.
authors.forename: Akio
authors.initials: A
authors.lastname: Sakamoto
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Oda
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology* / Q000601:surgery; D015622:Epithelioid Cells / Q000473:pathology*; D005260:Female; D005269:Femur / Q000473:pathology* / Q000601:surgery; D006394:Hemangiosarcoma / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D011379:Prognosis