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March 2010

Large Nodular Plaque on Leg in the Setting of Chronic Lymphedema—Diagnosis

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Arch Dermatol. 2010;146(3):337-342. doi:10.1001/archdermatol.2010.6-b

Pathologically, there was a deeply infiltrating proliferation of cells with hyperchromatic nuclei and red blood cell extravasation. The cells were focally spindled and dissected between collagen bundles (Figure 2 and Figure 3), while the majority of the lesion was densely cellular. The neoplastic cells were positive for CD31, CD34, factor VIII, and FLI-1 and were negative for HHV-8, AE1/AE3, CD45, CD20, CD3, and S-100, supporting a diagnosis of angiosarcoma. Imaging findings showed lymphadenopathy with suspected metastasis. Findings from fine-needle aspiration of the left inguinal node were negative. The left groin node was dissected and was negative for metastasis on frozen section examination. In view of this, the patient underwent an amputation. Postoperatively, the final pathologic test result of the left groin node was positive for metastasis. Thus, radiation therapy was planned. He subsequently developed a recurrent lesion in his surgical incision that was biopsied, revealing angiosarcoma. He completed radiotherapy, but his follow-up computed tomographic scan showed tumorous nodules in the lung, a mass in the right lobe of the liver, and left inguinal adenopathy.

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