case report
Post-radiation epithelioid angiosarcoma of the urinary bladder
and prostate
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Gang Wang, MD, PhD; Peter C. Black, MD; Brian F. Skinnider, MD; Malcolm M. Hayes, MB, ChB;
Edward C. Jones, MD1
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Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada; Department of Urology, Vancouver General Hospital, Vancouver, BC, Canada; Department of Pathology, British Columbia
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Cancer Agency, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
Cite as: Can Urol Assoc J 2016;10(5-6):E197-200. http://dx.doi.org/10.5489/cuaj.3220
Published online May 12, 2016.
Case report
A 79-year-old man was treated in 2007 with external beam
radiotherapy for prostatic adenocarcinoma. In the spring
of 2013, he developed irritative lower urinary tract symp-
toms and gross hematuria. Cystoscopy revealed a papil -
lary bladder tumour, which was resected transurethrally.
Microscopically, a widely infiltrating, poorly-differentiated
neoplasm was identified (Fig. 1A). The tumour had epithe-
lioid cytologic features (Fig. 1B), with areas of hemorrhage
and spindle cell patterns (Figs. 1C, 1D). The findings were
considered to be in keeping with a high-grade urothelial
carcinoma with sarcomatoid dedifferentiation. Some of the
curetted surfaces contained proliferative urothelial epithe-
lium with a reactive polypoid/papillary hyperplasia (Fig. 1A)
that had the potential to be misinterpreted as a noninvasive
papillary component of urothelial carcinoma. The immu-
nostain for cytokeratin 7 was positive in the majority of the
tumour cells (Fig. 1E). The tumour cells were negative for
prostate-specific antigen (PSA) and Pap on immunostaining.
The cytokeratin 20 immunostain was positive in the surface
urothelium and negative in the tumour cells.
Two months following the transurethral curettage, the
patient underwent radical cystoprostatectomy. Microscopic
examination demonstrated an extensively invasive, high-
grade neoplasm involving the prostate gland, both seminal
vesicles, and bladder trigone. Multiple resection margins
of the prostate and bladder wall were involved by invasive
tumour. The malignancy showed a range of morphologic
appearances, with some areas of solid and epithelioid pat-
tern resembling a poorly differentiated carcinoma and other
areas showing more pronounced vascular differentiation
with anastomosing, angular, blood-filled spaces lined by
elongated hyperchromatic tumour cells (Figs. 2A, 2B, 2C).
Immunohistochemical stains showed expression of vascular
markers CD31 (Fig. 2D), CD34, FLI1, and ERG (Fig. 2E) in
the tumour cells. The tumour cells showed patchy positivity
for cytokeratin 7. Both the prostate and bladder tumour com-
Abstract
Angiosarcoma of the lower urinary tract is exceedingly rare. A
minority of cases are associated with local radiotherapy. Epithelioid
angiosarcoma is a variant of angiosarcoma composed of large
rounded epithelioid endothelial cells that are positive for cytokera-
tin on immunostaining. There are only two cases of post-radiation
epithelioid angiosarcoma reported in the urinary bladder, and none
in the prostate gland. We report a case of epithelioid angiosarcoma
involving the urinary bladder and prostate in a patient with a his-
tory of radiotherapy for prostatic adenocarcinoma. A brief review
of literature regarding post-radiation epithelioid angiosarcomas in
the lower urinary tract is discussed.
Introduction
Angiosarcoma of the lower urinary tract is exceedingly rare.
In the urinary bladder, only 34 cases have been reported
in the English literature, 13 of which were associated with
local radiation therapy. There are only 14 reported cases
of angiosarcoma of the prostate, five of which were associ-
ated with radiation therapy.
Epithelioid angiosarcoma is a variant of angiosarcoma
composed of large rounded epithelioid endothelial cells
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that are positive for cytokeratin on immunostaining. There
are 12 reported cases of epithelioid angiosarcoma of the
bladder, only two of which were associated with previous
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radiation.
To the best of our knowledge, epithelioid
angiosarcoma of the prostate gland has not been previously
reported. It is important to be aware of epithelioid angiosar-
coma, as its histologic appearance and positive cytokeratin
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immunostain may mimic a poorly differentiated carcinoma.
We report a case of epithelioid angiosarcoma involving
the urinary bladder and prostate in a patient with a history
of external beam radiation for prostatic adenocarcinoma.
CUAJ • May-June 2016 • Volume 10, Issues 5-6
2016 Canadian Urological Association
E197
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