PMC6207953_01
Right leg lymphedema, sero-hemorrhagic drainage, notice extensive fibrinous and eschar tissue (before debridement and antibiotic therapy).
10.1177_2050313X18796343-fig1.jpg
PMC6207953_01_10.1177_2050313X18796343-fig1.jpg
fig1-2050313X18796343
Physical examination revealed chronic changes of elephantiasis, specifically verrucous skin, with a noticeable serosanguinous foul-smelling discharge, more prominent on the right than the left leg (Figures 1 and 2).
Right leg 1-week after debridement and under broad-spectrum intravenous antibiotic therapy.
10.1177_2050313X18796343-fig2.jpg
PMC6207953_01_10.1177_2050313X18796343-fig2.jpg
fig2-2050313X18796343
Physical examination revealed chronic changes of elephantiasis, specifically verrucous skin, with a noticeable serosanguinous foul-smelling discharge, more prominent on the right than the left leg (Figures 1 and 2). A 2-week follow-up visit revealed some improvement in the odor and discharge; however, vascular-like lesions were now more obvious on both of his legs (Figure 2), and a punch biopsy was taken.
Highly atypical and pleomorphic neoplastic cells form solid aggregations and rudimentary vascular structures (H&E, upper) and strongly express CD31 (immunostaining, lower).
10.1177_2050313X18796343-fig3.jpg
PMC6207953_01_10.1177_2050313X18796343-fig3.jpg
fig3-2050313X18796343
The histopathology report depicted an extensive infiltrate of the dermis with small irregular aggregations of the highly atypical and pleomorphic cells (Figure 3).
These atypical cells strongly express CD31 immunostaining (lower), and stained positively for vimentin, CD34 typical of epithelioid sarcoma (angiosarcoma) but negative for Kaposi sarcoma-associated human herpesvirus-8 (HHV-8), pankeratin (AE1/AE3), p63, CK7, CK20, S100, SOX10 and CD45.
10.1177_2050313X18796343-fig4.jpg
PMC6207953_01_10.1177_2050313X18796343-fig4.jpg
fig4-2050313X18796343
These atypical cells stained positively for vimentin, CD31 (Figure 4) and, CD34, typical of epithelioid sarcoma (angiosarcoma) but negative for human herpesvirus-8 (HHV-8).