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Presented by Jonathan Epstein, M.D. and prepared by Jospeh Kronz, M.D.
Case 5: 87-year-old male with a red cheek mass
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1. Question
Week 3: Case 5
87-year-old male with a red cheek mass
Correct
Answer: Angiosarcoma
Histology: An increased number of well-formed vessels are visualized within the superficial dermis. These vessels are irregularly shaped and often contain islands of collagen surrounded by endothelium within the center of the vascular lumina. Other vessels have a more interanastomosing appearance. Although the endothelium lining most of these vessels appear bland, in areas endothelial cells have a hobnailed appearance with hyperchromatic nuclei. Abundant hemosiderin deposition is present within the dermis. The dissection around adnexal structures and the presence of little islands of collagen surrounded by hyperchromatic endothelial cells are typical for well-differentiated angiosarcoma. In cases where angiosarcoma has a very bland cytologic appearance, clinical correlation is helpful; this patient’s lesion was extensive with satellite nodules.
Discussion: Telangiectasia would merely show rounded dilated vessels in the dermis without the complex shapes seen in the current case. The lesion would also be restricted to the very superficial dermis and not infiltrate around adnexal structures. Port wine stains and hemangiomas both contain rounded, well-formed vessels lined by bland endothelium. Whereas hemangioma consists of vessels that are closely compacted in a circumscribed nodule, the vessels in port wine stain are more loosely arranged in the dermis and lack circumscription.
Incorrect
Answer: Angiosarcoma
Histology: An increased number of well-formed vessels are visualized within the superficial dermis. These vessels are irregularly shaped and often contain islands of collagen surrounded by endothelium within the center of the vascular lumina. Other vessels have a more interanastomosing appearance. Although the endothelium lining most of these vessels appear bland, in areas endothelial cells have a hobnailed appearance with hyperchromatic nuclei. Abundant hemosiderin deposition is present within the dermis. The dissection around adnexal structures and the presence of little islands of collagen surrounded by hyperchromatic endothelial cells are typical for well-differentiated angiosarcoma. In cases where angiosarcoma has a very bland cytologic appearance, clinical correlation is helpful; this patient’s lesion was extensive with satellite nodules.
Discussion: Telangiectasia would merely show rounded dilated vessels in the dermis without the complex shapes seen in the current case. The lesion would also be restricted to the very superficial dermis and not infiltrate around adnexal structures. Port wine stains and hemangiomas both contain rounded, well-formed vessels lined by bland endothelium. Whereas hemangioma consists of vessels that are closely compacted in a circumscribed nodule, the vessels in port wine stain are more loosely arranged in the dermis and lack circumscription.
