Cutaneous angiosarcoma: report of three different and typical cases admitted in a unique dermatology clinic

Abstract

Angiosarcoma is a rare and aggressive tumor with high rates of metastasis and relapse. It shows a particular predilection for the skin and superficial soft tissues. We report three distinct and typical cases of angiosarcoma that were diagnosed in a single dermatology clinic over the course of less than a year: i) Angiosarcoma in lower limb affected by chronic lymphedema, featuring Stewart-Treves syndrome; ii) a case of the most common type of angiosarcoma loated in the scalp and face of elderly man and; iii) a skin Angiosarcoma in previously irradiated breast. All lesions presented characteristic histopathological findings: irregular vascular proliferation that dissects the collagen bundles with atypical endothelial nuclei projection toward the lumen.

Figure 1

A. Red-to-purple confluent macules, papules and nodular lesions associated with chronic lymphedema on the left lower limb. B. Red-to-purple tumoral lesions

Figure 2

A. Irregular vascular clefts, consisting of endothelium with atypical and prominent nuclei towards the lumen (purple macule lesion) (HE, 100x). B. Epithelioid tumor masses, formed by atypical, large, rounded cells, with acidophilic cytoplasm and frequent mitotic figures (tumoral lesion) (HE, 100x). C. The two histological aspects visualized in the same field (HE, 100x)

Figure 3

Extensive, infiltrative, confluent purple-black lesions on the scalp, frontal region and face, forming an easily bleeding left periorbital mass

Figure 4

A. Proliferation of irregular, anastomosed clefts (HE, 100x). B. Atypical endothelium, with hyperchromatic nuclei, projecting into the lumen (HE, 400x).

Figure 5

A. Papulotumoral, red-to-purple, hardened lesions in the lower lateral quadrant of the left breast. B. Central purple-black tumor lesion, surrounded by “satellites” reddish papules

Figure 6

A. Anastomotic suture of sinusoidal vessels, with an infiltrative aspect (HE, 25x). B. Endothelium with mild to moderate atypia and prominent nuclei into the vessel (HE, 100x)