Radiological Appearance of Primary Ovarian Angiosarcoma in a 79-Year-Old Woman: a case report and literature review

Primary ovarian angiosarcoma is an extremely rare disease. Most reports concern young premenopausal patients, and relatively few case reports regarding elderly patients exist [1]. In this report, we present a case of ovarian angiosarcoma in a 79-year-old woman. The patient’s initial chief complaint was abdominal distention. Sonography, computed tomography (CT), and magnetic resonance imaging (MRI) demonstrated a large heterogeneous mass with hemorrhaging, solid compartmentalization, and an abundant vascular network. The diagnosis of primary ovarian angiosarcoma was verified using immunohistochemistry staining with CD34, CD31, and Fli-1. In this report, we describe the sonographic, CT, and MRI features of this case of angiosarcoma. Correspondence Author to: Chin-Ming Jeng Department of Radiology, Cathay General Hospital, Taipei, Taiwan No. 280, Sec. 4, Ren-Ai Road, Taipei 106, Taiwan J Radiol Sci 2013; 38: 105-109 Radiological appearance of primary ovarian angiosarcoma 106 J Radiol Sci September 2013 Vol.38 No.3 showed a heterogeneous mass lesion with a multi-loculated cystic hyperintense component at the superior dorsal region. A post-contrast T1-weighted FS-FSE MR image showed a strong curvilinear contrast enhancement of the lesion (Fig. 3). Based on the images of a large pelvic mass lesion, laparotomy, abdominal total hysterectomy, bilateral salpingo-oophorectomy, and pelvic peritoneal tumor resection were performed to remove a large left ovarian tumor with a gray-white to dark red solid, fibrous to fleshy surface, which was abundant with vasculature and large areas of hemorrhaging (Fig. 4a). A transverse section of the specimen showed a hypercellular left ovarian tumor and fibrous hypervascular tissue (Fig. 4b). Histologic features manifested as a proliferated, irregular, slit-like structure lined with atypical endothelial neoplasms undergoing frequent mitosis (Fig. 4c), which were immunopositive for CD31, CD34 (strongly), and Fli-1 (focally) and immunonegative for D2-40 (Fig. 4d). Based on these findings, the patient was confirmed to have angiosarcoma arising from the focal background of the left ovary.