PMC3814070_01
Clinical presentation of the patient with angiosarcoma prior to treatment.
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On clinical examination, the patient was found to have a flesh-colored subcutaneous nodule measuring 1.5 x 0.9 cm in diameter on his left forehead and poorly demarcated red, scaly patches which were most prominent on the right contralateral cheek (Figure 1).
The main tumor was bulky and composed of atypical and pleomorphic spindle cells with numerous mitotic figures (a). On the periphery of the tumor, areas of vessel formation with hyperchromatic and "hob-nailing" (blue arrow) of the neoplastic endothelium were seen (b).
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An excisional biopsy was performed, which revealed angiosarcoma with positive lateral and deep margins (Figure 2).
Scouting biopsies revealed a subtle infiltration in the superficial dermis with poorly formed malignant vascular structures similar to those seen at the periphery of the main tumor.
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Because of the pervasive nature of this tumor, two scouting biopsies were taken from the right cheek, which were also consistent with angiosarcoma (Figure 3).
A localized infection of Enterobacter cloacae developed on the patient's left forehead.
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During his last month of treatment, the patient developed a localized infection of Enterobacter cloacae on the left forehead, which was resolved with topical garamycin (Figure 4).
Presentation of the patient 1 month after treatment with radiation treatment as a single modality.
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Results of follow-up physical examination by the multidisciplinary team at six months did not show any evidence of tumor recurrence (Figure 5).