Giant primary angiosarcoma of the small intestine showing severe sepsis

Figure 1 Preoperative computed tomography. A: Abdominal computed tomography (CT) shows a giant tumor with central necrosis, extending from the epigastrium to the pelvic cavity; B: Chest CT shows multiple lung metastases.

Figure 2 Intraoperative images. A: On laparotomy, a giant, flexible tumor occupies the peritoneal cavity; B: The tumor is adherent to the small intestine and appears hemorrhagic. Multiple small tumors are recognized at other sites of the small intestine (arrow) and abdominal wall.

Figure 3 Resected specimen. A: The resected tumor is solid, weighing 3490 g and measuring 24 cm × 17.5 cm × 18 cm. Continuity is seen between the tumor and small intestine (arrows show small intestine); B: The inside of the tumor appears necrotic. Furthermore, a hole (3 cm in diameter) is present between the tumor and small intestine, and a large amount of coagulated blood is present in the small intestine (arrow).

Figure 4 Histopathological examination. A: Positive staining for CD31; B: Positive staining for factor VIII-related antigen.