Aetiology
Cutaneous angiosarcomas arise in three settings:
in sun-damaged skin, particularly the scalp, in the elderly
lymphoedema-associated, usually on the arm after surgery for breast carcinoma. Less commonly, the lymphoedema may be secondary to filiariasis or congenital oedema. The latency is measured in decades.
post-radiation. The median latency is 5 to 6 years but may be as short as one year on the breast/chest wall.
Post-radiation angiosarcomas often cover large ares of skin and are multifocal.
The tumour infiltrates dermis and subcutis. There is a wide spectrum of differentiation. Well differentiated tumours form vessels that grow ins diffusely infiltrative manner between collagen fibres. The endothelial cells are multilayered and show cytological atypia. Poorly differentiated tumours consist of solid sheets of cells which may be spindled or epithelioid. They show severe cytological atypia, a high mitotic rate and necrosis. Vasoformation by be evidenced by intracytoplasmic lumina which may contain erythrocytes. In proximity to the angiosarcoma, there may be atypical vascular lesions.
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positive |
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positive |
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positive |
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may be positive |
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may be positive |
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Sporadic and lymphoedema-associated angiosarcoma has a high metastatic rate and a five-year survival or only about 10%. The behaviour of post-radiation angiosarcomas is less certain, with a high rate of local recurrence but possibly less frequent metastases.
3 Unpublished case seen by myself and the pathology department, Christie Hospital, Manchester
This page last revised 22.12.2008.
©SMUHT/PW Bishop