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A 34-year-old lady who presented with intractable epistaxis was found to have a leucoerythroblastic blood picture. Bone marrow examination revealed extensive involvement by non-cohesive large mononuclear cells (top left) which had round to indented nuclei, homogeneously condensed chromatin, distinct nucleoli and copious amounts of deeply basophilic and vacuolated cytoplasm. Some tumour cells showed a superficial resemblance to plasmablasts because of the eccentric nuclei and deep blue cytoplasm (top right). Intracytoplasmic, probably intraluminal, erythroid cells were seen in tumour cells (bottom left). Trephine biopsy showed complete replacement of the marrow by tumour cells which formed anastomosing vascular spaces (bottom right). Immunostaining showed that the tumour cells expressed CD31, thus confirming a diagnosis of angiosarcoma. Computerized tomography of the head and neck regions subsequently revealed a large tumour infiltrating the base of the skull and paranasal sinuses. The patient developed adult respiratory distress syndrome with multiorgan failure and succumbed to the disease 1 week after diagnosis, despite intensive medical support.

Cytological description of angiosarcoma involving the marrow has rarely been reported, largely as a result of its rarity and the technical difficulty in marrow aspiration. The findings of heavy cytoplasmic vacuolation in the tumour cells and intracytoplasmic haemopoietic elements reminiscent of the vasoformative property of angiosarcoma may help in the diagnosis.