Pathology
Images
Atlas of dermatopathology
Josef Feit, Hana Jedličková, Günter Burg, Luděk Matyska, Spasoje Radovanovic et al.
Index
Contents
Authors
ExpSys: non-tumors
ExpSys: tumors
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+ Introduction
+ Literature
+ Support
+ Skin biopsy
+ Non-tumorous skin diseases
+ Skin tumors
+ Cysts of the skin and subcutis
+ Soft tissue lesions
+ Some lesions of the oral cavity
+ Dermatovenerology
+ Collection of histological slides by prof. Günter Burg
+ Collection of histological slides by prof. Werner Kempf
+ Collection of histological slides of dr. Ram Chandra Adhikari
Angiosarcoma
Clinical signs
  • highly malignant tumor of blood or lymphatic vessels
  • 3 clinical settings:
    • face and scalp of elderly people
    • angiosarcoma secondary to chronic lymphedema (Stewart-Treves, after mastectomy)
    • irradiated skin or after trauma or ulceration
  • Angiosarcoma of the face starts as erythematous patch, which later develops into nodules, plaques and ulcerates. Very poor prognosis.

Angiosarcoma (4169)

Pictures

Angiosarcoma of the head (biopsy see bellow): Angiosarcoma, Clinical picture (6151) Angiosarkom, head, Clinical picture (4169)

Histology

Irregular and slit-like vascular spaces within the dermis; atypical vessels around collagen fibres, dissecting through the dermal collagen; atypical endothelial cells; bleeding.

Angiosarcoma (1191)

Pictures

Angiosarcoma: Angiosarcoma, HE 10x (1190) Angiosarcoma, HE 20x (1191) Angiosarcoma, HE 20x (1192) Angiosarcoma, HE 40x (1193)

Angiosarcoma: Angiosarcoma, HE 20x (4403)

Another case of angiosarcoma: Angiosarcoma, HE 20x (4402)

Cellular, partially solid angiosarcoma, almost negative for FVIII and CD34, strong positive for CD31: Angiosarcoma, HE 20x (4401) Angiosarcoma, CD34 20x (4398) Angiosarcoma, Factor VIII 20x (4399) Angiosarcoma, CD31 20x (4397)

Angiosarcoma: Angiosarcoma, HE 60x (12862) Angiosarcoma, CD31 40x (12858) Angiosarcoma, CD34 40x (12859) Angiosarcoma, Factor VIII 40x (12860) Angiosarcoma, Melan A 40x (12861) Angiosarcoma, AE13 40x (12857)

Angiosarcoma with only focal differentiation of irregular vascular spaces: Angiosarcoma, HE 20x (4309) Angiosarcoma, HE 60x (12967) Angiosarcoma, HE 60x (12966) Angiosarcoma, CD31 60x (12968)

Angiosarcoma, mostly solid: Angiosarcoma, AE13 20x (13977) Angiosarcoma, CD31 20x (13978) Angiosarcoma, CD34 20x (13979) Angiosarcoma, Melan A 20x (13980) Angiosarcoma, vimentin 20x (13981)

Angiosarcoma: Angiosarcoma, HE 20x (14032) Angiosarcoma, HE 60x (14033)

Angiosarcoma: Angiosarcoma, HE 60x (14645) Angiosarcoma, HE 60x (14646) Angiosarcoma, HE 60x (14647) Angiosarcoma, CD31 20x (14638) Angiosarcoma, CD34 20x (14639) Angiosarcoma, desmin 20x (14640) Angiosarcoma, Melan A 20x (14641) Angiosarcoma, podoplanin 20x (14642) Angiosarcoma, S100 20x (14643) Angiosarcoma, SMA 20x (14644)

Case study
Angiosarcoma
MUDr. Hana Jedličková, PhD.
Introduction

Angiosarcoma of the skin is the most common type of angiosarcoma. Most commonly it arises in the scalp of elder men, it can occur also in chronic lymphedema, especially as a late complication after mastectomy and radiation therapy (Stewart Treves syndrome). It presents as ill defined violaceous nodules, plaques and ulcers with extensive infiltration of the clinically normal borders. Satellites are common. The prognosis is poor.

Three histopathological patterns have been described:

  • angiomatous
  • spindled
  • undifferentiated
History

79-year-old man presented with an infiltrated plaque with necrotic areas and purulent secretion in the scalp of 3 month duration. He was treated for seborrhoeic dermatitis of the scalp in the past. The appearance of the lesion was accompanied by severe headaches. He had a history of chronic heart disease, aortal aneurysm, chronic pulmonary disease, chronic renal failure, hypertension, polyneuropathy, transitory ischemic attack and venous insufficiency.

Histopathology showed angiosarcoma, x-ray of the scull was normal, other examinations did not reveal signs of metastatic disease. The patient died in the course of palliative radiotherapy, 3 months after the diagnosis.

Clinical signs

On the crown of the head there was an alopecic infiltrated plaque 10×10 cm with necrotic areas, draining pus. The lesion was painful, the area of dark red infiltration extended to the forehead.

Pictures

Angiosarcoma of the head: Angiosarcoma, Clinical picture (6151) Angiosarkom, head, Clinical picture (4169)

Histology

Mixed inflammatory infiltrate with superficial necrosis. In the dermis there are many irregular vessels with atypical endothelial cells dissecting collagen fibers.

Conclusion: angiomatous type of angiosarcoma.

Pictures

Angiosarcoma of the head, excision from the margin of the ulceration (the same patient whose clinical pictures are shown above): Angiosarcoma, head, HE 40x (4114)