PMC9702819_01
Histopathological examination results of parotid gland and scalp metastasis. Hematoxylin-eosin (HE) staining showed that salivary gland tissue was found in the sample tissue of the left parotid gland mass, and fibrous tissue hyperplasia was observed in some areas (A-C) Atypical cells were seen near the granulation tissue, which was indicated by immunophenotype as endovascular cells, and infiltration of lymphocytes and plasma cells was also observed, accompanied by bleeding (A). Immunohistochemical results showed CD34 negative (B) and CD31 positive (C). As for the HE result of scalp metastasis (D, E), squamous mucosa, epithelial erosion, a small amount of increased cytoplasmic ratio, irregular karyotype, and trace lesion tissue (D) were shown. Immunohistochemical results showed CD34 negative (E) and CD31 positive (F).
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Pathological findings postoperatively showed that vascular endothelial derived cells were responsible for the infection, and the immunohistochemical staining showed that CD31 was diffusely positive and the Ki-67 proliferation index was 50%-60%, whereas CD34 was negative ( Figures 1A-C ), with lymphoid and plasma cell infiltration and bleeding. A local biopsy revealed CD31, ERG, and Ki-67 were positive, P53 was partially positive, while CK, CD34, CD117, CEA, and P40 were negative, indicating that this was a metastasis ( Figures 1D-F ).
Different responses of retro auricular and scalp angiosarcoma metastases to anlotinib treatment. Changes in retro auricular recurrence and overhead metastases during anlotinib treatment on 13 July, 22 July, 25 July, 28 July, and 1 August 2019, respectively. Among them, the retro auricular tumor was relieved quickly after anlotinib treatment, and the bump was gradually reduced to disappear, achieving recovery (A-E). However, the scalp metastasis of the same period was not effective, and the lesion gradually deteriorated until it was uncontrollable (F-O). Continuous deterioration of the scalp metastatic during anlotinib maintenance on 4 August (K), 12 August (L), 8 October (M), 19 November (N), and 10 December 2019 (O).
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During the treatment, the tumor behind the left ear was quickly relieved until it disappeared  (Figures 2A-E) , but anlotinib was not effective for scalp metastasis, and the lesions continued to deteriorate until they were uncontrollable ( Figures 2F-O ).