Clinical and dermoscopic features of atypical abdominal brachytherapy-induced angiosarcoma

Hemangiosarcomas are rare malignancies derived from blood vessel endothelium. In most cases, the origin of the tumor is difficult to be accurately determined due to poor cell differentiation. As far as skin is concerned, there are three clinical forms of the neoplasm: 1. Idiopathic hemangiosarcoma – most commonly located on the facial skin or scalp. 2. Hemangiosarcoma presented with limb edema in patients after mastectomy – referred to as Stewart-Treves syndrome. 3. Radiation induced angiosarcoma (arising in previously irradiated skin areas). Angiosarcomas of deep soft and breast tissue in women were also reported. Recently an epithelioid angiosarco-ma has been described as a rare aggressive variant [1–4]. Neoplasms, due to their clinical picture, are usually diagnosed late. Initially, the lesions appear as purple or red slow-growing patches. Nodules, which can undergo ulceration, appear over time. Histopathological examination may reveal cell areas with polymorphic cells, numerous mitoses and irregular vascular channels. Some tumor cells have cytoplasmic vacuoles which correspond to the forming vessels. On the periphery, there are vascular channels with few atypi-cal endothelial cells. On dermoscopy, angiosarcoma is characterized by a combination of typical colors in vascular lesions – red, purple and blue. At the nodular part of the tumor, white lines can be detected. Radiation-induced angiosarcoma exhibits a more homogeneous pinkish-white pattern [5, 6]. Benign vascular lesions like rosacea, bruising, tumid lupus erythematosus or infections such as erysipelas and cellulitis are most often considered in differential diagnosis [7, 8]. The present case relates to a female patient with extensive angiosarcoma in the atypical location of the lower abdomen, which was treated locally over a long period of time, and dealt with as an erythematous spot of unknown etiology. The patient's history revealed brachy-therapy due to endometrial cancer. A 77-year-old patient exhibited her first skin lesions 5 months earlier; these suggested erythematous spots and were accompanied by severe itching. They were localized on the abdominal skin and were characterized by rapid growth. After 2 months, the lesions, bluish-violet at that time, progressed rapidly, and additional nodules and infiltrates appeared simultaneously. The patient history revealed brachytherapy due to endometrial cancer in 2002. The patient underwent a histopathological examination in an outpatient clinic in 2014 which revealed that the skin had numerous smaller blood vessels below the epidermis and within the dermis. The endothelium showed features of stimulation. At the time of admission to the Department of Dermatology at Medical University of Silesia, …