A previously healthy 25-year-old man presented with a 1-month history of left chest pain and dry cough. The patient’s general condition was fair, and shortness of breath, weight loss, or fever was not noted. A physical examination revealed a reduction in respiratory sounds in the left lower zone. Laboratory findings demonstrated an increased erythrocyte sedimentation rate (36 mm/h), an increased serum concentration of C-reactive protein (3.11 mg/dL), as well as a leukocyte count of 10.6 × 103 cells/μL (72% segmented neutrophils, 9% nonsegmented neutrophils, and 11% lymphocytes). A left hilar mass with parenchymal infiltrates in the lower left field was apparent in chest radiographs. A contrast-enhanced CT scan of the chest showed a hypodense and noncalcified solid mass (5.5 × 5 cm) in the left hilar lesion with mediastinal invasion. A bronchoscopic examination revealed a tumor occluding the lower left bronchus (Fig 1
, top left, A), and a bronchoscopic biopsy was performed. A histologic examination of the biopsy specimen showed vascular spaces lined by malignant endothelial cells, some containing vesicular nuclei (Fig 1
, top right, B), which is suggestive of high-grade angiosarcoma.9–
The tissue sample also was found to be positive for the endothelial markers, factor VIII-related antigen (Fig 1
, bottom left, C) and CD34 (Fig 1
, bottom right, D) by immunohistochemical analysis, confirming the diagnosis of angiosarcoma.10
Despite extensive examination, no other organs appeared to be affected. Thus, we diagnosed primary pulmonary angiosarcoma in the patient.