Primary High-Grade Poorly Differentiated Angiosarcoma of an Intra-parotid Lymph Node.
Head and neck angiosarcoma is an infrequent malignant vascular tumor most commonly found in the skin and soft tissue of the head and neck. Most head and neck angiosarcomas are metastatic to cervical lymph nodes from other primitive location. We describe herein a case of primary high-grade poorly differentiated angiosarcoma arising in an intra-parotid lymph node, discuss the value of immunohistochemical stains for differential diagnosis, and review the literature concerning head and neck angiosarcoma. A 47-year-old man presented with a painless mass that had grown for a period of 6 months in the parotid area. The CT-scan revealed a left parotid lesion of 17 mm. Fine needle aspiration was considered suspicious for lymphoma or poorly differentiated carcinoma. A superficial parotidectomy was performed. On gross examination, the lesion was a well-defined, gray, homogeneous mass of 15 mm of diameter. Microscopic examination showed a normal parotid tissue and a poorly differentiated malignant neoplasm in an intra-parotid lymph node. The tumor had a pseudo-alveolar pattern, with large pleomorphic epithelioid cells, abundant eosinophilic cytoplasm, large vesicular nuclei, and one or more prominent nucleoli. Atypical mitoses were seen. Neoplastic malignant cells stained positive for Vimentin, CD31, D2-40, factor VIII, ERG, and partially for CD34. A positron emission tomography scan was made to search for a primary neoplasia, but no other tumor was localized. The diagnosis of primary high-grade, poorly differentiated, intra-parotid lymph node angiosarcoma was established.
Pathology Department, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke University, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. eugenia.ducharne.asuaje@usherbrooke.ca.
Eugenia
E
Ducharne-Asuaje
Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke University, Sherbrooke, QC, Canada.
Dominique
D
Dorion
Pathology Department, Charles Lemoyne Hospital, Sherbrooke University, Sherbrooke, QC, Canada.
Louis
L
Lamarre
Institut Bergonié, Bordeaux, France.
Jean Michel
JM
Coindre
Pathology Department, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke University, 3001, 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada.
Sameh
S
Geha
D014408:Biomarkers, Tumor / Q000032:analysis; D044963:Biopsy, Fine-Needle; D006394:Hemangiosarcoma / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D010307:Parotid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
D014408:Biomarkers, Tumor
Lymph node tumour; Markers of vascular tumors; Poorly differentiated angiosarcoma; Primary angiosarcoma