Pleural Metastasis in Epithelioid Angiosarcoma

Epithelioid angiosarcoma (EAS) is a rare, highly aggressive endothelial cell malignancy characterized by a propensity for rapid metastatic spread and an exceptionally poor prognosis.Diagnosing EAS remains a major clinical and histopathological challenge due to its atypical cellular morphology, mimicry of poorly differentiated carcinomas or mesotheliomas, and insidious, nonspecific clinical presentation, which frequently leads to diagnostic delays.Given the scarcity of literature on this entity, expanding the current clinical knowledge base is essential to facilitate early identification.In this report, we present the case of a 60-year-old woman with a history of pituitary adenoma resection who presented with progressive chest pain, weight loss, and symptomatic anemia, which initially suggested a non-ST-segment elevation myocardial infarction (NSTEMI), given the presentation of precordial pain and the results of the cardiac biomarker evaluation, but was later identified as metastatic disease.Imaging and biopsy revealed a rare metastatic EAS involving the liver, spleen, and pleura, prompting palliative care, video-assisted thoracoscopic surgery (VATS), and pleurodesis.This case serves as a critical reminder of the diagnostic challenges posed by atypical pleural metastases, which can uniquely mimic primary pulmonary or mesothelial malignancies.By highlighting this rare secondary manifestation, this report underscores the necessity of combining meticulous immunohistochemical analysis with a principal emphasis on thoracoscopic findings to confirm the diagnosis.