Malignant Angiosarcoma Masquerading as Benign Epithelioid Hemangioma

Main Article Content

Karishma Daftary
Joaquin Brieva
Raj Chovatiya

Keywords

epithelioid hemangioma, epithelioid hemangioendothelioma, angiosarcoma, clinicopathologic correlation

Abstract

In this report, we describe a case of a healthy 67-year-old female with rapidly growing red nodules on the scalp that demonstrated histological features of benign epithelioid hemangioma on multiple instances yet behaved clinically as a malignant angiosarcoma. Despite multiple rounds of resection, radiation, and chemotherapy, the patient ultimately succumbed from her widely metastatic disease. Diagnosis of vascular neoplasms, including the spectrum of low-grade epithelioid hemangioma, intermediate-grade epithelioid hemangioendothelioma, and high-grade angiosarcoma remains challenging due to overlapping clinical and histopathological features. This report is presented to highlight the need for clinicians to interpret histopathology, whether benign or malignant, in the context of clinical observation as the clinical course may not always match the biopsy.

References

1. Guo R, Gavino AC. Angiolymphoid hyperplasia with eosinophilia. Arch Pathol Lab Med. May 2015;139(5):683-6. doi:10.5858/arpa.2013-0334-RS

2. Adler BL, Krausz AE, Minuti A, Silverberg JI, Lev-Tov H. Epidemiology and treatment of angiolymphoid hyperplasia with eosinophilia (ALHE): A systematic review. J Am Acad Dermatol. Mar 2016;74(3):506-12.e11. doi:10.1016/j.jaad.2015.10.011

3. Sardaro A, Bardoscia L, Petruzzelli MF, Portaluri M. Epithelioid hemangioendothelioma: an overview and update on a rare vascular tumor. Oncol Rev. Sep 23 2014;8(2):259. doi:10.4081/oncol.2014.259

4. Marcum CB, Zager JS, Bélongie IP, Messina JL, Fenske NA. Profound proliferating angiolymphoid hyperplasia with eosinophilia of pregnancy mimicking angiosarcoma. Cutis. Sep 2011;88(3):122-8.

5. Anderson T, Zhang L, Hameed M, Rusch V, Travis WD, Antonescu CR. Thoracic epithelioid malignant vascular tumors: a clinicopathologic study of 52 cases with emphasis on pathologic grading and molecular studies of WWTR1-CAMTA1 fusions. Am J Surg Pathol. Jan 2015;39(1):132-9. doi:10.1097/pas.0000000000000346

6. Requena L, Sangueza OP. Cutaneous vascular proliferations. Part III. Malignant neoplasms, other cutaneous neoplasms with significant vascular component, and disorders erroneously considered as vascular neoplasms. J Am Acad Dermatol. Feb 1998;38(2 Pt 1):143-75; quiz 176-8. doi:10.1016/s0190-9622(98)70237-3

7. Shin JY, Roh SG, Lee NH, Yang KM. Predisposing factors for poor prognosis of angiosarcoma of the scalp and face: Systematic review and meta-analysis. Head Neck. Feb 2017;39(2):380-386. doi:10.1002/hed.24554

8. Ishida Y, Otsuka A, Kabashima K. Cutaneous angiosarcoma: update on biology and latest treatment. Curr Opin Oncol. Mar 2018;30(2):107-112. doi:10.1097/cco.0000000000000427

9. Penel N, Bui BN, Bay JO, et al. Phase II trial of weekly paclitaxel for unresectable angiosarcoma: the ANGIOTAX Study. J Clin Oncol. Nov 10 2008;26(32):5269-74. doi:10.1200/jco.2008.17.3146

10. Zeitouni NC, Hanna S, Loree TR, Brooks J, Cheney RT. Angiolymphoid hyperplasia with eosinophilia: a classic clinical presentation with histologic features of angiosarcoma. Dermatol Surg. Aug 2002;28(8):772-5. doi:10.1046/j.1524-4725.2002.02006.x

Most read articles by the same author(s)

1 2 > >>