PMC3634548_01
Top: Mild periorbital erythema and left upper lid swelling were present on initial presentation. Bottom: One week later, periorbital erythema and left upper lid swelling have become more pronounced.
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F1
External examination revealed an area of red, indurated skin near the glabella with soft tissue edema extending into the left upper lid (fig. 1). The patient presented one week later with worsening forehead and upper eyelid swelling (fig. 1).
Top: CT scan. Non-specific soft tissue swelling temporal to the left orbit (left) and in the glabellar region (right). Bottom: T1-weighted MRI, post-gadolinium. A distinct soft tissue lesion is visible superficial to the left temporalis muscle and orbit (left, arrow), as well as in the glabellar region (right, arrow). Enhancement of adjacent subcutaneous tissues and fascia is also present.
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F2
Computed tomography (CT) of the orbits demonstrated non-specific soft tissue changes corresponding to the areas of edema found on clinical examination (fig. 2). Magnetic resonance imaging (MRI) revealed a soft tissue lesion lateral to the left orbit that extended medially into the mid-forehead (fig. 2).
Histopathological examination of tissue biopsy. Poorly differentiated tumor cells infiltrating the deep dermis with rudimentary vascular lumen formation (left). Antibody stains for CD31 (top right) and Factor 8 (bottom right) were both positive for vascular endothelial tissue, confirming the diagnosis of angiosarcoma.
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F3
The tumor cells were immunoreactive to CD31 and factor 8 immunohistochemical staining, which was consistent with a diagnosis of angiosarcoma (fig. 3).