Metastatic Angiosarcoma of Bone Marrow Mimicking a Pleomorphic Myeloma

Excerpt

A 55-year-old female presented with pain and swelling of the abdomen. On investigation, she was found to have ascites, multiple sclerotic lesions in the vertebra, ribs, hip bone, and femur, multiple enhancing lesions in bilateral liver lobes with hepatomegaly and splenomegaly. Her hemoglobin was 7.1 gm/dL, total leucocyte count 2.88 × 10⁹/L, total platelet count was 13 × 10⁹/L. The bone marrow aspirate showed large clusters of tumor cells. The tumor cells were large, round to spindle-shaped with central to eccentrically placed nuclei with prominent nucleoli and abundant gray-blue cytoplasm (Fig. 1a, b). The morphology on the aspirate smears resembled a pleomorphic myeloma. The bone marrow biopsy showed total replacement of the marrow spaces by a tumor composed of spindle to round pleomorphic cells arranged in the form of variable-sized vascular spaces and solid sheets (Fig. 1c, d). The tumor cells were immunopositive for CD31, CD34, (Fig. 1e, f) Vimentin, and BCL-2 and immunonegative for Pan-cytokeratin, S-100, HMB-45, Synaptophysin, LCA, CD38, Desmin, SMA and EMA. A diagnosis of metastatic angiosarcoma was made.

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