PMC4276302_01
Pretreatment: 5 x 5 cm ulcer on the medial left foot emanating a serosanginous discharge and similar ulcer present posteriorly along with blistering satellite lesions on the plantar surface of the foot.
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fig1
There were two major areas of ulceration in medial foot measuring approximately 5 x 5 cm that emanated a serosanguinous discharge (Figure 1), with blistering satellite lesions in the medial and lateral aspect of the foot.
Low power view showing extensive spindle cell proliferation involving dermis, subcutis, and deeper fibroadipose tissue.
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Microscopically, there was extensive spindle cell proliferation involving dermis, subcutis, and deeper fibroadipose tissue (Figure 2).
High power view showing multiple vascular sinuses lined by tufts of neoplastic endothelial cells.
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There were multiple vascular sinuses lined by tufts of neoplastic endothelial cells (Figure 3).
Positivity for vascular marker CD-31.
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Immunohistochemical stains revealed negative staining for cytokeratin while vascular markers CD31 (Figure 4), CD34, and D2-40 were strongly positive.
MRI of the left foot with contrast showing diffuse soft tissue T1 hypointense signal within both medial and lateral subcutaneous tissues, which is more prominent in the fat anterior to the Achilles tendon.
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FDG-PET and CT scan showing heterogeneous uptake in the medial and lateral foot with a more focal uptake in the medial foot, anterior to the Achilles tendon.
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Flourodeoxyglucose (FDG) PET and CT scan revealed heterogeneous uptake in the medial and lateral foot with a more focal uptake in the medial foot, anterior to the Achilles tendon (Figure 6).
Two months postradiation: marked diminishment of cutaneous ulceration with decline in discharge and drying of satellite nodules.
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fig7
At the end of two-month follow-up there was almost complete response and drying of the cutaneous ulceration and satellite nodules in his foot (Figure 7).