Angiosarcoma of the scalp

An 82-year-old woman was seen at our Dermatology Department for a plaque on the right parietal scalp that had recently increased in size, and bled. Th e lesion had been present for 3 months. The patient had a previous diagnosi s of chronic bronchitis, noninsulin-dependent diabetes mellitus, and hypert ension, but no previous history of cancer. Physical examination revealed a 7 x 10 cm plaque, composed of a central nec rotic and bleeding surface, surrounded by small purple-red satellite nodule s (Fig. 1). A biopsy showed an ill-defined infiltrative intradermal mass wi th a pattern of hypercellular sheets of large cells alternating with areas of dilated, irregular, blood-filled channels, dissecting the collagen bundl es. The endothelial cells lining these channels were plump and pleomorphic, surrounded by other spindle-shaped cells with pleomorphic and atypical nuc lei (Fig. 2). The diagnosis of angiosarcoma was made, and the patient was s ent to an oncology center for further evaluation and treatment, where a com puted tomography head scan was taken revealing no erosion of the skull. The patient refused surgery, so radiotherapy was proposed. One month later, sh e developed lymph node enlargement of the left anterior cervical nodes. A n eedle aspiration biopsy was consistent with sarcoma. Two weeks later, she w as started on palliative radiotherapy: a programmed dose of 4500 cGy was pr oposed of which she only received 3000 cGy because of treatment withdrawal and loss to follow-up. During this time, she showed partial initial respons e, but despite treatment the disease relentlessly progressed, with hemorrha ge and severe pain being the most striking features (Fig. 3).