Case Number : Case 1698 - 30 November - Dr Hafeez Diwan Posted By: Guest

Dr Hafeez Diwan rounds of what has been a great month for DermpathPRO.

Cheers, Geoff Cross - DermpathPRO Projects

Papillary endothelial hyperplasia(Masson)?

necrosis, some endothelial atypia, can't see any pre-existing vascular space where this proliferation is occuring, hence am thinking on the lines of an angiosarcoma

I am also thinking angiosarcoma.

Taking into account the patient’s age and the lesion’s site, I’d tend to construe those irregularly branching thin-walled vessels with dissecting growth pattern as an angiosarcoma.

Agree with above, but I would like know about EMA- CD31-D2-40, to rule out an odd ectopic meningothelial hamartomatous lesion in adult ( never seen before! )

Is there a psammoma body in last fig bottom right??? 

I have heard of a case that dr. Diwan had once but never actually saw the case. It was about a patient that had findings compatible with angiosarcoma but concomitantly showed large areas of necrosis and bacterial colonies. Apparently he suggested to treat the patient for the infection before confirming the dx of angiosarc. Apparently the treatment for the infection made also dissapear the vascular proliferation. If it is this case, I find it extremely challenging

20 minutes ago, Raul Perret said:

I have heard of a case that dr. Diwan had once but never actually saw the case. It was about a patient that had findings compatible with angiosarcoma but concomitantly showed large areas of necrosis and bacterial colonies. Apparently he suggested to treat the patient for the infection before confirming the dx of angiosarc. Apparently the treatment for the infection made also dissapear the vascular proliferation. If it is this case, I find it extremely challenging

Wao :-)

Angiosarcoma is a treacherous diagnosis!  I would recommend looking at the patient but one has to consider the possibility on this histology. I find immunos can be quite helpful.  Reactive vascular proliferations usually have endothelial staining for endothelial markes and rings of smooth muscle actin staining around the vessels (pericytes and smooth muscle cells), the latter not seen in angiosarcomas. Raul's post is most interesting!

I was searching where did I heard that and actually is in Dr. Diwan's blog link 

Thank Dr. Diwan for this interesting case. To me this is angiosarcoma until proven otherwise. Can't wait to see the dx. Cheers!

Raul, thanks for referring to the blog. Just had a look at what Dr Diwan said about that case, and it looks that this is the case! 

Without the reference, would have probably favoured/consistent with an angiosarcoma . Right clinical setting, age! However, I have never seen angiosarcomas with so much necrosis or bacterial debris.

You are welcome Nitin

Wow! ....i'm sure i had read that blog at some point but didnt connect it with this case... Raul's memory is clearly photographic!

Angiosarcoma, superinfected with Enterobacter.  This was a large, erythematous lesion on the scalp of this patient.