Chronic lymphedema due to morbid obesity: an exceptional cause of abdominal wall angiosarcoma (original) (raw)

Virchows Archiv, 2008

Abstract

Sir, Angiosarcomas are rare malignant soft tissue tumors that show differentiation toward endothelial cells occurring in various clinical settings, including lymphedema-associated angiosarcoma, idiopathic angiosarcoma on the head and neck in elderly people, angiosarcoma arising on chronically sundamaged skin and post-irradiation angiosarcoma [4]. Chronic lymphedema secondary to mastectomy and axillary lymphadenectomy for breast cancer, and more rarely to infectious disease, congenital disease and traumatism, is a known predisposing condition for cutaneous and superficial soft tissue angiosarcoma. We report a new case of high-grade abdominal wall angiosarcoma in a chronically lymphedematous abdominal panniculus due to morbid obesity. A 44-year-old morbidly obese man presented with a skin lesion in the periumbilical region. Clinical examination revealed a 10-cm papular lesion on a post-operative abdominal wall hernia. There was a clinical history of Crohn's disease diagnosed 34 years previously. Treatment included many abdominal operations. A contrast-enhanced computed tomography scan of the abdomen revealed extensive heterogeneous thickening of the skin and subcutaneous fat, with infiltration of the abdominal musculature (Fig. 1). In October 2006, a dermolipectomy was performed. Histologically, the tumor involved the whole dermis, subcutaneous fat with an infiltrative pattern and margins. Beside the tumor, many ectatic vessels lined by a normal appearing endothelium were noted (Fig. 2a). Cell proliferation consisted of solid sheets of fusiform cells with Virchows Arch (2008) 453:217–219 DOI 10.1007/s00428-008-0623-8

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