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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Primary Pleural Angiosarcoma in a 63-Year-Old Gentleman</title><author><name sortKey="Abu Zaid, Ahmed" sort="Abu Zaid, Ahmed" uniqKey="Abu Zaid A" first="Ahmed" last="Abu-Zaid">Ahmed Abu-Zaid</name><affiliation><nlm:aff id="I1">College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Mohammed, Shamayel" sort="Mohammed, Shamayel" uniqKey="Mohammed S" first="Shamayel" last="Mohammed">Shamayel Mohammed</name><affiliation><nlm:aff id="I2">Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center (KFSH&RC), P.O. Box 3354, Riyadh 11211, Saudi Arabia</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23844302</idno><idno type="pmc">3697234</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697234</idno><idno type="RBID">PMC:3697234</idno><idno type="doi">10.1155/2013/974567</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">003D17</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003D17</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Primary Pleural Angiosarcoma in a 63-Year-Old Gentleman</title><author><name sortKey="Abu Zaid, Ahmed" sort="Abu Zaid, Ahmed" uniqKey="Abu Zaid A" first="Ahmed" last="Abu-Zaid">Ahmed Abu-Zaid</name><affiliation><nlm:aff id="I1">College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia</nlm:aff></affiliation></author><author><name sortKey="Mohammed, Shamayel" sort="Mohammed, Shamayel" uniqKey="Mohammed S" first="Shamayel" last="Mohammed">Shamayel Mohammed</name><affiliation><nlm:aff id="I2">Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center (KFSH&RC), P.O. Box 3354, Riyadh 11211, Saudi Arabia</nlm:aff></affiliation></author></analytic><series><title level="j">Case Reports in Pulmonology</title><idno type="ISSN">2090-6846</idno><idno type="eISSN">2090-6854</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature. Herein, we report the case of a 63-year-old gentleman who presented with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. Chest X-ray showed bilateral pleural effusion with partial bibasilar atelectasis. Ultrasound-guided thoracocentesis showed bloody and exudative pleural fluid. Cytologic examination was negative for malignant cells. An abdominal contrast-enhanced computed tomography (CT) scan showed two right diaphragmatic pleural masses. Whole-body positron emission tomography/computed tomography (PET/CT) scan showed two hypermetabolic fluorodeoxyglucose- (FDG-) avid lesions involving the right diaphragmatic pleura. CT-guided needle-core biopsy was performed and histopathological examination showed neoplastic cells growing mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. Immunohistochemical analysis showed strong positivity for vimentin, CD31, CD68, and Fli-1 markers. The overall pathological and immunohistochemical features supported the diagnosis of epithelioid angiosarcoma. The patient was scheduled for surgery in three weeks. Unfortunately, the patient died after one week after discharge secondary to pulseless ventricular tachycardia arrest followed by asystole. Moreover, we also present a brief literature review on pleural angiosarcoma.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Maziak, De" uniqKey="Maziak D">DE Maziak</name></author><author><name sortKey="Shamji, Fm" uniqKey="Shamji F">FM Shamji</name></author><author><name sortKey="Peterson, R" uniqKey="Peterson R">R Peterson</name></author><author><name sortKey="Perkins, Dg" uniqKey="Perkins D">DG Perkins</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Alexiou, C" uniqKey="Alexiou C">C Alexiou</name></author><author><name sortKey="Clelland, Ca" uniqKey="Clelland C">CA Clelland</name></author><author><name sortKey="Robinson, D" uniqKey="Robinson D">D Robinson</name></author><author><name sortKey="Morgan, We" uniqKey="Morgan W">WE Morgan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lorentziadis, M" uniqKey="Lorentziadis M">M 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A">A Baisi</name></author><author><name sortKey="Raveglia, F" uniqKey="Raveglia F">F Raveglia</name></author><author><name sortKey="De Simone, M" uniqKey="De Simone M">M de Simone</name></author><author><name sortKey="Cioffi, U" uniqKey="Cioffi U">U Cioffi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Branch, Kd" uniqKey="Branch K">KD Branch</name></author><author><name sortKey="Smith, Mt" uniqKey="Smith M">MT Smith</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hart, J" uniqKey="Hart J">J Hart</name></author><author><name sortKey="Mandavilli, S" uniqKey="Mandavilli S">S Mandavilli</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lund, L" uniqKey="Lund L">L Lund</name></author><author><name sortKey="Amre, R" uniqKey="Amre R">R Amre</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yang, C F" uniqKey="Yang C">C-F 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Pulmonol</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Pulmonol</journal-id><journal-id journal-id-type="publisher-id">CRIM.PULMONOLOGY</journal-id><journal-title-group><journal-title>Case Reports in Pulmonology</journal-title></journal-title-group><issn pub-type="ppub">2090-6846</issn><issn pub-type="epub">2090-6854</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23844302</article-id><article-id pub-id-type="pmc">3697234</article-id><article-id pub-id-type="doi">10.1155/2013/974567</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Primary Pleural Angiosarcoma in a 63-Year-Old Gentleman</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">0000-0003-2286-2181</contrib-id><name><surname>Abu-Zaid</surname><given-names>Ahmed</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Mohammed</surname><given-names>Shamayel</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh 11533, Saudi Arabia</aff><aff id="I2"><sup>2</sup>Department of Pathology and Laboratory Medicine, King Faisal Specialist Hospital and Research Center (KFSH&RC), P.O. Box 3354, Riyadh 11211, Saudi Arabia</aff><author-notes><corresp id="cor1">*Ahmed Abu-Zaid: <email>aabuzaid@alfaisal.edu</email></corresp><fn fn-type="other"><p>Academic Editors: T. Koizumi and A. Turna</p></fn></author-notes><pub-date pub-type="ppub"><year>2013</year></pub-date><pub-date pub-type="epub"><day>13</day><month>6</month><year>2013</year></pub-date><volume>2013</volume><elocation-id>974567</elocation-id><history><date date-type="received"><day>28</day><month>4</month><year>2013</year></date><date date-type="accepted"><day>3</day><month>6</month><year>2013</year></date></history><permissions><copyright-statement>Copyright © 2013 A. Abu-Zaid and S. Mohammed.</copyright-statement><copyright-year>2013</copyright-year><license xlink:href="https://creativecommons.org/licenses/by/3.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature. Herein, we report the case of a 63-year-old gentleman who presented with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. Chest X-ray showed bilateral pleural effusion with partial bibasilar atelectasis. Ultrasound-guided thoracocentesis showed bloody and exudative pleural fluid. Cytologic examination was negative for malignant cells. An abdominal contrast-enhanced computed tomography (CT) scan showed two right diaphragmatic pleural masses. Whole-body positron emission tomography/computed tomography (PET/CT) scan showed two hypermetabolic fluorodeoxyglucose- (FDG-) avid lesions involving the right diaphragmatic pleura. CT-guided needle-core biopsy was performed and histopathological examination showed neoplastic cells growing mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. Immunohistochemical analysis showed strong positivity for vimentin, CD31, CD68, and Fli-1 markers. The overall pathological and immunohistochemical features supported the diagnosis of epithelioid angiosarcoma. The patient was scheduled for surgery in three weeks. Unfortunately, the patient died after one week after discharge secondary to pulseless ventricular tachycardia arrest followed by asystole. Moreover, we also present a brief literature review on pleural angiosarcoma.</p></abstract></article-meta></front><body><sec id="sec1"><title>1. Introduction</title><p>Angiosarcoma is an exceedingly uncommon malignant neoplasm derived from endothelial cells [<xref rid="B1" ref-type="bibr">1</xref>]. It accounts for roughly 1%-2% of all soft tissue neoplasms [<xref rid="B2" ref-type="bibr">2</xref>]. It most frequently occurs in skin and soft tissues [<xref rid="B3" ref-type="bibr">3</xref>]. Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature [<xref rid="B4" ref-type="bibr">4</xref>]. Herein, we report a case of primary epithelioid angiosarcoma of the right pleura in a 63-year-old gentleman who presented with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. In addition, a literature review on pleural angiosarcoma is included.</p></sec><sec id="sec2"><title>2. Case Report</title><p>A 63-year-old gentleman presented to King Faisal Specialist Hospital and Research Center (KFSH&RC) with a 3-month history of right-sided chest pain, dyspnea, and hemoptysis. Past medical history was remarkable for diabetes mellitus type 2, hypertension, ischemic heart disease, and congestive heart failure. The patient did not have previous history of tuberculous infection or asbestos exposure. Clinical respiratory examination was remarkable for bilateral reduced airway entry. All laboratory tests were normal.</p><p>A chest plain radiograph (X-ray) showed bilateral pleural effusion, partial bibasilar atelectasis, and linear pleural calcifications involving the right lung (<xref ref-type="fig" rid="fig1">Figure 1</xref>). Ultrasound-guided thoracocentesis showed bloody and exudative pleural fluid. Cytologic examination was negative for malignant cells. A chest, abdominal, and pelvic contrast-enhanced computed tomography (CT) scan showed bilateral pleural effusion, partial bibasilar atelectasis, and peripheral linear dense calcifications and thickening of the right lung. In addition, two pleural masses touching the right hemidiaphragm were identified and measured 3.2 × 2.1 cm and 4.3 × 4.8 cm. The masses were suspicious for neoplastic lesions. No axillary or mediastinal lymphadenopathy was identified. Furthermore, no evidence of distant metastasis was identified (<xref ref-type="fig" rid="fig2">Figure 2</xref>). CT-guided needle-core biopsy was performed, and the histopathological and immunohistochemical examinations revealed epithelioid angiosarcoma. Whole-body positron emission tomography/computed tomography (PET/CT) scan showed two hypermetabolic fluorodeoxyglucose- (FDG-) avid lesions involving the right diaphragmatic pleura, suggesting neoplastic lesions and supporting the earlier pathological CT scan and CT-guided needle-core biopsy findings (<xref ref-type="fig" rid="fig3">Figure 3</xref>). Accordingly, the patient was scheduled for surgery in three weeks.</p><p>Histopathological examination showed neoplastic proliferation consisting of highly atypical large epithelioid cells with abundant eosinophilic cytoplasm, round to oval nuclei with marked pleomorphism, vesicular chromatin, and prominent single nucleoli. The neoplastic cells grew mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells (<xref ref-type="fig" rid="fig4">Figure 4(a)</xref>). In addition, focal hemorrhagic areas were also identified (<xref ref-type="fig" rid="fig4">Figure 4(b)</xref>).</p><p>Immunohistochemical analysis showed strong positivity for mesenchymal (vimentin) and endothelial (CD31, CD68, and Fli-1) markers (Figures <xref ref-type="fig" rid="fig5">5(a)</xref>–<xref ref-type="fig" rid="fig5">5(d)</xref>). The tumor cells were negative for cytokeratin, cytokeratin 7, cytokeratin 20, cytokeratin 5/6, cytokeratin 8/18, calretinin, WT-1, HMB45, Melan-A, MITF, P63, S100, TTF-1, PLAP, PSA, AFP, EMA, HSA, CD10, CD20, CD30, CD38, and CD45. The overall pathological and immunohistochemical features supported diagnosis of a malignant epithelioid vascular tumor, consistent with epithelioid angiosarcoma.</p><p>The patient was discharged on the second day after the CT-guided needle-core biopsy in a stable condition. Unfortunately, the patient died after one week secondary to pulseless ventricular tachycardia arrest followed by asystole.</p></sec><sec id="sec3"><title>3. Discussion</title><p>Angiosarcoma is an exceedingly uncommon malignant neoplasm derived from uncontrolled proliferation of anaplastic vascular endothelial cells that line abnormal blood-filled sacs [<xref rid="B1" ref-type="bibr">1</xref>]. It accounts for approximately 1%-2% of all soft tissue neoplasms [<xref rid="B2" ref-type="bibr">2</xref>]. Skin and soft tissues (such as breast, heart, liver, spleen, and skeletal muscle) are the most frequent sites of involvement [<xref rid="B3" ref-type="bibr">3</xref>]. Pleural angiosarcomas are almost always secondary (metastatic) neoplasms from other primary sites [<xref rid="B5" ref-type="bibr">5</xref>]. Primary pleural angiosarcomas are exceptionally rare. As of 2010, only around 50 case reports of primary pleural angiosarcomas have been documented in the English literature so far [<xref rid="B4" ref-type="bibr">4</xref>]. Average age at presentation is 57 years, and males are affected more frequently than females (male-female ratio is 9 : 1) [<xref rid="B6" ref-type="bibr">6</xref>]. Etiology remains unknown. However, reported predisposing etiological factors are many and include exposure to chronic tuberculous pyothorax, chronic lymphedema, viral infections, radiation therapy, asbestos, and thorium [<xref rid="B1" ref-type="bibr">1</xref>, <xref rid="B2" ref-type="bibr">2</xref>, <xref rid="B7" ref-type="bibr">7</xref>]. When etiology is unrelated to predisposing factors, the term “de novo neoplasm” is applied [<xref rid="B3" ref-type="bibr">3</xref>, <xref rid="B7" ref-type="bibr">7</xref>].</p><p>Clinical signs and symptoms are nonspecific. The most frequently presenting clinical signs and symptoms include chest pain, pleuritic chest pain, shortness of breath, cough, hemoptysis, anemia, and massive recurrent hemothorax [<xref rid="B3" ref-type="bibr">3</xref>, <xref rid="B5" ref-type="bibr">5</xref>, <xref rid="B8" ref-type="bibr">8</xref>]. Radiological findings are also nonspecific and cannot differentiate pleural angiosarcomas from other primary or metastatic pleural neoplastic lesions. Chest plain radiographs (X-rays) usually demonstrate pleural mass lesions, diffused pleural thickening, and unilateral or bilateral pleural effusions [<xref rid="B3" ref-type="bibr">3</xref>, <xref rid="B5" ref-type="bibr">5</xref>, <xref rid="B8" ref-type="bibr">8</xref>]. Computed tomography (CT) scans typically exhibit pleural heterogeneous contrast-enhanced lobulated masses (blood-filled cysts) with ill-defined margins [<xref rid="B8" ref-type="bibr">8</xref>]. Positron emission tomography (PET) scans generally illustrate homogenous or diffused fluorodeoxyglucose- (FDG-) avid lesions, and are often utilized in delineating the extent of disease [<xref rid="B8" ref-type="bibr">8</xref>]. Collectively, clinical signs and symptoms as well as radiological findings are nonspecific and similar to the other closely related pleural neoplasms that will be considered in the differential diagnosis, such as mesotheliomas and adenocarcinomas. </p><p>Cytological examination of thoracocentesis (pleural effusion tap) specimens is frequently negative for malignancy, hence unhelpful in making the diagnosis [<xref rid="B7" ref-type="bibr">7</xref>]. Definitive diagnosis of pleural angiosarcoma is established by surgical biopsy specimens for histopathological and immunohistochemical examinations [<xref rid="B1" ref-type="bibr">1</xref>, <xref rid="B9" ref-type="bibr">9</xref>].</p><p>Microscopically, there are two histological variants of pulmonary/pleural angiosarcoma: classical and epithelioid [<xref rid="B10" ref-type="bibr">10</xref>, <xref rid="B11" ref-type="bibr">11</xref>]. Classical angiosarcomas exhibit vasoformative patterns such as irregularly and variably sized anastomosing vascular channels lined by atypical and pleomorphic malignant endothelial cells. Conversely, vasoformative patterns are minimal in epithelioid angiosarcomas. Furthermore, epithelioid angiosarcomas are characterized by solid-sheeted nodular growth patterns, large round to polygonal epithelioid neoplastic cells with plentiful eosinophilic cytoplasm, large pleomorphic nuclei and prominent nucleoli. Nemours mitotic figures and variable proportions of necrosis and hemorrhage can be present [<xref rid="B10" ref-type="bibr">10</xref>, <xref rid="B11" ref-type="bibr">11</xref>]. Extravasations of red blood cells (intracytoplasmic lumen containing red blood cells) can be visualized [<xref rid="B10" ref-type="bibr">10</xref>, <xref rid="B11" ref-type="bibr">11</xref>]. Although not routinely performed due to availability of specific immunohistochemical markers, electron microscopic recognition of several Weibel-Palade bodies and pinocytic vesicles highly confirms neoplasms of endothelial-derived origins [<xref rid="B12" ref-type="bibr">12</xref>]. Epithelioid histological variant is deemed to be an element of higher malignant potential when compared to the classical histological variant [<xref rid="B13" ref-type="bibr">13</xref>]. Pleural angiosarcomas are commonly epithelioid variants in about 75% of the cases [<xref rid="B1" ref-type="bibr">1</xref>, <xref rid="B7" ref-type="bibr">7</xref>, <xref rid="B14" ref-type="bibr">14</xref>] and are often misdiagnosed as mesotheliomas or adenocarcinomas [<xref rid="B15" ref-type="bibr">15</xref>, <xref rid="B16" ref-type="bibr">16</xref>].</p><p>Immunohistochemical examination is essential for distinguishing pleural angiosarcomas from the other histologically related mesotheliomas or adenocarcinomas [<xref rid="B17" ref-type="bibr">17</xref>]. Epithelial markers (e.g., cytokeratin) always stain strongly positive in mesotheliomas and adenocarcinomas whereas they occasionally stain positive in pleural angiosarcomas, particularly the epithelioid histological variants of pleural angiosarcomas [<xref rid="B11" ref-type="bibr">11</xref>]. Interestingly, our case report stained negative for epithelial markers. Endothelial (vascular) markers are necessary for warranting definitive diagnosis of angiosarcoma such as CD31, CD34, and factor VIII-related antigens [<xref rid="B7" ref-type="bibr">7</xref>]. By far, CD31 is the most sensitive and specific marker for vascular neoplasms and has been shown to hardly ever stain positive with nonvascular neoplasms (such as mesotheliomas and adenocarcinomas) [<xref rid="B7" ref-type="bibr">7</xref>, <xref rid="B18" ref-type="bibr">18</xref>, <xref rid="B19" ref-type="bibr">19</xref>]. Coexpression of mesenchymal (vimentin) and endothelial (particularly CD31 and Fli-1) markers along with epithelioid histopathological features confirms diagnosis of epithelioid angiosarcoma.</p><p>Management modalities of pleural angiosarcoma include surgery, radiotherapy, and chemotherapy [<xref rid="B3" ref-type="bibr">3</xref>, <xref rid="B7" ref-type="bibr">7</xref>, <xref rid="B18" ref-type="bibr">18</xref>, <xref rid="B20" ref-type="bibr">20</xref>]. Surgery must be performed whenever possible and is indicated in conditions of complete surgical resection, debulking with pneumonectomy and rib excision, as well as cauterization of bleeding sources [<xref rid="B2" ref-type="bibr">2</xref>, <xref rid="B3" ref-type="bibr">3</xref>]. Radiotherapy may have a beneficial role in postoperative settings in the absence of diffuse or metastatic disease [<xref rid="B3" ref-type="bibr">3</xref>]. Chemotherapy generally has minimal effect and is merely utilized for purposes of symptom palliation, and is rarely used in patients with poor performance status [<xref rid="B2" ref-type="bibr">2</xref>]. Preoperative vascular embolization can be used to reduce tumor vascularity and accordingly intraoperative pleural bleeding [<xref rid="B2" ref-type="bibr">2</xref>, <xref rid="B7" ref-type="bibr">7</xref>].</p><p>In conclusion, pleural angiosarcoma remains a highly aggressive malignant neoplasm with a rapidly fetal clinical course, despite the varying treatment modalities (surgery, radiotherapy, and chemotherapy) [<xref rid="B20" ref-type="bibr">20</xref>]. 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In addition, two pleural masses touching the right hemidiaphragm were identified and measured 3.2 × 2.1 cm and 4.3 × 4.8 cm (white arrows). The masses were suspicious for neoplastic lesions. No axillary or mediastinal lymphadenopathy was identified. Furthermore, no evidence of distant metastasis was identified.</p></caption><graphic xlink:href="CRIM.PULMONOLOGY2013-974567.002"></graphic></fig><fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label><caption><p>An axial chest positron emission tomography/computed tomography (PET/CT) scan showing two hypermetabolic fluorodeoxyglucose- (FDG-) avid mass lesions involving the right diaphragmatic pleura, suggestive of neoplastic lesions (white arrows).</p></caption><graphic xlink:href="CRIM.PULMONOLOGY2013-974567.003"></graphic></fig><fig id="fig4" orientation="portrait" position="float"><label>Figure 4</label><caption><p>(a) Histopathological examination of the right diaphragmatic pleural masses (magnification power, 40x) showing the neoplastic cells that grew mainly in sheets with focal areas suggestive of vascular spaces lined by cytologically malignant epithelioid cells. The neoplastic proliferation consisted of highly atypical large epithelioid cells with abundant eosinophilic cytoplasm, round to oval nuclei with marked pleomorphism, vesicular chromatin, and prominent single nucleoli. (b) Focal hemorrhagic areas were identified.</p></caption><graphic xlink:href="CRIM.PULMONOLOGY2013-974567.004"></graphic></fig><fig id="fig5" orientation="portrait" position="float"><label>Figure 5</label><caption><p>Immunohistochemical examination of the resected right diaphragmatic pleural masses. (a) Tumor cells stained positive for vimentin (magnification power, 40x). (b) Tumor cells stained positive for CD31 (magnification power, 40x). (c) Tumor cells stained positive for CD68 (magnification power, 40x). (d) Tumor cells stained positive for Fli-1 (magnification power, 40x).</p></caption><graphic xlink:href="CRIM.PULMONOLOGY2013-974567.005"></graphic></fig></floats-group></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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