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. 1. Introduction Angiosarcoma is an exceedingly uncommon malignant neoplasm derived from endothelial cells [1]. It accounts for roughly 1%-2% of all soft tissue neoplasms [2]. It most frequently occurs in skin and soft tissues [3]. Primary pleural angiosarcomas are extremely rare. As of 2010, only around 50 case reports have been documented in the literature [4]. 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. 2. Case Report 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
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