ANGIOSARCOMA PRESENTING AS ULCER WITH HEMORRHAGIC BLISTERS

Angiosarcomas are highly malignant vascular tumors, arising from both vascular and lymphatic endothelium, affecting primarily adult patients. We report a case of a 60 year old lady who presented with hemorrhagic blisters over right preauricular and retroauricular area along with an ulcerated plaque over right temporal scalp of two months duration. Computed Tomography(CT) scan of the head showed soft tissue swelling and no intracranial extension. USG abdomen and CT thorax were normal. Histopathology of the skin lesions showed the upper dermis composed of plump double layered solid, intravascular buds in one area with spindle like morphology and irregular vascular channels lined by atypical endothelial cells, dissecting the collagen. Immunohistochemical staining for CD31, CD34 and VEGF was positive and cytokeratin was negative, confirming the diagnosis of angiosarcoma. Initially we thought of herpes zoster in trigeminal area because of the clinical resemblance. However subsequent investigations pointed towards angiosarcoma. This case report highlights how angiosarcoma may be missed if clinical diagnosis and early investigations are delayed due to mixed presentation and absence of dissemination.