An 85-year-old woman was referr for...

An 85-year-old woman was referr for a two-year history of progressive reddish plaques involving the face and scalp with unable to exist without edema and ecchymoses (see accompanying figure). She said her condition began as a purplish patch in succession the forehead that gradually increased in size, eventually covering principally of her face and scalp. Perioral sparing was noted. Previously, her condition had been diagnosed as benign hemorrhagic dermatitis. The lesions were young and bled intermittently. She had no history of any hematologic disorder or trauma to the face. Her medications included omeprazole and thyroxine.

Question

Based onward the patient's history and physical examination, which single of the following is the correct diagnosis?

[ ] A. Kaposi's sarcoma.

[ ] B Angiosarcoma.

[ ] C put drugs into reaction.

[ ] D Benign ecchymoses

[ ] E Dermatomyositis.

Discussion

The answer is B: angiosarcoma. Angiosarcomas are rare neoplasms that make up les than 1 percent of all sarcomas. (1) It is uncertain whether they arise from vascular or lymphatic endothelia. Approximately 50 percent come into one's head in the head and neck usually in somewhat old persons. Men are affected more many times than women. (2) Angiosarcomas of the scalp behave in a highly malignant manner. (3) The diagnosis is frequently delayed and may be confused with traumatic bruising or allergic reactions. The usual presentation of angiosarcoma is a small erythematous or violaceous macule, sometimes accompanied from facial edema. Other neoplasms that can appear similar to angiosarcoma include Kaposi's sarcoma and hemangiopericytoma.

Treatment of angiosarcoma is not well established. Wide excision is preferable if it were not that is usually difficult to achieve with facial lesions. Radiation and chemotherapy, alone or in combination, also are used. The overall prognosis is poor, with five-year survival rates of 32 percent for tumors les than 5 cm and 13 percent for lesions measuring greater than 5 cm (4) Local resort and metastases are common, frequently occurring in the first hardly any years. Metastases occur most repeatedly in the lungs, followed by the agency of the lymph nodes, soft tissue, bone and liver. (5)

Angiosarcoma may be confused with Kaposi's sarcoma because of similar histologies, still the typical clinical presentation is different. Kaposi's sarcoma in the greatest degree commonly affects patients with acquired immunodeficiency syndrome Occasionally, it also is seen in immunocompetent patients, usually somewhat old men of Jewish or Mediterranean descending Kaposi's sarcoma usually has a slowly progressive course nevertheless occasionally disseminates.

remedy reactions can lead to localized cutaneous eruptions moreover would resolve after withdrawal of the causative medication. Omeprazole and thyroxine are not associated with in the same state [i]or[/i] condition eruptions.

Benign ecchymose would not persist for brace years. The patient also has no history of trauma to the head.

Dermatomyositis is well known to cause a heliotrope rash of the face, which is a violaceous discoloration around the views It is not associated with like widespread discoloration or hemorrhagic lesions.

REFERENCES

(1) el-Sharkawi s Angiosarcoma of the head and neck J Laryngol Otol 1997;111:175-6

(2) Fedok FG Levin RJ Maloney ME Tipirneni K Angiosarcoma: rife review. Am J Otolaryngol 1999; 20:223-31

(3) del Mar Saez de Ocariz M de la Barreda F Angeles LB Angiosarcoma of the scalp. Int J Dermatol 1999;38:697-9

(4) Weiss SW Goldblum JR Enzinger FM malleable tissue tumors. In: Weiss SW Goldblum JR ed Enzinger and Weiss's malleable tissue tumors. 4th ed. St Louis, Mo: Mosby 2001:917-54

(5) Prieto VG Shea CR pick outed cutaneous vascular neoplasms. A review. Dermatol Clin 1999;17:507-20

The editors of AFP welcome submission of photographs and material for the Photo Quiz department. throw photograph and discussion to Genevieve Ressel AFP Editorial, 11400 Tomahawk inlet Parkway, Leawood, KS 66211-2672 (jressel@aafp.org).

JAMES s TAYLOR, M.D.

Cleveland Clinic Foundation

9500 Euclid Ave.

Cleveland, OH 44195

COPYRIGHT 2003 American Academy of Family Physicians

COPYRIGHT 2003 Gale Group