Correct!
4. Fungal elements consistent with coccidioidomycosis

The pathology diagnosis was epithelioid hemangioenothelioma or angiosaracoma based on the pattern of growth, cellularity, cellular atypia and immunostaining that was positive for CD 31 and CD 34. There is no evidence of coccidioidomycosis.

An angiosarcoma is an uncommon malignant neoplasm characterized by rapidly proliferating, extensively infiltrating anaplastic cells derived from blood vessels. Angiosarcomas are aggressive and tend to recur locally, spread widely, and have a high rate of lymph node and systemic metastases. The rate of tumor-related death is high. Primary pulmonary angiosarcomas are extremely rare and when angiosarcomas are present in the lung often result from metastasis from the heart, pulmonary arteries or another distant site.

In this patient pulmonary CT angiography and echocardiography did not reveal a primary tumor. She is currently undergoing chemotherapy.

References

1. Marchiori E, Zanetti G, Mano CM, Hochhegger B, Irion KL. The reversed halo sign: another atypical manifestation of sarcoidosis. Korean J Radiol 2010;11:251-2.
2. Patel AM, Ryu JH. Angiosarcoma in the lung. Chest 1993;103:1531-5.
3. Ozcelik C, Onat S, Yaldiz M, Ozcelik Z. Primary epithelioid angiosarcoma of the lung presenting as pulmonary hemorrhage. Asian Cardiovasc Thorac Ann 2006;14:69-71.