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Angiosarcoma — SCE Dermatology MCQ

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HardSkin CancerAngiosarcomaSCE Dermatology

A 70-year-old man presents with a violaceous nodule on the shin of his left leg. He has chronic lymphoedema following hip replacement surgery. Biopsy shows atypical vascular channels with endothelial cell atypia. He is HIV negative. What is the most likely diagnosis?

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Correct answer: D — Angiosarcoma associated with chronic lymphoedema

Angiosarcoma arising in chronic lymphoedema (Stewart-Treves syndrome) is a well-described, aggressive malignancy. It classically occurs in post-mastectomy lymphoedema but can arise in lymphoedema of any cause, including post-surgical lymphoedema. Histologically, it shows atypical endothelial cells forming irregular vascular channels with nuclear atypia and mitotic figures, positive for CD31, CD34, and D2-40. Kaposi sarcoma is HHV-8-associated and occurs in different clinical settings (HIV, Mediterranean, iatrogenic). Bacillary angiomatosis (Bartonella henselae) occurs in immunocompromised patients.

Reference: BAD 2021; Dermatological Surgery 2020