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Clinical Problem Solving: Pathology
February 21, 2011

Pathology Quiz Case 1: Diagnosis

Author Affiliations


Arch Otolaryngol Head Neck Surg. 2011;137(2):198-202. doi:10.1001/archoto.2010.247-b

Diagnosis: Angiosarcoma

Angiosarcoma is a rare malignant neoplasm of the skin and soft tissues, the cells of which variably recapitulate the morphological and functional features of normal endothelium.1 Angiosarcomas represent fewer than 1% of all sarcomas, and up to half of angiosarcomas involve the head and neck.2 They typically present as bruiselike violaceous macules or plaques that are almost always found on the face or scalp of elderly white men; sometimes, however, they appear simply as nondescript nodules. They are typically asymptomatic, although bleeding, ulceration, and pain can occur late in the disease progression. The diagnosis is often missed or delayed owing to the asymptomatic nature and polymorphous appearance of these lesions, which may mimic a wide range of more common dermatologic conditions, including allergic reactions, cellulitis, rosacea, or granuloma pyogenicum. As a result, up to 30% of patients may have distant metastasis at the time of presentation.

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