Clinical Experience of an Angiosarcoma of the Scalp

ABSTRACT

Angiosarcoma is a rare malignant vascular tumor featuring endothelial cells. Angiosarcoma have four clinical manifestations that are angiosarcoma in the scalp and face, angiosarcoma in chronic lymphedematous areas, angiosarcoma in previously irradiated sites and malignant angioendothelioma. The most common lesions are those that occur in the scalp and in the face of elderly people. The male to female ratio is 2 : 1. In my case, a 65-years-old male presented progressively growing tumor on the left frontal scalp. The tumor began as an ill-defined bluish macule, which was initially mistaken for an old bruise. The rapidly growing lesion extended to form violaceousm compressible and hemorrhagic plaques. The mass was 6 x 4.5 cm in size. Distinguishing features are the frequent occurrence of a peripheral erythematous ring, satellite nodules, the presence of intratumoral hemorrhage, and the tendency to bleed spontaneously, or after minimal trauma. Histologically the tumor comprised anaplastic pleomorphic endothelial cells with new vascular channels and irregular vascular spaces lined by plump endothelial cell's stroma among them. The lesion was diagnosed as angiosarcoma. No metastasis to other organs were found as evaluated by chest CT, bone and liver scan. We performed wide excision, skin graft, bilateral transposition flap, chemotherapy and radiation. The tumor was recurred at 4 months after surgical excision and with metastasis to the lung. The progress was characterized by an extremely rapid growth accompanied by distant metastasis. Surgery, irradiation and chemotherapy having no effect on the final outcome, the patient died 7 months after diagnosis.