Epithelioid angiosarcoma of the cervical spine: A case report

Figure 1 Radiological changes in the cervical spine and lung. A: Computed tomography of the spine shows no obvious spinal fracture, kyphotic deformity, or alignment deformity; B: Cervical lateral radiograph shows C6 burst fracture with severe kyphosis; C: Computed tomography (CT) of the lung shows diffuse nodules in both lungs. The metastasis was suspected; D: Repeat CT of the lung 1 month later shows rapid progression of the tumor in both lung and pleura.

Figure 2 Pre-operative cervical spine magnetic resonance imaging, intra-operative C-arm radiograph, and post-operative chest radiograph. A: Spinal magnetic resonance images demonstrate the C6 pathologic fracture on T1-weighted images; B: With central necrosis and mixed some fluid and hematoma on T2-weighted images; C: Poor and heterogenous enhancement on T1-weighted images with gadolinium administration; D: The C-arm radiograph images show C2/3/4/7/T1 transpedicular screw and C5-6 corpectomy with tibia bone graft fusion and plate fixation in lateral view; E: The C-arm radiograph images show C2/3/4/7/T1 transpedicular screw and C5-6 corpectomy with tibia bone graft fusion and plate fixation in coronal view; F: Rapid progression of acute respiratory distress syndrome 3 weeks after the second surgery.

Figure 3 Histopathological examination of the tumor. Proliferation of cells exhibiting epithelioid morphology, prominent nucleoli and abundant eosinophilic cytoplasm. Tumor necrosis is present. A: Hematoxylin-eosin (HE), 40 ×; B: HE, 100 ×; C: High-power view demonstrates pleomorphic epithelioid cells, intermixed with acute inflammation. Mitotic cells are present (HE, 400 ×); D: Anastomotic vascular channels lined by epithelioid endothelial cells (HE, 200 ×).

Figure 4 Immunohistochemical staining of the tumor. Immunohistochemical staining shows diffuse nuclear staining of tumor cells expressing cytokeratin. A: AE1/AE3; B: CD31; C: CD34; D: ERG. All pictures are 40 × magnification.